What is it?

Persistent Complex Bereavement Disorder (PCBD) and Prolonged Grief Disorder (PGD) describe a pattern of grief that persists well beyond expected cultural norms, causing intense longing or preoccupation with the deceased and marked impairment in daily functioning. Diagnostic systems have evolved — PGD is now included in ICD-11 and DSM-5-TR/DSM-5 text revisions use related criteria; PCBD was introduced in DSM-5 as a condition for further study. Clinicians should apply criteria with cultural sensitivity and clinical judgement.

Core symptoms (typical clusters)

• Persistent yearning or longing for the deceased nearly every day.
• Preoccupation with the deceased or the circumstances of the death.
• Intense emotional pain — sadness, guilt, anger, or numbness related to the loss.
• Difficulty accepting the death and disbelief or trouble moving forward.
• Social/identity disruption — withdrawal, reduced interest in activities, feelings that life is meaningless.
• Functional impairment — work, relationships or self-care significantly affected.

Duration thresholds differ by system (ICD-11 uses ~6 months minimum for adults in most cases; DSM-5-TR commonly uses 12 months), so apply criteria with sensitivity to cultural norms and individual context.

How is it different from normal grief, depression or PTSD?

• Normal grief typically reduces in intensity over months; people can still function and integrate the loss over time.
• PGD/PCBD features persistent, pervasive longing and preoccupation with the deceased that remain disabling and are not explained by cultural expectations.
• Depression involves pervasive low mood, anhedonia and self-critical thoughts not focused primarily on the deceased; comorbidity is common.
• PTSD centers on fear and re-experiencing of a traumatic event; grief-related traumatic loss can co-occur with PTSD symptoms.

Risk factors

• Relationship closeness (spouse, child) and sudden/violent death
• Limited social support or social isolation
• History of mood/anxiety disorders or prior losses
• Perceived lack of meaning or unresolved issues with the deceased
• Cultural factors that limit mourning rituals or social acknowledgement

Assessment — practical approach

1. Take a thorough bereavement history: timeline, circumstances of death, current symptoms, functional impact, cultural mourning practices.
2. Use validated screening tools where helpful (e.g., Prolonged Grief Scale, Inventory of Complicated Grief) as part of, not instead of, clinical assessment.
3. Assess for comorbid depression, PTSD, substance use and suicide risk — manage acute risk immediately.
4. Consider medical contributors (sleep, pain, endocrine issues) and medication effects.
5. Discuss cultural/religious expectations about grief to avoid pathologising normal variants.

Treatment — evidence-based options

Research supports targeted psychological treatments for prolonged/complicated grief. Medication may help comorbid depression/anxiety but is not a specific cure for grief itself.

• Complicated Grief Therapy (CGT): A structured, grief-focused psychotherapy combining techniques from CBT, interpersonal therapy and prolonged exposure (ie, processing loss-focused memories). CGT has the strongest evidence base for PGD/PCBD and reduces core grief symptoms and functional impairment.
• Targeted CBT approaches: Cognitive restructuring, behavioural activation, imaginal revisiting and meaning-oriented interventions tailored to grief themes.
• Interpersonal therapy (IPT) adaptations: Addressing role transitions, social support and attachment-related issues.
• Group therapy and bereavement support: Can offer social connection and normalisation; useful as adjunctive support.
• Pharmacotherapy: Antidepressants (SSRIs) may be considered for comorbid major depression or severe anxiety; evidence for their effect on core prolonged-grief symptoms is limited. Medication decisions should be individualised.

Practical clinical steps

• Prioritise safety: assess suicide risk and acute psychiatric symptoms.
• Provide psychoeducation: normal grief vs. prolonged grief, expected course, and treatment options.
• Offer grief-focused therapy (CGT or grief-adapted CBT) when criteria and functional impairment are present.
• Enhance social support: involve family where appropriate and connect to community resources.
• Monitor and treat comorbid conditions (depression, PTSD, substance misuse).
• Respect cultural mourning practices and integrate them into care when helpful for the client.

When to refer and urgent red flags

• Active suicidal ideation, intent or plans
• Severe functional decline preventing basic self-care
• Complex psychiatric comorbidity (psychosis, severe PTSD) or medical instability
• Need for a specialist grief programme or inpatient support

Key takeaways

• Persistent, impairing grief that continues beyond cultural expectations may represent PCBD/PGD and merits clinical attention.
• Use structured assessment, screen for comorbidity and always prioritise safety.
• Complicated Grief Therapy and grief-focused CBT are the treatments with the strongest evidence; medication is used mainly for comorbid conditions.
• Respect cultural context, involve supports, and provide clear psychoeducation about grief and recovery pathways.