When does grief need more help?

What does ordinary grief look like?

The U.S. National Cancer Institute’s guide to grief describes normal grief broadly: numbness and disbelief at first, then sadness, crying, anger, guilt, poor sleep, low appetite, tiredness and longing. For most people, the guide says, these symptoms lessen between 6 months and 2 years after the loss. The American Psychiatric Association (APA) agrees that for most people grief eases over time and does not usually need mental health treatment.

Grief can look like depression, but the Cancer Institute notes that in grief, painful feelings tend to come and go, and people usually keep their sense of self-worth. Depression can also follow a loss, and it can be treated, so constant low mood or feelings of worthlessness are worth raising with a doctor. See also Why does grief hurt so much, even physically?

What is prolonged grief disorder?

In March 2022, the APA added prolonged grief disorder to the DSM-5-TR, its manual of mental disorders. In plain words, the criteria for adults are these:

1. Someone close to you died at least 12 months ago (6 months for children and teens).
2. Since then, you have felt intense longing for the person, or been caught up in thoughts and memories of them, nearly every day for at least the last month.
3. You also have at least 3 of these 8 signs, nearly every day for the last month: feeling as if part of you has died; strong disbelief about the death; avoiding reminders that the person is dead; intense emotional pain, such as anger, bitterness or sorrow; trouble getting back to friends, interests or plans; emotional numbness; feeling that life is meaningless without them; and intense loneliness.
4. The grief causes real distress or problems at home, at work or in other parts of life.
5. It lasts longer than your culture or faith would expect, and another condition, such as depression, does not explain it better.

The World Health Organization’s classification, ICD-11, also includes prolonged grief disorder. As a 2024 study by Treml and colleagues explains, it sets the minimum at 6 months and asks for fewer symptoms. That gap is one reason researchers still debate where ordinary grief ends.

How many grieving people develop it?

Estimates vary with who is studied and the rules used. The APA estimates 4% to 15% of bereaved adults. A 2017 review of 14 studies of adults after non-violent losses found 9.8%, about one in ten, but warned that the studies differed and were not always representative. In the 2024 German study, which drew a random sample of the population, 4.7% of 1,062 bereaved people gave questionnaire answers that fit the DSM-5-TR criteria, and 5.4% fit the ICD-11 criteria.

Some losses carry more risk. The APA names sudden or unnatural deaths, the death of a child or partner, a history of depression, a very close or dependent relationship, and a lack of social support. A 2020 review of 25 studies after accidents, disasters, suicides or homicides put the pooled rate at 49%, with a warning that the studies varied widely. The authors say this shows why it matters to check for prolonged grief after such losses. If your loss was sudden or violent, the signs in this answer are worth knowing.

Which signs mean you should get help now?

Some signs cannot wait. The U.S. National Institute of Mental Health lists warning signs of suicide, including:

• talking about wanting to die, great guilt or shame, or being a burden to others;
• feeling empty, hopeless, trapped or without a reason to live, or in unbearable emotional or physical pain;
• making a plan, withdrawing from friends, saying goodbye or giving away important things;
• using drugs or alcohol more often, or eating or sleeping more or less.

If any of these apply to you or someone you love, especially if they are new or getting worse, get help as soon as possible. In the US, call or text 988, or chat at 988lifeline.org. The 988 Lifeline is free, confidential and open 24/7, and you can reach out for a friend or relative too. Elsewhere, call your local emergency number. Some grieving people wish they could be with the person who died. If that wish ever turns into thoughts of ending your life, reach out now.

What actually helps?

Therapy that focuses on grief. Randomized trials, which assign people to treatments by chance, have tested it. In a 2005 trial of 95 adults with complicated grief, a closely related label used in earlier studies, 51% responded to 16 sessions of complicated grief treatment, compared with 28% who had a standard talk therapy. A 2016 trial of 395 adults gave everyone a pill (an antidepressant or a placebo) plus information, monitoring and encouragement. Of those who also had 16 weekly sessions of grief therapy with a placebo pill, 82.5% responded, compared with 54.8% of those on the placebo pill alone. Suicidal thoughts eased more with therapy. And in a 2014 trial of 80 patients in Sydney, Australia, everyone had group therapy plus 4 one-on-one sessions that either revisited memories of the death or offered supportive counseling. Among those who finished, fewer in the memory group still met the criteria six months later (14.8% vs. 37.9%).

Not pills alone. The APA says there are currently no medicines to treat the specific symptoms of grief, though research is under way. In the 2016 trial, the antidepressant citalopram alone did not do significantly better than placebo, though adding it to therapy eased depression symptoms.

Help aimed at those who need it. A 2008 review of 61 controlled studies found that, overall, grief help had a small effect right after treatment and no clear benefit later. Studies that did not first check who was struggling had weak results, possibly because people in the comparison groups also improved on their own. Help aimed only at people having marked trouble adapting compared well with therapy for other problems. Later reviews of 14 and 31 trials point the same way, with a warning that some weak results may never have been published.

Support groups and people who understand. The APA says bereavement support groups and peer support can offer connection and help people feel less alone. Lack of social support is itself a risk factor.

Faith communities, for those who have them. The Cancer Institute reports mixed findings: some studies show religion helps people cope with grief, others show it does not help or adds distress, and support from a religious community is linked with better outcomes. In Judaism, as Chabad.org explains, mourning moves through set stages: the seven days of shiva, when family, friends and community comfort mourners with their presence, then the thirtieth day, called shloshim, and on through the first year. As another Chabad.org article puts it, “we must mourn, but we must also set boundaries to our mourning.”

What is the strongest objection?

Some grieving people and researchers worry that calling grief a disorder turns sorrow into sickness. A 2021 study that tested the new criteria notes that there has been opposition to treating pathological grief as a separate mental disorder. In a 2025 survey of 755 bereaved adults, over half of whom had lost a child, 72.2% rated a grief diagnosis as unhelpful, 11.4% as helpful, and 16.4% were unsure. Themes in their answers included grief as the measure of love and the harm of treating grief as an illness, though some also found the language of disorder useful.

In a 2009 study of 135 widowed people, 15 of the 16 who had complicated grief said they would be relieved to learn they had a recognizable problem, and all 16 said they would be interested in treatment. The 2021 study found the new criteria reliable, distinct from depression, PTSD and anxiety, and linked with suicidal thoughts and a worse quality of life. Whatever you think of the label, the trials above show that targeted help works for many people whose grief has stalled.

What do people often get wrong?

“If it still hurts after a year, I must have a disorder.” Not necessarily. Waves of pain on holidays and anniversaries are part of ordinary grief. The diagnosis requires intense symptoms nearly every day that disrupt your life.

“Getting help means letting go of the person.” Not necessarily. The APA describes one approach, Prolonged Grief Therapy, as helping people accept the reality of the loss and work toward goals and satisfaction in a world without the person. It also says online programs that let mourners express their grief in notes to the person who died have been found to reduce symptoms. Many people keep a bond with the person who died; see Is it normal to feel that someone who died is still with me?

How can you check this yourself?

• Read the criteria. The APA’s prolonged grief disorder page lists them in plain language.
• Ask about screening. Researchers built a questionnaire, the PG-13-Revised, to match the new criteria; a doctor or therapist can help you read it.
• Check who was studied. In the 2016 trial, 78% of participants were women and 82% were white, so results may not fit everyone equally.

The answer stays the same after all this detail. Most grief softens with time. When it stays intense and blocks your life, targeted help often works. Thoughts of ending your life need help right away. If a question is personal right now, our care page is a gentle place to start, and Is it possible to make peace with the idea of dying? explores fears about death itself.