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  • Writer's picturePia Singh

Inside the Brain of a person living with Prolonged Grief Disorder

Prolonged Grief Disorder (PGD), also known as persistent complex bereavement disorder, is a profound and enduring response to the loss of a loved one that transcends the expected mourning period. Beyond its emotional and psychological impact, PGD leaves an indelible mark on the intricate neural pathways of the brain. In this exploration, we embark on a journey into the neurological dynamics of individuals living with Prolonged Grief Disorder, unraveling the nuanced interplay of altered brain regions and neurobiological responses that define this complex and challenging grief experience.

Amygdala: The Emotional Sentinel At the heart of the neural response to grief lies the amygdala, a pair of almond-shaped structures deep within the brain. The amygdala is a central hub for processing emotions, particularly those associated with fear, sadness, and loss. In individuals with PGD, the amygdala often exhibits heightened reactivity, contributing to the intensity of emotional responses to grief-related stimuli. This heightened emotional sensitivity can prolong the grieving process and contribute to the enduring nature of the disorder.

Prefrontal Cortex: The Executive Decision-Maker The prefrontal cortex, situated at the front of the brain, is responsible for executive functions such as decision-making, impulse control, and emotional regulation. In individuals with PGD, the prefrontal cortex may show alterations in function, particularly in the dorsolateral prefrontal cortex (dlPFC). This can result in difficulties in regulating emotions, making sound decisions, and adapting to the profound changes brought about by the loss.

Hippocampus: Memory and Grief Processing The hippocampus, a seahorse-shaped structure nestled within the brain, plays a crucial role in memory formation and contextual understanding. In individuals with PGD, the hippocampus is intricately involved in the encoding and processing of grief-related memories. While structural changes in the hippocampus are not as prominent as in some other disorders, alterations in its function may contribute to difficulties in integrating and contextualizing memories of the deceased, prolonging the grieving process.

Neurotransmitters: Chemical Messengers of Grief Neurotransmitters, the brain's chemical messengers, play a pivotal role in regulating mood and emotional responses. In individuals with PGD, imbalances in neurotransmitters such as serotonin and dopamine may contribute to mood dysregulation and symptoms like depression and anhedonia. The disrupted balance of these neurotransmitters further complicates the emotional landscape of individuals with prolonged grief.

The HPA Axis: Dysregulation of the Stress Response The Hypothalamic-Pituitary-Adrenal (HPA) axis, a complex hormonal system, regulates the body's stress response. In individuals with PGD, the HPA axis may become dysregulated, leading to abnormal cortisol levels. Chronic exposure to grief-related stress can result in alterations in cortisol secretion, impacting overall stress adaptation, sleep patterns, and contributing to the physical and emotional toll of prolonged grief.

Neuroinflammation: The Silent Storm Emerging research suggests a link between prolonged grief and neuroinflammation, an immune system response within the brain. Chronic exposure to grief-related stress may trigger a persistent state of inflammation, impacting neural function and contributing to the cognitive and emotional symptoms associated with PGD.

Neuroplasticity: Adapting to Prolonged Loss Neuroplasticity, the brain's ability to adapt and reorganize itself, is a central theme in prolonged grief. The brain undergoes adaptive changes in response to the enduring stress of loss, shaping the neural circuits that govern emotional responses and coping mechanisms. While neuroplasticity can facilitate adaptation, maladaptive changes may occur if grief-related stress persists, contributing to the complexity of PGD symptoms.

Impact on Daily Life: Navigating the Enduring Loss Individuals with PGD often experience persistent and intense emotional pain related to the loss. Grief-related emotions such as sadness, longing, and despair may persist, impacting overall mood and well-being.


Prolonged grief can interfere with daily functioning, making it challenging for individuals to engage in activities, make decisions, and maintain a sense of normalcy in their lives.


Grief-related distress can lead to social withdrawal, as individuals may find it difficult to connect with others or engage in social activities. The isolation can exacerbate the sense of loneliness and despair.


Prolonged grief can manifest in physical symptoms such as fatigue, insomnia, and changes in appetite. The somatic impact of grief further contributes to the overall burden of the disorder.


Treatment Approaches: Nurturing Healing in Prolonged Grief

Psychotherapeutic approaches, such as grief-focused cognitive-behavioral therapy (CBT) and meaning reconstruction, are crucial in treating PGD. These therapies focus on helping individuals process and integrate their grief, develop coping strategies, and find meaning in the face of loss.


Psychotropic medications, including antidepressants, may be prescribed to alleviate specific symptoms of PGD, such as depression and anxiety. Medication is often used in conjunction with psychotherapy for comprehensive treatment.


Participating in grief support groups or bereavement counseling provides individuals with a sense of community and understanding. Sharing experiences with others who have faced similar losses can be a valuable component of the healing process.


Incorporating mindfulness-based interventions and self-compassion practices can help individuals with PGD manage their emotional distress. Mindfulness meditation and self-compassion exercises promote present-moment awareness and emotional regulation.

The neural landscape of individuals living with Prolonged Grief Disorder is marked by the intricate interplay of altered brain regions, heightened emotional responses, and the adaptive changes of neuroplasticity in response to enduring loss. Understanding the neurobiology of PGD provides valuable insights into the challenges faced by those navigating the complexities of grief that extends beyond the expected mourning period. As we unravel the neural dynamics of PGD, the journey towards effective interventions becomes not only a scientific endeavor but a compassionate mission to support and empower individuals on the path to healing and resilience.

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