As the questions here suggest, confusing it with Major Depressive Disorder. Antidepressants and Interpersonal Psychotherapy have been shown to be helpful for bereavement related depression but not for grief. PGD is about yearning and feeling without a needed person who provided comfort, understanding, a sense of worth and meaning to one's existence. It is not a trauma as much as an attachment disturbance and rewarding to reminisce about the deceased in a bittersweet way. There is this push away from the reality of the death, and pull toward comforting reminders of the deceased.

Intense yearning for the deceased, preoccupation with thoughts of the deceased, feeling that life is meaningless without the deceased, feeling an identity disturbance (a part of themselves died along with the deceased; no longer sure who they are or where they fit in or what they should be doing)

Yes David Brent and Nadine Melhem at University of Pittsburgh have studied PGD in children. Kathleen Nader and I have developed some PGD tools for losses in childhood. Christopher Layne and Bob Pynoos at UCLA are experts in this area, too.

Yes. Based on decades of research it is not only that PGD is itself now recognized as a mental disorder in DSM-5, but it appears to heighten risk for depression, PTSD, generalized anxiety disorder and suicidal thoughts and gestures. This is why it should be properly diagnosed and treated

Prolonged Grief Disorder A. The death of a person close to the bereaved at least 12 months previously (for children and adolescents, at least 6 months previously). B. Since the death, there has been a grief response characterized by intense yearning/longing for the deceased person or a preoccupation with thoughts or memories of the deceased person. This response has been present to a clinically significant degree nearly every day for at least the last month. (Note: in children and adolescents, preoccupation may focus on the circumstances of the death.) C. As a result of the death, at least 3 of 8 of the following symptoms have been experienced to a clinically significant degree, nearly every day, for at least the last month:

1. Identity disruption (e.g., feeling as though part of oneself has died)
2. Marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead (Note: in children and adolescents, this may be manifest as a desire to avoid reminders that the person is dead)
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
5. Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future)
6. Emotional numbness
7. Feeling that life is meaningless
8. Intense loneliness (i.e., feeling alone or detached from others) D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The duration of the bereavement reaction clearly exceeds expected social, cultural or religious norms for the individual’s culture and context. F. The symptoms are not better explained by another mental disorder.

Yes it can follow the loss of anything or anyone that is a loved, cherished thing. Please see other responses to similar questions.

The name has changed over the years but the core symptoms have not. I developed the Inventory of Complicated Grief (ICG) and most of the best performing items were derived from it and are now used to assess and diagnose Prolonged Grief Disorder. At its core, it is a disorder of attachment, characterized by intense, chronic yearning for the deceased. In a sense the Prolonged Grief Disorder assessments (e.g., our PG-13) are the "best of" the ICG.

Prolonged Grief Disorder A. The death of a person close to the bereaved at least 12 months previously (for children and adolescents, at least 6 months previously). B. Since the death, there has been a grief response characterized by intense yearning/longing for the deceased person or a preoccupation with thoughts or memories of the deceased person. This response has been present to a clinically significant degree nearly every day for at least the last month. (Note: in children and adolescents, preoccupation may focus on the circumstances of the death.) C. As a result of the death, at least 3 of the 8 following symptoms have been experienced to a clinically significant degree, nearly every day, for at least the last month:

1. Identity disruption (e.g., feeling as though part of oneself has died)
2. Marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead (Note: in children and adolescents, this may be manifest as a desire to avoid reminders that the person is dead)
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
5. Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future)
6. Emotional numbness
7. Feeling that life is meaningless
8. Intense loneliness (i.e., feeling alone or detached from others) D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The duration of the bereavement reaction clearly exceeds expected social, cultural or religious norms for the individual’s culture and context. F. The symptoms are not better explained by another mental disorder.

Complicated grief, traumatic grief were terms my research group and I have used before settling on call the disorder Prolonged Grief. I will insert here the symptoms of PGD approved for inclusion in DSM-5 below. We have compared temporal subtypes and it does not appear to matter if onset is delayed until 12 months (or 6 months) or persistently high/chronic for 12 months (or 6 months) to be at risk for enduring dysfunction at 24 months postloss.

Prolonged Grief Disorder A. The death of a person close to the bereaved at least 12 months previously (for children and adolescents, at least 6 months previously). B. Since the death, there has been a grief response characterized by intense yearning/longing for the deceased person or a preoccupation with thoughts or memories of the deceased person. This response has been present to a clinically significant degree nearly every day for at least the last month. (Note: in children and adolescents, preoccupation may focus on the circumstances of the death.) C. As a result of the death, at least 3 of 8 of the following symptoms have been experienced to a clinically significant degree, nearly every day, for at least the last month:

1. Identity disruption (e.g., feeling as though part of oneself has died)
2. Marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead (Note: in children and adolescents, this may be manifest as a desire to avoid reminders that the person is dead)
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
5. Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future)
6. Emotional numbness
7. Feeling that life is meaningless
8. Intense loneliness (i.e., feeling alone or detached from others) D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The duration of the bereavement reaction clearly exceeds expected social, cultural or religious norms for the individual’s culture and context. F. The symptoms are not better explained by another mental disorder.

We tested the stages of grief model explicity in my Yale Bereavement Study (Maciejewski et al. JAMA 2007). Although the data suggested that the average "negative grief indicators" all declined over the first six months post loss, while acceptance of the loss increased, a rescaling did reveal support for the stage model. We found that disbelief or shock was most strongly expressed initially, followed by separation distress, anger, depression and then acceptance (or what we prefer to term resignation). The likelihood that that sequence would occur by chance was p<..008. There is undeniably shock over a significant loss at first and gradual resignation to the reality of the loss over time, so there is clearly some evidence in support of what Kubler-Ross/Bowlby/Parkes proposed. People get caught up on being pigeon-holed and note that some stages can reoccur and occur out of sequence, but the notion that there is shock, protest, anger, depression then acceptance on the whole, seems largely to be true so indicating that there is hope and that time can heal (except for those stuck in chronic grief; that is, PGD) would appear consistent with the data.

The single biggest risk for PGD is strong emotional dependence on the deceased. The strongest protective factor is being securely attached and having a supportive social network inclusive of one or more confidantes.

Yes it is. And it is also a risk for suicidal thoughts and behaviors among bereaved individuals, regardless of PGD, though PGD is the mental disorder among the bereaved which we have found to present the highest risk for suicidal thoughts and behaviors.

Yes, a very long time ago I reviewed an article that found that the age of the mother and number of other children she had were significant risk factors for PGD in the context of early pregnancy loss. It would appear the loss might be a function of loss of the possibility of being a mother that is critical to PGD in this context.

There has been very little research on pharmacotherapy for PGD. The initial studies found tricyclic antidepressants and IPT were not effective for symptoms of grief as they were for those of depression. A few open trials of SSRIs have yielded modest results. We are now developing experimental trials of naltrexone, based on a review of the literature implicating reward system dysfunction in PGD, but expect there will be pushback to this suggestion.

Yes, you may be familiar with Bowlby's "personalities pronte to pathological mourning"?. We have studied this and a few "insecure attachment styles" (e.g., compulsively self-reliant, excessively dependent, compulsive caregiving) were associated with elevated PGD symptomatology compared to secure attachment styles among the bereaved individuals studied.

We have compared types of loss and those from violent crimes result in more anger (rage) and questioning of why. There may be elements of PTSD, with fear, helplessness and horror complicating the bereavement adjustment. In this case, it is not simple an attachment disturbance, but a traumatic stress response replete with feelings of the injustice of what happened, intrusive thoughts, a sense of helplessness and foreshortened future.

There have not been significant gender differences associated with PGD. Some studies show men are more at risk, some show women are more at risk, most show no significant association with PGD risk by gender. The exception is mothers who have lost a child who appear more devastated on average than fathers, but even in this circumstances there are many exceptions to this exception.

I'm not sure I understand the question. Are you asking if pain could trigger PGD? I have been asked this multiple times, which suggests to me that there might be something too it -- so the loss is of normal function -- and the survivor grieves the loss of normalcy. Having no evidence to confirm this relationship, however, I'd rather not speculate.

I'm unfamiliar with the term but if this suggests that grieving is necessary to a healthy, adaptive adjustment to loss, then that is sounding like the Freudian notion of grief work (i.e., that a person needs to express or work on grief to adjust). If by this non-expression of grief there is a conclusion that this represents resilience, then I think that there are many instances in which either the person was not that attached to the deceased so there is not much grieving experienced and that is not resilience, per se, or that there is a delayed grief reaction which is also not necessarily resilience (e.g., in combat this can happen when someone is overwhelmed by loss and grief and cannot process what has happened). I would need to know more about the what is meant by resilient grieving to be able to answer this satistfactorily.

Yes. Grief is essentially wanting something very much (e.g., something that is self-defining, a source of comfort and security and place in this world) that you cannot have. If the "thing" lost is one's freedom, autonomy, livelihood, marriage, and you yearn intensely to have it back and do not know what to do without it and how you will get on, then that thing could trigger PGD.

When decades of research demonstrate that a significant minority of bereaved people meet the proposed criteria, that those that do are at significantly increased risk of making a suicide attempt, hospitalization, physical and mental disorders, then it is no different than accurately and reliably diagnosing any other disorder, be it diabetes or cancer.