Persistent Complex Bereavement Disorder

Mourning Coffee, by Tracy Renee Lee

Complicated grief disorder has been redefined as persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Persons suffering persistent complex bereavement disorder (PCBD) experience an extreme yearning for their deceased loved one over an extended or prolonged time. This grief disorder is unusually disabling and often accompanied by destructive thoughts and behaviors. These survivors are in pressing need of assistance from professional intervention as their experience destroys their ability to resume a healthy life on their own.



Bereavement is the period of time spent adjusting to loss.

During bereavement, survivors generally experience varying levels of grief’s symptoms.

Shock, numbness, sadness, yearning, disbelief, fatigue, crying, emptiness, fear, anger, guilt, and pain are included as a few of the symptoms of grief.

Survivors may experience disturbances in their abilities to function at their usual capacity and may suffer changes in their daily patterns of eating, sleeping, working, tolerance levels, and interactions with others.

If these symptoms become incapacitating, or if the survivor suffers from them for a prolonged period of time (beyond six months), it may be prudent to consider the assistance of a mental health professional. (Mourning Light III, 2019)

Persistent complex bereavement disorder (PCBD)  is characterized by unshakeable grief that does not follow the general pattern of improvement over time; instead, individuals continue to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of functioning, or that cause extreme distress (Shear, Simon, Wall, Zisook, Duan, Reynolds, 2011).

The symptoms of grief closely correlate with the symptoms of persistent complex bereavement disorder (PCBD). The underlying difference is that the symptoms of grief generally correct themselves back to a place of functionality within a relatively brief period (usually within six months), while those who suffer persistent complex bereavement disorder experience a deepening intensity of symptoms in a continuing fashion.

Approximately 10 to 12 percent of bereaved individuals experience a syndrome of grief that does not resolve naturally and persists for an indefinite period with varying degrees of incapacitation. This has been labeled complicated or prolonged grief disorder and can have adverse long-term health effects (Prigerson, Horowitz, Jacobs, Parkes, Aslan, Goodkin, Raphael & Marwit, 2009). Normal grief is not generally considered a severe threat to the health and welfare of the survivor.

Certain risk factors seem associated with PCBD, including the first-degree relationship to the deceased, separation anxiety in childhood, controlling parents, abuse by or death of parents during childhood, a poorly functioning marriage or insecure attachment style prior to widowhood, emotional dependency of the deceased, lack of preparation for the death and in-hospital death of the loved one. (Ott, Lueger, Kebler & Prigerson, 2007) A prolonged state of abnormal grief has been associated with elevated rates of suicidal ideation and suicide attempts. Cancer, hypertension, and cardiac events are more likely after several years, and immune disorders and evidence of immune dysfunction are more frequent. Adverse health behaviors are more frequent and reported functional impairment is greater. Health care services are used to a greater extent, and more sick leave is taken. (Lannen, Wolfe, Prigerson, Onelov $ Kreicbergs, 2008) Personality traits such as a negative outlook and specific factors like a violent cause of death (such as suicide) may be associated with the onset of complicated grief, along with insecure attachment style or a history of trauma. Individuals who were formerly caregivers to the deceased may also be at greater risk. (Lobb, Kristjanson, Aoun, Monterosso, et al., 2010)

There is no single treatment method for PCBD, however, Complicated Grief Treatment (CGT), developed through Columbia University’s School of Social Work, has proven uniformly positive with an average response rate of 70 percent.   Funded by the National Institute of Mental Health, CGT has been evaluated in three separate clinical trials. It is by far the most documented treatment offered for grief ailments.

 Grief is not a voyage that one day ends. It is an ongoing, continuous journey. One does not experience the loss of a loved one and then, after a brief time, return to life as though nothing has happened. The death of a loved one changes the mechanical, psychological, and emotional make-up of a survivor’s life. Nothing is, nor ever will be, as it once was. These facts affect a change in the survival strategies of the living. For those who are unable to overcome these changes and implement new strategies of survival, PCBD looms on their horizon. These survivors have generally exhausted their supply of supportive companionship and their effectiveness of personal coping mechanisms. They live in a space without anywhere to turn for guidance, assistance, or peace. For these individuals, Complicated Grief Therapy may be their greatest life-preserver.

My name is Tracy Renee Lee. I am a Certified Grief Counselor (GC-C), Funeral Director (FDIC), published author, syndicated columnist, and co-founder of the “Mikey Joe Children’s Memorial” and Heaven Sent, Corp. I write books, weekly bereavement articles, and Grief BRIEFs related to understanding and coping with grief.  I am the American Funeral Director of the Year Runner-Up and recipient of the BBB’s Integrity Award. 

It is my life’s work to comfort the bereaved and help them live on.

For additional encouragement, read other articles or watch video “Grief Briefs,” please go to my website at

Please follow me on Instagram at “GoinInStyleFunerals”.


Persistent Complex Bereavement Disorder DSM-5

Dr. Kevin Fleming, Ph.D.

Miles E. Drake, Jr., M.D.

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