Prolonged Grief Disorder occupies a contested and evolving position within the depth-psychology and bereavement literature. The corpus reveals a field in active negotiation: clinicians and researchers variously label the phenomenon pathological grief, complicated grief, chronic grief, or prolonged grief, with each designation carrying distinct theoretical commitments and diagnostic consequences. Worden’s taxonomy situates prolonged grief as one manifestation of complicated mourning — a rubric encompassing delayed, exaggerated, and masked forms — while insisting that its diagnosis should not precede the first anniversary of the death. O’Connor’s neurobiological framing draws a careful distinction between complicated grief (affecting roughly one or two in ten bereaved persons) and the more stringently defined prolonged grief disorder (affecting between one and ten in one hundred), mapping both onto identifiable trajectories of chronic grieving that diverge from normative bereavement adaptation. The nosological debate is far from settled: Horowitz’s proposal to reclassify complicated grief as a trauma disorder, the DSM’s gradual incorporation of persistent complex bereavement disorder, and the tension between early versus late diagnostic thresholds all index unresolved political and scientific pressures. What unifies the major voices is acknowledgment that some bereaved individuals do not recover without targeted intervention — and that naming this condition, however imperfectly, is clinically and ethically necessary.
In current clinical science, complicated grief captures a larger number of people in that upper end of the continuum (about 1 or 2 in 10) than does prolonged grief disorder (between 1 and 10 in 100).
O’Connor distinguishes complicated grief from the more restrictive diagnostic category of prolonged grief disorder by prevalence, situating both on a continuum of chronic grieving.
, The grieving brain the surprising science of how we learn, 2022thesis
It is sometimes called pathological grief, unresolved grief, complicated grief, chronic grief, prolonged grief, delayed grief, or exaggerated grief.
Worden catalogs the proliferating nomenclature for abnormal grief, demonstrating that ‘prolonged grief’ is one of several contested labels for the same clinical phenomenon.
, Grief Counseling and Grief Therapy A Handbook for the, 2018thesis
The emerging diagnosis of complicated grief (now called prolonged grief) discussed previously relates well here, because it suggests that chronic grief may be identified early through the criteria found in the diagnosis.
Worden maps the terminological shift from ‘complicated grief’ to ‘prolonged grief’ and argues for early identification and preventive intervention using standardized instruments.
, Grief Counseling and Grief Therapy A Handbook for the, 2018thesis
A group of experts on grief and trauma, including researchers and clinicians, convened in 1997 to discuss whether they could agree on the symptoms of a chronic grieving disorder.
O’Connor traces the historical origin of diagnostic consensus-building around prolonged or chronic grief disorder to a 1997 expert convening, situating the category within a specific scientific-political moment.
, The grieving brain the surprising science of how we learn, 2022thesis
Horowitz has suggested that assessments for complicated grief should not be made until after the first anniversary of the death, and this has always made a lot of sense to me.
Worden endorses Horowitz’s temporally conservative position on diagnosing prolonged grief, highlighting the critical debate over when grief becomes pathological.
, Grief Counseling and Grief Therapy A Handbook for the, 2018thesis
Bonanno and his colleagues found that there were four trajectories that could be used to categorize people’s grieving. These trajectories include resilient… chronic grieving (depression that begins after the death of a loved one and is prolonged).
O’Connor presents Bonanno’s trajectory model, which empirically distinguishes chronic grieving — the substrate of prolonged grief disorder — from other bereavement patterns including resilience and pre-existing depression.
, The grieving brain the surprising science of how we learn, 2022supporting
For a person with chronic grieving, the feelings, the distress, the difficulties are all tied to the absence of the person who has died.
O’Connor offers a phenomenological criterion distinguishing chronic grief from depression: in prolonged grief, all distress is indexed to the specific absence of the deceased rather than to pervasive affective disorder.
, The grieving brain the surprising science of how we learn, 2022supporting
Horowitz (2005) has come up with an alternate proposal outlined in an article titled ‘Meditating on Complicated Grief Disorder as a Diagnosis.’ He would prefer that complicated grief be included as a trauma disorder.
Worden reports Horowitz’s dissenting proposal to reclassify complicated grief within the trauma spectrum, revealing the nosological contest that shapes the prolonged grief diagnosis.
, Grief Counseling and Grief Therapy A Handbook for the, 2018supporting
An interesting possibility is that genetic variations in the oxytocin receptor might put people at risk for developing complicated grief.
O’Connor introduces a neurobiological risk-factor hypothesis — oxytocin receptor genetics linked to adult separation anxiety — as a potential substrate for vulnerability to prolonged grief.
, The grieving brain the surprising science of how we learn, 2022supporting
Shear and Gribbin-Bloom (2016) have developed a 16-session treatment for persons experiencing complicated bereavement.
Worden identifies a structured, time-limited manualized treatment as the clinical response to complicated or prolonged grief, grounding diagnosis in therapeutic actionability.
, Grief Counseling and Grief Therapy A Handbook for the, 2018supporting
grief disorder, 87–91 psy[chology]
O’Connor’s index entry for ‘grief disorder’ signals the book’s sustained engagement with prolonged grief as a discrete clinical and neurobiological category.
, The grieving brain the surprising science of how we learn, 2022supporting
In most of those I have treated, grief was not absent around the time of the loss, but for some reason, usually the absence of social support, the person didn’t process it adequately, and it reappeared much later.
Worden’s clinical account of delayed grief — inadequate processing due to absent social support — illuminates one pathway into the chronic, prolonged presentations that characterize prolonged grief disorder.
, Grief Counseling and Grief Therapy A Handbook for the, 2018aside
Helene Deutsch (1937), in her paper on the absence of grief, comments on this phenomenon… grief that is excessive in its duration and intensity.
Worden invokes Deutsch’s foundational distinction between absent and excessive grief, situating prolonged grief at the far end of a spectrum that has been theorized since the psychoanalytic tradition.
, Grief Counseling and Grief Therapy A Handbook for the, 2018aside
Bereaved people as well as survivors of CSA who exhibit a delayed grief response begin to experience the pain of their loss, but they turn away from befriending it and realizing its meaning.
Neimeyer’s framework connects delayed and prolonged grief responses to meaning-making failures, extending the concept to populations with complex trauma histories such as childhood sexual abuse survivors.