How to Help Someone with Complicated Grief

You've watched someone you care about grieve. You expected the worst to pass in months. It's been over a year, and they're not improving — if anything, they seem more stuck.

The advice that supports normal bereavement may not be enough here. "Give them time" assumes time is doing its work. When grief meets PGD criteria, time alone may not be enough.

Recognise What You're Dealing With

Prolonged Grief Disorder (PGD) is a clinically recognised condition in the DSM-5-TR, distinct from both depression and normal bereavement. In adults, it can be considered after 12 months and involves persistent yearning or preoccupation, at least three additional symptoms present nearly every day for at least the past month, and significant impairment beyond what's expected in the person's cultural and social context. A clinician makes the diagnosis.

Not everyone who grieves develops PGD. Closer assessment may be useful after a sudden or traumatic death, when the loss involves a close attachment figure, or when social support is limited.

What distinguishes complicated grief from intense-but-normal grief:

• Normal grief comes in waves that gradually soften. Complicated grief stays at the same intensity or worsens.
• A positive moment does not rule out PGD. The condition involves persistent symptoms and significant impairment, even though a person may still have moments of relief or connection.
• PGD involves significant functional impairment, but that doesn't always mean someone stops working, socialising, or managing basic self-care.

What Not to Do

Well-meaning support often makes complicated grief worse:

Don't set a timeline. "It's been a year — you need to move on" is the single most damaging thing you can say. They know how long it's been. They can't move on. That's the disorder.

Don't compare griefs. "I lost my mother too, and I was back at work in a month" implies their grief is a choice or a character failing. PGD is a clinical condition, not insufficient willpower.

Don't avoid the deceased's name. People with complicated grief often report that everyone around them has stopped mentioning the person who died, which deepens their isolation. Say the name. Ask about the person. Let them talk.

Don't push "getting back out there." Forcing social reintegration before the bereaved person is ready can increase avoidance behaviour — one of the core symptoms of PGD.

Don't armchair diagnose. Recognising the signs is valuable. Telling someone "I think you have Prolonged Grief Disorder" without clinical training is not. Frame it as concern, not diagnosis.

What Actually Helps

Show up consistently. The most reported pain point in complicated grief is isolation. Friends and family rally in the first weeks, then gradually withdraw. The person with PGD feels abandoned by both the deceased and the living. Regular, low-pressure contact — a text, a walk, sitting together without requiring conversation — matters more than grand gestures.

Handle logistics. Research shows the administrative burden of estate settlement averages 420 hours over 18-20 months. A workplace bereavement survey found that 43% of bereaved full-time employees struggled with concentration, so practical help may be more valuable than emotional advice. Pick up groceries, help with paperwork, drive them to appointments.

Tolerate repetition. People with complicated grief often need to tell the same stories about the deceased, revisit the same memories, express the same pain. This isn't regression — it's the brain trying to process what it can't yet integrate. Listen without trying to fix it.

Gently introduce the idea of professional help. The evidence-based treatments for PGD — specifically Prolonged Grief Disorder Therapy (PGDT) and complicated grief treatment protocols — show strong outcomes. Standard talk therapy and antidepressants are less effective because PGD is an attachment disorder, not a mood disorder.

Frame it as: "There are therapists who specialise specifically in this kind of grief. The treatment is different from regular counselling. Would it help if I looked into options?"

Help them assess without pressure. Screening tools like the PG-13-R (a 13-item scale where scores of 30+ indicate probable PGD) and the Brief Grief Questionnaire (scores of 4+ flag significant risk) can give the bereaved person information to bring to a clinical conversation; they do not diagnose PGD. The Complicated Grief Navigation System includes both instruments along with a crisis escalation protocol.

Protecting Yourself

Supporting someone with complicated grief is exhausting. Their pain doesn't resolve on the timeline your own emotional resources can sustain. A few boundaries that help:

• You're a support person, not a therapist. You can't fix their grief — you can be present while they do the work.
• Set limits you can maintain. It's better to text every Wednesday reliably than to call daily for a month and then burn out and disappear.
• Monitor your own grief responses. Secondary grief — absorbing someone else's pain until it becomes your own — is real, especially if you also knew the deceased.
• If they express suicidal ideation — including wanting to die to rejoin the deceased — treat it as an immediate safety concern. Do not leave them alone. In the United States or Canada, call or text 988; elsewhere, contact local crisis or emergency services.

The hardest part of supporting someone with complicated grief is accepting that your love and presence, while essential, aren't sufficient to heal them. Professional treatment exists because this condition exceeds what social support alone can resolve. Your role is to stay close enough that they can reach for help when they're ready.