Prolonged Grief Disorder Is a Real Diagnosis but It's Missing Half the Picture
What the Clinical Language for Extended Grief Still Doesn't Account For and Why That Gap Is Producing Harm.
In 2022, Prolonged Grief Disorder (PGD) became an official diagnosis in the DSM-5-TR. Many clinicians in the mental health community saw this as a significant step forward. It acknowledges that some individuals experience grief that goes beyond what’s considered normal, which can require professional attention and help. This recognition is crucial; those living with debilitating grief deserve care that respects their experiences, rather than being told to simply wait it out and let grief run its course, essentially.
However, the current definition of PGD is lacking in an essential aspect. This isn't just a minor flaw; it's a significant gap that impacts how mental health professionals understand and treat many individuals who fit the diagnostic criteria. The missing element is the spiritual aspect of grief. Often, grief doesn’t linger because a person is unusually attached, avoidant, or unable to process their emotions. No. Instead, it may persist because the spiritual implications of their loss haven't been addressed. The ongoing presence of the deceased might be seen as pathologically attached rather than as a legitimate part of their grief. The cultural and ancestral factors are often remain unrecognized in clinical settings, and grieving individuals often have experiences that are failed to be accommodated with the current diagnostic framework for grief.
When Stuck Grief Is Actually Unmet Spiritual Need
Clinicians frequently encounter individuals whose grief extends well beyond the typical timeframe of 6 months. These individuals may have engaged in significant therapeutic work and can articulate their feelings with clarity and emotional insight. Yet, they still carry an unresolved weight, often described as "unfinished business," with no clear source. This situation might resemble PGD, and sometimes the diagnosis fits perfectly, that help symptoms of grief alleviate with appropriate clinical interventions; but, in some cases, grief endures because it reflects an unmet spiritual need. These individuals may yearn for an ongoing relationship with the deceased, which the clinical framework mistakenly interprets as unhealthy attachment. They might also need their cultural and ancestral connections to be acknowledged, rather than reduced to individual psychological experiences. The spiritual signs and experiences that arise after a loss i.e.: dreams and feelings of presence are often dismissed instead of being recognized as valid.
When treatment focuses solely on the psychological aspects of grief without addressing the spiritual dimension, progress can stagnate. This plateau might be misread as resistance to treatment, or as complexity that requires a different approach. In reality, it signals that the full scope of what grief is responding to hasn't been fully understood.
The Risk of Over-Medicalizing What Isn't Pathology
The medicalization of grief is a tricky topic. At different times the field has underplayed severe grief responses that truly needed attention while also over-diagnosing normal grief reactions. The introduction of PGD continues this complicated trend. The criteria for PGD state that grief must cause significant distress or impairment for at least twelve months following the loss to permit a diagnosis. This framework isn’t inherently flawed; it captures genuine cases where grief has become disabling. However, a nuanced understanding requires cultural and spiritual literacy that many training programs for clinicians lack.
Take, for example, a BIPOC/BBIA woman mourning her mother has maintained a vibrant relationship with her mother's Spirit through ancestral practices. Her deep and prolonged grief, viewed through a dominant cultural lens, may resemble PGD. Applying that label without understanding her cultural context would be misguided and cause harm. It imposes a dominant framework on grief that may not fit her lived experience.
Where the DSM Framework and Lived Spiritual Experience Separate
The DSM has been shaped by a clinical culture that often overlooks the spiritual dimension of human experience. As a result, the diagnostic system can effectively capture the psychological and behavioral signs of grief but tends to ignore what grief is addressing on a spiritual level.
For many BIPOC/BBIA women, grief doesn’t separate into neat psychological and spiritual categories. The DSM sees ongoing longing for the deceased as indicative of disordered grief. In contrast, many cultural traditions view that longing as a natural expression of love, demonstrating that death doesn’t sever all ties. The DSM may interpret difficulty in accepting a loss as a symptom of prolonged grief, while spiritual frameworks recognize the reluctance to accept finality as spiritually valid rather than psychologically avoidant.
These differences aren't insignificant; they reflect fundamentally divergent interpretations of grief's purpose and produce different treatment approaches. Not addressing the spiritual dimension can lead to stagnation and create obstacles for clients whose grief is tied to something beyond psychological factors.
The solution isn’t to abandon clinical care for spiritual practices. Instead, it's about finding a balance, integrating both perspectives. A framework that respects the need for clinical precision alongside spiritual understanding is essential. Clinicians trained in this approach can acknowledge PGD as a valid diagnosis while also discerning when a client's grief stems from unmet spiritual needs. This vital understanding shifts how the therapeutic process unfolds.
Learn This Framework Before October Is Gone
For clinicians eager to develop this integrated model, the Psychospiritual Grief Method offers training. It encourages a deep understanding of both clinical and spiritual tools needed for working with clients experiencing complex grief.
🎓 The Psychospiritual Grief Method Training October 17th, 2026, for clinicians who are ready to develop both/and model in their own practice, with the clinical and spiritual rigor that the clients carrying the most complex grief require. Six CEUs, small cohort by design, seats are filling.
Register for the training here
🍂 The Elements of Grief Course: opens October 25th, a self-paced psychospiritual course built for clients navigating grief that standard frameworks haven't been able to reach, and a resource clinicians can refer clients to with confidence that the framework holding the course is both clinically grounded and spiritually literate.
Waitlist coming soon
✨ The Inner Circle is for women ready for deeper, more personalized ongoing support as the understanding of what grief is and what it requires continues to deepen.
📞 Grief Consultation Call is for California residents navigating grief that hasn’t moved despite consistent effort, where a conversation about what grief is actually responding to is the place to begin.
Schedule consultation call here
With care and intention,
Amber
