Grief

Normal vs Pathological Grief

Normal Grief

• Duration: Typically ≤12 months; often shows improvement within 6 months.

• Features:

  • Intense sadness, episodes of tearfulness

  • Preoccupation with the deceased (memories, yearning)

  • Social withdrawal but able to function in daily life (e.g. attending work, completing ADLs)

  • May have fleeting hallucinations (briefly hearing or seeing the deceased)

  • Occasional thoughts of wanting to die to “join” the deceased, but no sustained suicidal intention or significant functional impact

Pathologic Grief (Chronic or Complicated)

• Duration: Persisting distress >12 months

• Features:

  • Marked functional impairment (struggling to work, care for self/family)

  • Persistent numbness or detachment from life’s usual activities

  • Feelings of purposelessness or meaninglessness

  • Possible persistent and intense guilt or blame about the death

• Now classified as Prolonged Grief Disorder if it meets specific criteria (see below).

Prolonged Grief Disorder (Complicated Grief)

• Timeframe: Ongoing, severe distress impairing functionality for ≥12 months (adults) or ≥6 months in children/adolescents (per DSM-5-TR criteria)

• Key Features:

  • Intense yearning or longing for the deceased

  • Emotional numbness, detachment, or difficulty engaging with others

  • Intrusive or distressing thoughts/memories of the deceased

  • Excessive guilt or remorse regarding the circumstances of the death

  • A sense that life is empty or meaningless without the deceased

  • Irritability, anger, bitterness

Management

Psychological Support

• Consider bereavement counsellors, mental health professionals (psychologist/psychiatrist)

• Community-based palliative care or bereavement programs if available

Therapies

• Complicated Grief Therapy: A specialised form of psychotherapy targeting prolonged grief symptoms

• Behavioural Activation with exposure-based approaches for trauma/loss reminders

• Interpersonal Psychotherapy (IPT): Focuses on social supports, role transitions

• Acceptance and Commitment Therapy (ACT): Helps with acceptance of painful feelings and commitment to personal values and life goals

• Family/Group Therapy: Can be helpful if multiple family members are grieving

Assessment Tools

• Prolonged Grief Disorder-13 Revised (PG-13-R)

• Brief Grief Questionnaire

  • Tools to gauge severity and functional impact of grief

Referral

• Specialist palliative care or bereavement support if severe, persistent, or complicated grief.

• Consider psychiatry referral if coexisting depression, suicidal risk, psychosis, or severe functional decline.

Notes

• Normal Grief varies widely in presentation and duration, but typically does not profoundly impair function long-term.

• Screen for depression or anxiety disorders if grief symptoms are intense or prolonged.

• Emphasise non-judgmental support and normalisation of grief while monitoring for pathological features.