Most people expect grief to soften with time. Often it does, although rarely in a straight line. Grief that doesn’t get easier is more common than most people realise. For some people, months or even years after a death, the pain is as raw as it was in the first week, or heavier. If that sounds like you, or someone you love, it does not mean you are grieving the wrong way, and it does not mean you are weak. It may mean your grief has become what clinicians call complicated grief, now formally named prolonged grief disorder, a recognised condition that responds well to specialised support.
This guide explains what complicated grief is, how it differs from normal grief, what the symptoms look like, why grief sometimes gets stuck or gets worse, and what treatment and support are available in Australia.
The short version
- Complicated grief is the older, widely used name for prolonged grief disorder (PGD). Research suggests about one in ten bereaved adults is affected.
- It is not defined by a deadline. What matters is how intense the grief is, how long it stays that intense, and how much it interferes with your life.
- Formal diagnostic guidelines look for persistent yearning or preoccupation with the person who died, plus other symptoms, at least 6 months after the loss (ICD-11) or at least 12 months for adults (DSM-5-TR).
- Grief-focused therapy has the strongest evidence. Medication alone has not been shown to treat prolonged grief itself.
- In Australia, a GP can start the process, and Medicare rebates may apply to psychologist sessions. Free phone and walk-in supports are also available.
What Is Complicated Grief?
Complicated grief is grief that stays intense, painful, and disabling long after most people would expect it to ease, keeping a person stuck in longing for the person who died. It is now formally called prolonged grief disorder. Research suggests it affects roughly one in ten bereaved adults, and it can happen after any significant death.
In an ordinary grief reaction, the pain is still real, but over time it usually becomes something you can carry alongside daily life. In complicated grief, the loss stays at the centre of everything. A pooled analysis of studies published in 2017 estimated that about 9.8 percent of bereaved adults met criteria for prolonged grief disorder, and the figure tends to be higher after sudden, violent,n,t or unexpected deaths.
Importantly, complicated grief is not a sign of loving someone “too much” or failing to cope. It is better understood as the natural grief process becoming stuck, often because of certain thoughts, avoidance patterns, circumstances of the death, or a lack of support.
Is Complicated Grief the Same as Prolonged Grief Disorder?
Yes, in everyday use they mean the same thing. “Complicated grief” is the older research and clinical term. “Prolonged grief disorder” is the formal diagnostic name, added to the American Psychiatric Association’s DSM-5-TR in March 2022 and recognised in the World Health Organization’s ICD-11.
You will also hear other labels used informally. They are not separate diagnoses, but they describe patterns people recognise:
Term | What people usually mean |
Chronic grief | Grief that continues at high intensity for a very long time |
Delayed grief | Grief that seems absent at first, then arrives months or years later |
Unresolved grief | Grief that feels stuck, with no sense of acceptance or movement |
Traumatic grief | Grief mixed with horror or shock, usually after a sudden or violent death |
An earlier DSM-5 (2013) entry called persistent complex bereavement disorder was listed as a condition needing further study. It has been replaced by prolonged grief disorder.
Normal Grief vs Complicated Grief: How to Tell the Difference
Normal grief is painful but gradually becomes more manageable, with periods of relief, connection,o,n and even positive memories mixed in. Complicated grief stays intense and constant, and keeps getting in the way of daily functioning. The key differences are intensity, persistence, and impact on your ability to live your life, not how much you miss the person.
Normal grief | Complicated grief | |
Intensity over time | Comes in waves and gradually softens | Stays intense and constant, or worsens |
Relief and good moments | Possible, even early on | Rare or feel impossible |
Yearning for the person | Present, but not all-consuming | Dominates most days |
Daily functioning | Disrupted at first, then recovers | Work, relationships, and self-care stay impaired |
Sense of self | Changed but intact | Feeling that part of you has died |
Looking ahead | Can imagine a future, in time | Future feels meaningless or empty |
Reminders | Painful but tolerable | Avoided at all costs, or impossible to escape |
If you are wondering how to know whether your grief is complicated, three questions help most. Is the longing for the person still as intense as it was in the early weeks? Is it stopping you from doing things that matter to you, such as working, caring for others, or seeing people? And does it feel as though there is no way forward? Answering yes to all three is a good reason to talk to a GP or psychologist.
Grief is also shaped by culture, faith and family. Some communities mourn openly for long periods, and rituals can last a year or more. A good clinician will always consider what is expected in your cultural and religious context before suggesting your grief is out of the ordinary.
Does grief ever get easier?
For most people, yes. Research on bereavement consistently finds that most people experience intense grief at first and then gradually adapt, while still feeling sadness at times for years. Easier does not mean over. Many people describe learning to carry grief rather than getting rid of it.
How Long Does Grief Last? When Does Grief Become a Disorder?
There is no fixed time limit on grief, and no correct number of months. Grief becomes a possible disorder when intense longing or preoccupation with the person who died is still present nearly every day, along with other symptoms, at least 6 months after the loss under ICD-11, or at least 12 months for adults (6 months for children and adolescents) under DSM-5-TR, and it significantly affects daily life.
The two diagnostic systems differ slightly:
- ICD-11 (World Health Organization): persistent, pervasive longing for or preoccupation with the person who died, with intense emotional pain, lasting at least 6 months and clearly beyond what is expected in the person’s culture and context, causing significant impairment.
- DSM-5-TR (American Psychiatric Association): at least 12 months since the death for adults (6 months for children and adolescents), intense yearning and/or preoccupation nearly every day for at least the last month, plus at least three of eight listed symptoms, with significant distress or impairment.
Both systems deliberately wait before diagnosing, so that normal early grief is not treated as an illness.
How long is too long to grieve?
There is no such thing as grieving for too long, and nobody gets a deadline for missing someone. A better question is whether your grief is still stopping you from living. Is it normal to still grieve after five years? Yes, it can be, especially around anniversaries or life milestones. It becomes a concern when the grief remains as intense as ever and keeps you from work, relationships, health, or any sense of future.
What about the stages of grief?
The well-known “five stages of grief” (denial, anger, bargaining, depression, acceptance) were originally described in relation to people facing their own death, not bereavement, and they were never meant to be a fixed sequence. Modern research shows grief does not move in tidy steps. People swing between feelings, skip some entirely, and revisit others. Not passing through “all the stages” is not a sign anything is wrong.
A more useful model is the dual process idea: healthy grieving involves moving back and forth between facing the loss and taking breaks from it to deal with daily life. Complicated grief often involves getting stuck at one end, either unable to stop grieving or unable to face it at all.
Complicated Grief Symptoms and Signs
The core symptom of complicated grief is a persistent, intense yearning for the person who died, or constant preoccupation with thoughts and memories of them. Other signs include feeling that part of yourself has died, disbelief about the death, avoiding reminders, intense emotional pain, numbness, loneliness, and a sense that life is meaningless.
Under DSM-5-TR, a diagnosis requires at least three of these eight symptoms, nearly every day for at least a month, alongside the core yearning or preoccupation:
- Identity disruption: feeling as though part of you has died, or that you no longer know who you are
- Marked disbelief: being unable to accept that the person is really gone
- Avoidance of reminders: steering clear of places, photos, or conversations that confirm the death
- Intense emotional pain: such as anger, bitterness,s,s or sorrow connected to the loss
- Difficulty reintegrating: struggling to reconnect with friends, pursue interests,t,s or plan ahead
- Emotional numbness: feeling cut off or unable to feel much at all
- Feeling that life is meaningless: a sense of emptiness or purposelessness
- Intense loneliness: feeling alone or detached from other people
Other common signs people describe, even though they are not formal criteria, include:
- Guilt after loss: replaying what you did or did not do, or believing you could have prevented the death
- Preoccupation with the circumstances of the death, especially after a sudden or traumatic loss
- Difficulty sleeping, eating,g or concentrating
- Withdrawing from friends and family, or pulling away from activities you used to enjoy
- Increased drinking, drug use, or risk-taking to numb the pain
- Physical symptoms such as fatigue, aches, or a heavy, tight chest
If thoughts of ending your life or wishing you could join the person who died are part of the picture, please speak to someone straight away. Support options are listed at the end of this article.
Why Does Grief Not Go Away? What Causes Complicated Grief
Complicated grief usually develops from a mix of factors rather than one cause. The type of loss, your relationship with the person, your personal history, and the support you have all play a part. On top of that, certain thought and behaviour patterns, such as avoidance, rumination, and self-blame, can keep grief intense.
Circumstances of the loss
- Sudden, unexpected, violent or traumatic deaths
- The death of a child
- The death of a partner or someone you depended on closely
- Loss by suicide
- Deaths where there was no chance to say goodbye, or where the person’s body was not found
Relationship and personal factors
- A very close, interdependent relationship, or a complicated or conflicted one
- Previous losses or earlier trauma
- A history of depression, anxiety or insecure attachment
- Being older, since average prevalence tends to rise with age
Life after the loss
- Little social or practical support
- Other major stressors at the same time, such as money problems, relocation or caring for others
- Being unable to take part in rituals such as a funeral
- Grief that is not recognised by others (see disenfranchised grief below)
Thinking and coping patterns that keep grief stuck
- Persistent guilt or “if only” thoughts
- Believing that accepting the loss means betraying the person
- Avoiding anything that reminds you of the death, which prevents the loss from slowly sinking in
- Constantly dwelling on the loss, without any breaks
Why is my grief getting worse? Can grief get worse over time?
Yes, grief can intensify over time, and that does not mean you are going backwards. The numbness and busyness of the first weeks can fade, leaving the full reality of the loss to arrive months later. Anniversaries, holidays, birthdays, and life events can bring grief surging back, and new stress or secondary losses can make it heavier.
Common reasons grief feels worse after the first few months include:
- The shock wearing off: early numbness and practical tasks can hide the pain at first
- Anniversary reactions: dates linked to the person or the death can bring a sharp return of grief
- Secondary losses: the loss of income, home, role, friendships or future plans that follow a death
- Delayed grief: feelings postponed because of responsibilities, finally surfacing
- Less support: friends and family often stop checking in after a few months
- New life events: a wedding, a birth or a graduation that the person is missing
A rough patch around a significant date is normal. Grief that steadily worsens, or stays at its peak with no easing, is worth talking to a GP or psychologist about.
Types of Loss That Can Complicate Grief
Some losses carry extra weight or are harder for others to recognise, which can make grief harder to process.
- Sudden or traumatic loss: when a death happens without warning or involves violence, accident or suicide, grief and trauma reactions can blend together. Shock, horror and intrusive images of the death may accompany the longing.
- Loss of a child: many bereaved parents describe it as the loss of both the child and the future. It is one of the circumstances most strongly linked with prolonged grief, and specialist support exists in Australia.
- Loss of a partner: losing a life partner can mean losing a daily routine, a shared identity and a main source of support all at once. Practical changes, such as living alone or managing finances, can add pressure.
- Loss of a parent: this can reshape your sense of who you are, particularly if your relationship was very close or conflicted. Grief after losing a parent can also resurface years later, for example, when you have your own child or reach the age your parent died.
- Disenfranchised grief: grief that society does not openly acknowledge or support, such as the loss of an ex-partner, a pet, a miscarriage, or a relationship others did not know about. Without validation, people often grieve alone.
- Ambiguous loss: loss without clear closure, such as a missing person or someone with dementia who is physically present but changed. The absence of a funeral or a clear ending can leave grief unresolved.
- Anticipatory grief: grief felt before a death, for example while caring for someone with a terminal illness. It can be painful and exhausting, although it does not always make grief after the death easier.
Complicated Grief vs Depression vs PTSD vs Anxiety
Complicated grief overlaps with depression, post-traumatic stress disorder and anxiety, and the conditions can occur together. The main difference is the focus: in complicated grief, the longing and preoccupation centre on the person who died, while depression involves a more general low mood and loss of interest, and PTSD centres on fear related to a traumatic event.
Complicated grief | Depression | PTSD | |
Central feature | Intense yearning for the person who died | Persistent low mood, loss of interest in most things | Re-experiencing, fear, and hypervigilance after a traumatic event |
Typical thoughts | Missing them, replaying the loss, guilt | Worthlessness, hopelessness about everything | Danger, threat, reliving the event |
Self-esteem | Often intact | Often reduced | Varies |
Mood pattern | Pangs triggered by reminders | Low most of the day | Triggered by trauma cues |
Can occur together? | Yes, with each other and with anxiety | Yes | Yes |
Grief and depression can look similar, particularly when sadness is deep, and sleep or appetite is disrupted. Grief and anxiety can also coincide, for example,e when losing someone triggers constant worry about losing others. A GP or psychologist can help separate these, which matters because it changes the treatment. For example, antidepressants can help with co-occurring depression, but they do not treat prolonged grief itself.
Complicated Grief in Children and Teens
Children and teenagers grieve differently from adults. They tend to move in and out of grief in short bursts, may show it through behaviour rather than words, and can look fine one moment and distressed the next. That is normal and not a sign they do not care.
Diagnostic criteria use a shorter timeframe for younger people, at least 6 months after the death, and in children the preoccupation may focus on the circumstances of the death rather than the person. Signs that a child or teen may need extra support include:
- Ongoing distress, clinginess, or fear of separation
- Regression, such as bedwetting or baby talk
- Falling behind or avoiding school
- Withdrawing from friends, or sudden irritability and anger
- Persistent worry that they or others will die
- Talk of wanting to join the person who died
A GP can discuss a referral to a psychologist experienced in child and adolescent grief. Kids Helpline (1800 55 1800) offers free support for young people, and many schools have wellbeing staff who can help.
Is Complicated Grief a Mental Illness?
Grief itself is never a mental illness. It is a natural response to loss. Prolonged grief disorder, however, is a recognised mental health condition in both DSM-5-TR and ICD-11, diagnosed only when grief is intense, persistent, and disabling. Having it says nothing about your strength or how much you loved the person.
The inclusion of prolonged grief disorder in the diagnostic manuals has been debated, with some worried about turning normal grief into a disorder. That is why the criteria include waiting periods and require clear impairment. For the people who do meet them, a diagnosis can be a relief: it explains why grief feels so stuck and opens the door to treatment that works.
Complicated Grief Treatment: What Works?
Complicated grief is treated mainly with grief-focused psychotherapy. The best-studied approach, prolonged grief disorder therapy, is a structured program of about 16 sessions. In a large trial, more than 8 in 10 people who received it were rated much or very much improved, and it outperformed both medication alone and placebo.
Does grief therapy work?
For people with prolonged grief disorder, targeted grief therapy works well. In the largest randomised trial to date, 395 adults with complicated grief were assigned to citalopram, placebo, grief therapy plus citalopram, or grief therapy plus placebo. Both groups that received grief therapy did best, with response rates around 83 percent. Research reviews also suggest that most people who are grieving normally do not need formal therapy, which is why treatment is aimed at those whose grief has become stuck.
Complicated grief therapy techniques
A trained clinician tailors treatment to you, but evidence-based grief therapy commonly includes:
- Understanding grief: learning how grief works and what keeps it stuck
- Grief monitoring: tracking your grief over time to see patterns and progress
- Revisiting the story of the death: telling it in detail in a safe setting, so it becomes less overwhelming
- Gradually approaching avoided reminders: places, photos, or activities you have been steering away from
- Memory work: including exercises that help you reconnect with positive memories and feel a continuing bond with the person
- Working on thoughts: such as guilt, self-blame, I should have” thinking. Rebuilding life goals: reconnecting with relationships, meaning and plans for the future, without leaving the person behind
- Behavioural activation: slowly returning to valued activities
Cognitive behavioural therapy approaches adapted for prolonged grief use many of the same ingredients.
Can medication help with complicated grief?
No medication is approved specifically to treat prolonged grief disorder. In the major trial mentioned above, the antidepressant citalopram did not improve grief symptoms more than placebo. However, when combined with grief therapy, it reduced depressive symptoms in people who also had depression. Medication may be considered if you have co-occurring depression or anxiety, and that is a decision to make with your GP or psychiatrist.
Group support and peer support
Grief support groups in Australia can help people feel less alone. Griefline and Red Nose both run support groups, and some local community services do too. Groups can be especially helpful for specific losses, such as suicide or the death of a child or a partner. They work well alongside therapy and can be a good first step, although they are not a substitute for treatment when grief is severe and disabling.
How Do I Get Help for Grief in Australia?
For complicated grief treatment in Australia, the usual starting point is a GP, who can assess how you are going, rule out other causes such as depression, and discuss referral to a psychologist or other grief specialist. You can also reach out directly to free services, with no referral needed.
Step 1: See your GP
Tell your GP about the loss, how long ago it happened, and how it is affecting your sleep, work and relationships. They may use a short questionnaire and, where appropriate, prepare a Mental Health Treatment Plan. Since 1 November 2025, Better Access Medicare rebates require the plan and referral to come from a GP at the practice where you are enrolled in MyMedicare, or your usual GP.
Step 2: Is grief counselling covered by Medicare?
Medicare rebates apply to sessions with eligible providers under the Better Access initiative, which include psychologists, as well as accredited mental health social workers and occupational therapists. With a Mental Health Treatment Plan, you can claim up to 10 individual sessions each calendar year. Current rebates are $149.05 per session with a clinical psychologist and $101.55 with a registered psychologist, and many practices charge more than the rebate, leaving a gap. Counselling with providers who are not eligible under Better Access does not attract a Medicare rebate, although private health insurance extras may cover some of it. If you see a psychologist often, the Medicare Safety Net can lift rebates once your out-of-pocket costs reach a threshold.
Your GP decides whether a Mental Health Treatment Plan is appropriate based on your symptoms. A formal grief diagnosis is not the only way in. Many people are assessed because of depression, anxiety, or prolonged grief symptoms.
Step 3: Choosing a psychologist for grief
When looking for a psychologist for grief or a grief counsellor near you, it helps to ask:
- Do you have experience treating prolonged or complicated grief?
- What approach do you use, and is it evidence-based (for example,prolonged grief disorder therapy or grief-focused CBT)?
- Do you offer telehealth, and is it Medicare-rebated for me?
- What is your fee, and how much will I pay after the rebate?
Psychologists are registered with the Australian Health Practitioner Regulation Agency (AHPRA), and you can check registration on the public register. Counsellors are not registered with AHPRA, so look for membership of a professional body such as PACFA or the Australian Counselling Association.
Online grief counselling in Australia
Many psychologists offer secure video sessions, which can make it easier to get specialised grief care if you live regionally, have limited mobility, or find leaving the house hard. Research on telehealth psychology generally shows it can work well for many conditions, although what suits you is a personal choice.
Free grief support in Australia
- Griefline (1300 845 745): free national grief and loss helpline for adults, run largely by trained volunteers, with online resources and support groups. Check the Griefline website for current hours.
- Medicare Mental Health Centres and phone line (1800 595 212): free mental health support with no referral or appointment needed at walk-in centres, plus phone support to help you find services.
- Red Nose Grief and Loss (1300 308 307): free 24/7 support for anyone affected by the death of a baby or child, including pregnancy loss and stillbirth.
- Lifeline (13 11 14): 24/7 crisis support and suicide prevention.
- Kids Helpline (1800 55 1800): free support for children and young people.
For grief support after a sudden death in Australia, ask your GP, hospital social worker or the relevant services about specialist programs, since some states and organisations run services for people bereaved by suicide, road trauma, or homicide.
Grief and Bereavement Leave in Australia
Under the National Employment Standards, all employees are entitled to two days of compassionate (bereavement) leave each time an immediate family or household member dies or has a life-threatening illness or injury. It is paid for full-time and part-time employees and unpaid for casual employees. Your award or agreement may offer more.
Two days is a minimum, and many people need longer. If your grief is affecting your health or your ability to work, talk to your GP. You may be able to use sick leave for a health condition, and your employer may agree to extra annual leave, unpaid leave or flexible work.
How to Cope With Prolonged Grief Day to Day
These strategies can sit alongside professional support. They are not a substitute for treatment, but they can make daily life more manageable.
- Let grief come in doses. Give yourself time to feel it, and permission to take breaks. Both are healthy.
- Keep a basic routine. Regular sleep, meals, and some movement support your body while your mind is under strain.
- Plan for hard dates. Decide in advance how you want to spend anniversaries, birthdays, a, nd holidays, and who you would like with you.
- Keep a connection. Talking about the person, writing them a letter, looking at photos,s or creating a ritual can help you feel connected rather than cut off.
- Gently approach what you have been avoiding. A little at a time, ideally with support, can reduce its power.
- Watch alcohol and other numbing habits. They can offer short-term relief but often prolong grief.
- Reach out. Tell one trusted person how you are really going.
- Be wary of “just move on” advice. Moving forward does not mean leaving the person behind.
How to Support Someone With Complicated Grief
If someone you love is stuck in grief, the most helpful thing is steady, patient presence rather than solutions.
- Say the person’s name, and ask about them. Most grieving people want to talk about the person who died.
- Keep checking in after the first few months, when other support tends to fade.
- Offer practical help, such as meals, lifts, or company on difficult dates.
- Avoid comments like “they are in a better place,” “at least…” or “you should be over it by now.”
- Gently encourage them to see a GP if grief is not easing, and offer to help make the call or go along.
- Take any talk of wanting to die or join the person who died seriously, and encourage immediate support.
When Should You See a GP or Psychologist About Grief?
Consider seeing a GP or psychologist if you notice any of the following:
- Your grief is not easing, or is getting worse, many months after the loss
- You are unable to function at work, home, or in relationships
- You feel numb, empty, or that life has no meaning
- You are avoiding anything connected to the person to the point that it limits your life
- You are using alcohol or drugs to cope
- You feel overwhelming guilt or blame
- Grief is mixed with panic, flashbacks, or deep low mood
- You have thoughts of ending your life, or of wanting to be with the person who died
You do not need to wait for a particular anniversary or a diagnosis to ask for help. If you are unsure whether your grief is complicated, a GP or psychologist can help you work that out.
Frequently Asked Questions
What is the difference between normal grief and complicated grief?
Normal grief is painful but gradually becomes more manageable, with moments of relief. Complicated grief stays intense and constant, with persistent yearning, and keeps interfering with daily life. The difference lies in intensity, persistence, and impact, not in how much you loved or miss the person.
How long does grief last before it’s considered complicated?
There is no cutoff for grief itself. Diagnostic criteria consider prolonged grief disorder at 6 months after the loss under ICD-11, or 12 months for adults (6 months for children) under DSM-5-TR, but only when intense symptoms nearly every day significantly affect your life.
Is it normal to still grieve after 5 years?
Yes, it can be. Many people still feel waves of sadness years later, particularly around anniversaries, and this is not necessarily a disorder. If your grief remains as intense as ever and still stops you from functioning, speak to a GP or psychologist.
Can grief hit years later, such as after losing a parent?
Yes. Delayed grief and anniversary reactions can bring intense feelings years after a death, often triggered by life events such as becoming a parent yourself, a health scare, or reaching an age your parent never did. Late grief is common and treatable.
What causes complicated grief?
It usually develops from a combination of factors, including a sudden or traumatic loss, a very close relationship, earlier losses or mental health history, little support, and patterns such as avoidance, rumination, and self-blame.No single cause explains it, and it is no one’s fault.
Can grief get worse over time?
Yes. Once initial shock and numbness fade, the reality of the loss can hit harder. Anniversaries, secondary loss, and reduced support can also intensify grief. Grief that steadily worsens or never eases is a good reason to seek professional support.
How is complicated grief treated?
Mainly with grief-focused therapy, such as prolonged grief disorder therapy, which usually runs for about 16 sessions, or grief-focused CBT. Medication does not treat prolonged grief itself, but may help co-occurring depression or anxiety.
Is grief counselling covered by Medicare?
Medicare rebates apply to sessions with eligible providers, such as psychologists, under Better Access, with a Mental Health Treatment Plan from your GP covering up to 10 individual sessions a year. Counselling with providers who are not eligible does not attract a rebate.
How do I get a referral to a psychologist for grief?
Book a GP appointment and explain how your grief is affecting you. Your GP can assess you and, if appropriate, prepare a Mental Health Treatment Plan and refer you to a psychologist. Since 1 November 20,25 this must be done by a GP at your MyMedicare practice or your usual GP.
Can I get free grief counselling in Australia?
Yes. Griefline offers a free national helpline, Medicare Mental Health Centres provide free walk-in support, and Red Nose offers free support after the death of a baby or child. These services can support you directly, or help you find longer-term care.
If You Need Support Right Now
If you or someone you know is in immediate danger, call 000. For 24-hour crisis support, contact Lifeline on 13 11 14 or the Suicide Call Back Service on 1300 659 467. For grief support, call Griefline on 1300 845 745. For support after the death of a baby or child, call Red Nose Grief and Loss on 1300 308 307.
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