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Prolonged Grief Disorder in Vancouver: When Grief Doesn’t Fade With Time — and What Actually Helps

If someone you love has died and the pain feels exactly as sharp as it did in the first week — months or even a year later — you are not failing at grief. You may be experiencing prolonged grief disorder (PGD), a condition that the American Psychiatric Association formally added to the DSM-5-TR in 2022. It is not depression, it is not “normal sadness that just needs more time,” and it responds to a specific form of therapy that standard antidepressants alone do not replace. Across fourteen countries, research finds that roughly 9.8 percent of bereaved adults develop PGD after a non-violent loss — and the rate climbs to nearly 50 percent when the death was sudden or violent, such as a car accident or a crime (Djelantik et al., 2024). In Vancouver and across British Columbia, counselling for prolonged grief is available now, covered by most extended health plans — and Samuel Ezzatilord, PhD, RCC, CCC, LMCC has over 25 years of clinical experience with trauma and bereavement.

What Is Prolonged Grief Disorder — and How Is It Different From Normal Grief?

Grief after the death of someone close is not a disorder. It is a universal human experience — painful, disorienting, sometimes physically exhausting — and it does not follow a tidy timeline. There is no “right” way to grieve and no deadline by which you should feel “better.”

But prolonged grief disorder is a distinct clinical pattern. The DSM-5-TR defines it as the persistence of intense, disabling grief for at least twelve months after the death of someone close (the ICD-11 uses a six-month threshold). The key features are:

Intense yearning or longing for the person who died — not a memory that visits and leaves, but a pull that dominates most of the day, most days.
Preoccupation with the deceased — intrusive thoughts, images or memories that make it difficult to focus on anything else.
Identity disruption — feeling that a meaningful part of yourself died with the person.
Marked difficulty re-engaging with ongoing life — relationships, work, activities and goals feel pointless or emotionally unreachable.
Emotional numbness, disbelief or avoidance — not wanting to accept the reality of the loss, or avoiding anything that is a reminder.

The critical difference from depression: in PGD the suffering is anchored to the specific loss, not to a generalized sense of hopelessness. You may be perfectly capable of feeling happy about other things in a brief moment — and then the wave of longing crashes again. Standard depression treatment, including antidepressants alone, does not reliably resolve PGD (Shear et al., 2016).

Not sure whether what you’re feeling is prolonged grief, depression, or both? You do not need to diagnose yourself. Text or call Samuel directly at 604-721-0604 or WhatsApp — no receptionist, no intake forms. The first 20 minutes are free and completely confidential.

Who Is at Higher Risk for Prolonged Grief?

Losing anyone you love can lead to prolonged grief, but research identifies several factors that raise the risk significantly:

Sudden or violent death. When a loved one dies in a car accident, by homicide, or by suicide, the bereaved face a dramatically higher risk — a global review of 25 studies found a pooled PGD prevalence of 49 percent in these cases (Djelantik et al., 2024).
Losing a child or a partner. The closer the bond, the greater the risk.
Insufficient social support. Grief that is carried alone — whether because you have moved to a new country, or because your community discourages talking about loss — is grief that gets stuck more easily.
Immigration and distance. Immigrants who lose a parent or sibling in their home country face a layered grief: the loss itself, the impossibility of being present at the deathbed or funeral, and the guilt of having “chosen to leave.” Research on transnational bereavement shows that these factors compound standard grief into something more persistent and isolating (Nesteruk, 2018).
Previous mental health conditions. Pre-existing anxiety, depression, or prior trauma raise vulnerability.

In Vancouver’s diverse immigrant communities — including the large Iranian-Canadian community Samuel works closely with — these risk factors often overlap. The person may have lost a parent in Iran without being able to attend the funeral, may have no extended family nearby to share the mourning rituals, and may face cultural expectations to “be strong” and move on quickly.

What Does Prolonged Grief Feel Like From the Inside?

People experiencing PGD often describe:

“I know it has been a year, but it feels like yesterday. Nothing has changed inside me.”
“I go through the motions at work, but I am not really there. My mind is with them.”
“I feel angry at myself for being here, living my life, when they are gone.”
“Other people have moved on. They expect me to be over it. I just stopped talking about it.”
“I avoid their favourite restaurant, their music, even the neighbourhood they lived in. But then I also go through their photos for hours.”

If any of this sounds familiar, it does not mean you are broken. It means your brain’s grieving system has not completed a process that usually — with time and support — resolves on its own. With the right help, it can still complete.

You deserve support, and it is more accessible than you think. Samuel provides a free 20-minute phone consultation — no paperwork, no commitment, no receptionist. Fees and expenses are covered by ICBC, CVAP, FNHA, IFHP, RCMP, VAC, and most other insurers, and direct billing is available. Evenings and weekends available. جلسات به فارسی برگزار می‌شود.

What Treatment Actually Works for Prolonged Grief?

The most researched treatment for PGD is complicated grief treatment (CGT), a structured psychotherapy developed by Dr. M. Katherine Shear at Columbia University. In a landmark randomized controlled trial of 395 bereaved adults across four academic medical centres, CGT produced a response rate of 82.5 percent — compared to 54.8 percent for interpersonal psychotherapy (Shear et al., 2016, JAMA Psychiatry). The number needed to treat was 3.6, meaning that for roughly every four people who receive CGT, one additional person recovers who would not have recovered with standard talk therapy alone.

CGT works by helping you:

Revisit the loss — not to relive pain endlessly, but to gradually process the reality of the death in a way that your brain has been avoiding.
Rebuild connection to the living world — setting personal goals, re-engaging with activities and relationships, and learning to hold the memory of the person alongside a functioning present life.
Address guilt and regret — particularly the “if only” thoughts that keep grief trapped in a loop.
Integrate the loss into your life story — not forgetting the person, but finding a way to carry them without being immobilized.

One important finding: adding an antidepressant (citalopram) to CGT did not improve grief outcomes — the response rate was virtually identical (83.7% vs. 82.5%). Medication alone was not significantly better than placebo for grief symptoms. However, when depression co-occurs with prolonged grief — which it does in roughly two-thirds of PGD cases — medication can help with the depressive symptoms specifically (Shear et al., 2016).

Samuel integrates elements of CGT with IFS (Internal Family Systems), EMDR-informed processing and neurofeedback, tailoring the approach to each person’s needs.

How Is Prolonged Grief Different From Depression and PTSD?

These conditions can co-occur, but they are distinct:

Prolonged grief disorder: The core is yearning for the specific person. You may function well in some areas but feel that life has lost its meaning without them.
Major depression: The core is pervasive low mood, loss of interest in nearly everything, and feelings of worthlessness that are not exclusively tied to the loss.
PTSD: The core is reliving a traumatic event — flashbacks, nightmares, hypervigilance. When the death itself was violent (a car accident, for example), PTSD and PGD often overlap.

Getting the right diagnosis matters because the treatments differ. Antidepressants can help depression; prolonged exposure helps PTSD; CGT targets grief specifically. Samuel’s initial assessment distinguishes these patterns so treatment addresses what is actually keeping you stuck.

Prolonged Grief and Immigration: When Distance Makes Loss Harder

For immigrants in Vancouver, grief carries an additional dimension that research calls transnational bereavement. Dr. Iryna Nesteruk’s research on immigrant families found that geographic distance, visa restrictions and financial constraints often prevent bereaved immigrants from attending funerals, performing culturally meaningful mourning rituals, or being present during a loved one’s final days (Nesteruk, 2018, Family Process).

The result is a compounded grief: the loss itself, plus the loss of the chance to say goodbye, plus survivor guilt about having emigrated. A 2026 study on Turkish migrants in Germany found that those experiencing migratory grief — the ongoing sense of loss associated with leaving the homeland — were significantly more likely to develop prolonged grief disorder after a bereavement (Arat et al., 2026, European Journal of Psychotraumatology).

Samuel understands this layered grief as both a clinician and an Iranian-Canadian who works in Farsi and English. The cultural context — the concept of عزاداری (azadari), the community expectations around mourning, the pressure to be strong for the family — is not something you need to explain from scratch.

Frequently Asked Questions About Prolonged Grief Disorder

How long does grief normally last?

There is no fixed timeline. Most people find that the sharpest pain gradually softens over six to eighteen months, though waves of grief can return for years — and that is normal. What distinguishes prolonged grief disorder is not duration alone but the intensity and functional impairment: the yearning stays as strong as the first weeks, and it prevents you from re-engaging with your own life.

Can prolonged grief disorder develop even if the death was expected?

Yes. While sudden or violent death carries higher risk, PGD also develops after the death of someone with a long illness — especially when caregivers suppressed their own emotional needs during the illness and never processed the anticipatory grief.

Is it possible to have both prolonged grief and depression at the same time?

Very common — roughly two-thirds of people with PGD also meet criteria for major depression. The two conditions feed each other: grief blocks motivation and joy, while depression saps the energy needed to process the loss. Treatment addresses both, often simultaneously.

Will medication help with prolonged grief?

On its own, an antidepressant does not reliably resolve prolonged grief — the landmark JAMA Psychiatry trial found no significant difference between citalopram and placebo for grief symptoms specifically. However, when depression accompanies grief, medication can reduce the depressive symptoms and make grief-focused therapy more effective.

My family says I should be over it by now. Are they right?

No. Grief does not come with a socially acceptable expiration date, and the pressure to “move on” can actually make prolonged grief worse by forcing the bereaved person to suppress rather than process their feelings. If your grief is still interfering with your daily life after twelve months, the right response is not to push through harder — it is to get professional support.

Can neurofeedback help with grief?

Neurofeedback can help regulate the nervous-system dysregulation that often accompanies grief — the sleep disruption, the hyperarousal, the emotional flooding. Samuel uses it as a complement to grief-focused therapy, not a replacement. When the brain is calmer and sleep has improved, talk therapy tends to be more productive.

Does ICBC cover grief counselling if my loved one died in a car accident?

Yes. If an immediate family member died in a motor-vehicle crash, ICBC Part 7 accident benefits cover your counselling — you do not need to have been in the vehicle yourself. Samuel direct-bills ICBC so there is no out-of-pocket cost at the time of your session.

I live outside Vancouver — can I still work with Samuel?

Yes. Samuel provides secure video sessions across all of British Columbia. Many clients in grief prefer the privacy and convenience of online sessions, especially in the early weeks when leaving the house feels overwhelming.

How do I know when I am ready to start grief counselling?

There is no “too early” and no “too late.” Some people benefit from starting within weeks of the loss; others come years later when they realize the weight has not lifted. The only prerequisite is a willingness to talk about what happened — and even that develops gradually within the therapeutic relationship.

What if I feel guilty about starting to feel better?

This is one of the most common experiences in grief therapy. Feeling better can feel like a betrayal of the person you lost — as if moving forward means forgetting them. A core part of grief-focused therapy is helping you understand that healing does not mean erasing their importance. You can carry their memory and still live fully. The two are not in conflict.

Ready to talk? Call or text Samuel at 604-721-0604, message on WhatsApp, or book a free callback. The first 20 minutes are free — no receptionist, no intake forms, no commitment. Evenings and weekends available. جلسات به فارسی برگزار می‌شود.

Written with expert editorial assistance.

Sources

Djelantik, A. A. A. M. J., et al. (2024). Bereavement issues and prolonged grief disorder: A global perspective. Cambridge Prisms: Global Mental Health. doi:10.1017/gmh.2024.F401F072

Shear, M. K., et al. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685–694. doi:10.1001/jamapsychiatry.2016.0892

Prigerson, H. G., et al. (2024). Prolonged grief disorder: Detection, diagnosis, and approaches to intervention. World Psychiatry, 23(1). doi:10.1002/wps.21228

Nesteruk, O. (2018). Immigrants coping with transnational deaths and bereavement: The influence of migratory loss and anticipatory grief. Family Process, 57(4), 1012–1028. doi:10.1111/famp.12336

Hartog, I., et al. (2025). Bereavement and mental health factors associated with seeking and receiving support following loss among Canadian bereaved adults. Social Psychiatry and Psychiatric Epidemiology. PMID 41331147