For many, the sharp pain of grief gradually subsides over time, becoming a manageable part of their life. However, for a subset of individuals, this distress persists, evolving into what is recognized as prolonged grief disorder (PGD). A recent review of this condition, which impacts approximately 5% of those experiencing loss, offers new insights into its development. These findings hold the potential to assist clinicians in identifying recently bereaved individuals who may benefit from additional support.
The inclusion of prolonged grief disorder in the American Psychiatric Association’s diagnostic manual in 2022 ignited considerable discussion. Questions arose regarding whether this classification pathologized a natural human response to loss and imposed an arbitrary timeline on what constitutes “normal” grieving. Current research, however, analyzing brain activity in individuals with and without PGD, suggests that it is indeed a distinct condition.
Richard Bryant of the University of New South Wales in Sydney, Australia, conducted a comparative study of brain activity. He examined individuals with PGD and those experiencing other psychiatric conditions following bereavement, such as post-traumatic stress disorder (PTSD), depression, or anxiety. The analysis revealed that while overlaps exist, individuals with PGD consistently demonstrate more pronounced alterations in a wider array of reward-related brain circuits.
For example, several studies have identified significantly greater activation in the nucleus accumbens—a region involved in processing reward and motivation—in individuals with PGD when exposed to grief-related words and imagery. This activation was notably more intense than in bereaved individuals who do not have PGD. Furthermore, the strength of this neural response correlated directly with self-reported yearning for the deceased, underscoring the profound impact on their reward processing.
In contrast to individuals with PTSD or anxiety, those with PGD exhibit a tendency to focus on reminders of the deceased. Conversely, individuals experiencing PTSD or anxiety tend to display neural activity that promotes avoidance behaviors, a key differentiator in their cognitive and emotional responses to loss.
Further research indicates heightened activation in the amygdala and the right hippocampus—areas crucial for emotion processing and memory—among individuals with PGD when they view death-related images, such as a graveyard. This contrasts with individuals experiencing typical grief, where these same regions may show different activity patterns. Such heightened activation in response to death-related stimuli, coupled with greater deactivation in response to positive images like serene landscapes, suggests a disruption in emotional regulation and a reduced capacity to experience positive emotions in PGD.
Bryant explains that in PGD, the brain’s reward system becomes fixated on the deceased, hindering the ability to find satisfaction or reward elsewhere. This leads to an intense and persistent longing for the lost loved one. “The key distinction between PGD and normal grief is the time frame—that is, the person is ‘stuck’ in their grief such that they do not adapt in the way that most people do,” Bryant stated.
Katherine Shear from Columbia University in New York acknowledged the comprehensiveness of the review but noted that its findings do not yet offer a straightforward diagnostic tool for PGD. This limitation stems partly from the impracticality of widespread brain scanning for all grieving individuals and the inherent complexity and variability of grief, making it difficult to capture with a single assessment.
Shear suggests that neuroimaging is beginning to address this complexity through “two-person neuroscience.” This approach examines brain activity during direct interactions, providing insights into how social context, cultural norms, and support systems shape the experience of grief.
The review may prove valuable in identifying individuals at risk of developing PGD following a bereavement. One study observed bereaved adults, scanning their brains within a year of loss and at subsequent intervals over six months. The initial scans revealed that greater connectivity between the amygdala and areas responsible for planning, behavioral inhibition, and information filtering predicted a worsening of grief symptoms over time. This suggests that these neural patterns and associated behaviors might serve as indicators of an individual’s potential risk for PGD.
Although several psychosocial factors are known to differentiate individuals more susceptible to PGD, reliably identifying those on a trajectory towards the disorder remains challenging, according to Joseph Goveas at the Medical College of Wisconsin. “Early detection would allow for timely interventions, which could range from supportive approaches such as grief groups to more specialised care,” he commented.
The emergence of evidence detailing specific neurobiological mechanisms further strengthens the argument for recognizing PGD as distinct from other grief-related conditions. These findings also offer guidance for tailoring treatment approaches. Goveas noted, “Understanding both overlapping and distinct neurobiological mechanisms may help reduce misdiagnosis and inappropriate treatment. For example, while PGD typically does not respond to antidepressants, it does respond to grief-specific psychotherapies. Conversely, when PGD co-occurs with major depression, combining antidepressants with PGD-targeted therapy can effectively treat depressive symptoms.”
For immediate support, individuals in the UK can contact Samaritans at 116123. In the US, the Suicide & Crisis Lifeline is available at 988. Hotlines are also available in other countries.
Journal reference: Trends in Neurosciences DOI: 10.1016/j.tins.2026.01.001