Understanding Long-Term Grief Disorder: Reasons Some Struggle to Move On After a Loved One’s Death

While grief is a natural response to loss, for approximately 5% of bereaved individuals, this grief becomes prolonged, evolving into prolonged grief disorder (PGD). Recent research has provided insights into the development of this challenging condition, potentially aiding healthcare professionals in identifying those who may require additional support following a loss.

Inclusion of PGD in the American Psychiatric Association‘s diagnostic manual in 2022 sparked significant discourse regarding its implications on the understanding of normal grief responses and the constraints of defining acceptable grieving timelines. Current studies analyzing brain activity suggest that PGD is indeed a distinct mental health condition.

Richard Bryant and researchers from the University of New South Wales in Sydney have compared brain activity patterns in individuals with PGD to those experiencing other grief-related conditions, including post-traumatic stress disorder (PTSD), depression, and anxiety. Their findings indicate that while some overlap exists, PGD patients consistently demonstrate more significant alterations in brain circuits related to reward processing.

For instance, studies indicate that PGD patients may experience greater activation in the nucleus accumbens, the brain region responsible for processing rewards and motivations, in response to grief-related stimuli compared to those not suffering from PGD. The strength of this activation correlates strongly with the intensity of longing for the deceased.

Individuals with PGD also exhibit distinct responses to reminders of the deceased, showing a preference for avoiding such stimuli, unlike individuals with PTSD and anxiety, who generally demonstrate behaviors aimed at avoidance.

Moreover, research indicates that PGD patients experience heightened amygdala and right hippocampus activation when confronted with death-related imagery, in contrast to typical grievers, who might display increased deactivation in response to positive images, highlighting a disruption in emotional regulation and a diminished capacity for positive emotional experiences.

Bryant elucidates that in PGD, the brain’s reward system becomes inextricably linked to the deceased, leading to an overwhelming yearning for the lost loved one. “The principal distinction between PGD and normal grief lies in the duration, indicating that individuals become ‘stuck’ in their grief, unable to heal like the majority,” he explains.

While this review provides valuable insights, the complexity of PGD makes it difficult to implement standardized diagnostic approaches, as noted by Catherine Shear at Columbia University. Access to brain scans is often unavailable for grieving individuals, and the intricate nature of grief complicates one-time assessments.

Shear also suggests that “two-person neuroscience” can enhance our understanding of grief by monitoring brain activity during interpersonal interactions, further unraveling how grief is influenced by social contexts, cultural norms, and individual support levels.

This comprehensive review aids in predicting individuals at risk for PGD post-bereavement. In a significant study, bereaved adults underwent brain scans shortly after their loss and periodically over the next six months. Stronger connections between the amygdala and regions involved in behavior regulation and information filtration observed during initial scans may forecast worsening grief symptoms, implying that such patterns can indicate a higher likelihood of developing PGD in the future.

Despite the identification of psychosocial factors that may predispose certain individuals to PGD, conclusive predictions remain challenging, according to Joseph Govias from the Medical College of Wisconsin. Early identification may facilitate intervention, ranging from support groups to specialized treatments.

Advancements in understanding specific neurobiological mechanisms reinforce the need to acknowledge PGD as distinctly separable from general grief, guiding tailored treatment strategies for affected individuals.

“Recognizing both the shared and unique neurobiological underpinnings may prevent misdiagnosis and inadequate care,” Govias states. “For instance, PGD less commonly responds to antidepressants, whereas focused grief therapy proves effective. Conversely, in cases where PGD coincides with major depression, a combination of antidepressants and grief-targeted therapies may yield optimal results.”

If you or someone you know needs emotional support, consider reaching out to British Samaritans at 116123, the US 988 Suicide and Crisis Lifeline at 988, or explore international crisis hotlines.