How to Tell If Your Grief Is Normal or Needs Treatment

If you're asking this question, here's the short answer: validated screening instruments can help flag symptoms that merit clinical evaluation. They cannot determine on their own whether your grief is normal or diagnose Prolonged Grief Disorder. You can use a screening tool to prepare for a conversation with a clinician.

The two instruments clinicians use are the PG-13-Revised (13-item validated screener for PGD severity) and the Brief Grief Questionnaire (5-item rapid screener). Both are self-administered and have published screening cutoffs. A PG-13-R score of 30 or above indicates probable Prolonged Grief Disorder and warrants clinical review. A BGQ score of 4 or above indicates significant risk; 8 or above suggests probable PGD. Neither score is a diagnosis.

The Problem With Self-Assessment

The cruelty of complicated grief is that it impairs exactly the cognitive functions you need to assess whether you are impaired. Grief degrades executive function, working memory, concentration, and emotional regulation — the same capacities required to step back, evaluate your own state, and decide whether what you are experiencing falls outside the range of normal.

This is why 43% of full-time bereaved employees report concentration difficulty, 30% of bereaved people report marked memory impairment, and 93% experience acute anxiety. You are trying to evaluate your own cognitive state using the cognitive state that needs evaluating. It is a closed loop with no external reference point.

Family and friends are not reliable calibrators either. They compare your grief to their own experience, which may have been uncomplicated. "It's been a year — you should be moving on" is not clinical guidance. Neither is "everyone grieves differently" when applied to someone who has not left the house in three months.

The Clinical Line Between Normal and Not

The American Psychiatric Association formalized this distinction in 2022 by adding Prolonged Grief Disorder to the DSM-5-TR. The diagnostic criteria provide the clearest answer to "is this normal":

Normal bereavement: Pain comes in waves. The waves gradually become less frequent and less intense over 6–12 months. You can function between waves — return to work, engage socially, experience moments of pleasure or meaning. The grief integrates into your life without dominating it.

Prolonged Grief Disorder: For adults, the loss occurred at least 12 months ago (6 months for children and adolescents). Intense yearning or preoccupation is present nearly every day, along with at least three of these eight symptoms nearly every day for at least the past month: identity disruption, disbelief about the death, avoidance of reminders, intense emotional pain, difficulty reengaging with life, emotional numbness, a sense that life is meaningless, or profound loneliness. The symptoms cause clinically significant distress or impairment and exceed cultural, social, or religious norms.

The key differentiator is not the intensity of grief — acute grief is supposed to be devastating. It is whether the devastation integrates over time or stays fixed.

How the Screening Instruments Work

PG-13-R (Prolonged Grief-13, Revised)

Thirteen items rated on a 5-point scale from "not at all" to "overwhelmingly." It assesses both the gateway symptoms (yearning, preoccupation) and the eight accessory symptoms, asking about their frequency and intensity over the past month. Takes 5–8 minutes.

Screening cutoff: A total score of 30 or higher suggests probable PGD and warrants review with a licensed mental health clinician. The score does not diagnose PGD or determine treatment by itself.

Brief Grief Questionnaire (BGQ)

Five items rated 0–2 (not at all, somewhat, a lot). Evaluates trouble accepting the death, grief interference with functioning, intrusive images, avoidance of reminders, and feeling cut off from others. Takes 2–3 minutes.

Screening cutoff: 4 or higher indicates significant risk of complicated grief. 8 or higher suggests probable PGD. The five-item screener was developed by Dr. M. Katherine Shear at Columbia University.

Why the Diagnosis Matters for Treatment

PGD, Major Depressive Disorder, and PTSD share overlapping symptoms but respond to fundamentally different treatments. Getting the diagnosis wrong does not just delay recovery — it can make things worse.

Standard antidepressants alone have shown no significant benefit for core prolonged-grief symptoms when PGD is primary. That does not mean medication is never appropriate: a clinician can assess for depression and other co-occurring conditions. Screening results can help start a discussion about what assessment and care fit your situation.

Who This Is For

• Your grief has persisted at full intensity for many months and you are wondering whether something is clinically wrong
• You want objective data before your first therapy appointment — a score to bring, not just "I don't feel right"
• You are supporting a grieving family member and need a framework for assessing severity without relying on their (impaired) self-report
• You are in a location where PGD-specialized therapists are scarce and you need to know whether seeking a specialist is worth the effort
• Your doctor or therapist has not raised the possibility of PGD and you want to bring it up yourself with clinical evidence

Who This Is NOT For

• You are in acute grief (for adults, within the first 12 months; for children, within the first 6 months) and experiencing intense but gradually shifting pain — this may be normal bereavement, even when it feels unbearable
• You are experiencing active suicidal ideation — skip the screening and contact 988 (US/Canada), 116 123 (UK), 13 11 14 (Australia), or your local crisis line immediately
• You have already been diagnosed and are in active treatment with a PGD specialist — re-screening adds little value at that stage

Where to Find These Instruments

The PG-13-R and BGQ are published in clinical literature. However, locating the actual instruments (not summaries or descriptions of them), understanding the scoring system, and interpreting results in the context of the full PGD diagnostic criteria requires assembling information from multiple academic sources.

The When Grief Gets Complicated toolkit includes both instruments in fillable format with scoring guides, interpretation frameworks, and the full DSM-5-TR diagnostic criteria explained in plain language. It also includes the differential diagnosis table (PGD vs depression vs PTSD), a crisis escalation protocol for when screening reveals high severity, and communication scripts for bringing your results to a clinician. The idea is to move from "something feels wrong" to "here is my score, here is what it means, and here is what I need" in a single evening.

Tradeoffs

Self-screening with a toolkit: Immediate, private, produces screening data. But you are interpreting clinical instruments without clinical training — the score is a signal, not a diagnosis. A PG-13-R score of 30+ suggests probable PGD and should be reviewed with a clinician.

Waiting for a therapist: The clinician administers the instruments, interprets the results in context, and can discuss appropriate care. Specialist availability and wait times vary. While arranging an appointment, screening information and structured tools may help you prepare and manage practical tasks.

Talking to your GP: Your GP can discuss symptoms and referral options. Ask whether they can assess for PGD or refer you to a clinician with relevant experience; they can also evaluate depression or other co-occurring conditions.

You can complete screening tools before speaking with a clinician and bring the scores as context. They do not replace a full clinical intake, assessment, or discussion of your history.

Frequently Asked Questions

How long should I wait before taking a grief screening test?

The PGD diagnostic criteria require at least 12 months since the death for adults and 6 months for children and adolescents. Before that threshold, intense grief may still be normal acute bereavement, but serious distress or impairment deserves attention at any time. Screening results are not a diagnosis; discuss concerns with a clinician.

Can a screening tool actually diagnose Prolonged Grief Disorder?

No. A screening tool identifies probable PGD based on published clinical cutoffs. Formal diagnosis requires a qualified clinician who can rule out comorbid conditions (depression, PTSD), confirm that symptoms cause clinically significant distress or impairment, and verify that the presentation is not better explained by another disorder. What screening gives you is data — a starting point for a clinical conversation, not an endpoint.

What if my score is below the clinical cutoff but I still feel terrible?

A score below the PGD screening cutoff does not diagnose PGD, but it also does not rule it out or rule out another condition. It does not mean your suffering is not real or does not deserve support. Discuss persistent symptoms and impairment with your provider; "My PG-13-R score is 24 and I'm struggling" gives a therapist useful context.

My family member refuses to see a therapist. Can I use these tools to assess their grief?

The screening instruments are designed for self-administration, but a family member can observe behavioral indicators such as avoidance, withdrawal, emotional numbness, or disbelief. Warning signs include complete loss of appetite, total withdrawal from support networks for more than a month, or expressed thoughts of wanting to die to rejoin the deceased. These signs call for professional attention; suicidal thoughts require immediate crisis support.

Is there a difference between complicated grief and Prolonged Grief Disorder?

"Complicated grief" is an older, informal term. "Prolonged Grief Disorder" is the formal DSM-5-TR diagnosis established in 2022. The terms overlap, but PGD is the formal diagnosis used in current clinical criteria. In everyday conversation, "complicated grief" remains widely understood.