Not everyone is able to cope with grief well and begin rebuilding a life. Sometimes the feelings of hurt, loneliness, and guilt are so overwhelming that they become the focus of the survivor’s life to such

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an extent that there is never any closure and the grief continues to interfere indefinitely with one’s ability to function. When this occurs, individu­als are viewed as having prolonged grief disorder, which is distinguished from depression and from normal grief (Boelen & Prigerson, 2007). What distinguishes prolonged grief is (a) symptoms of separation distress such as preoccupation with the deceased to the point that it interferes with everyday functioning, upsetting memories of the deceased, longing and searching for the deceased, and isola­tion following the loss; and (b) symptoms of trau­matic distress such as feeling disbelief about the death, mistrust, anger, and detachment from others as a result of the death, feeling shocked by the death, and the experience of physical presence of the deceased (Boelen & Prigerson, 2007; Prigerson & J acobs, 2001).

Two common manifestations of prolonged grief are excessive guilt and self-blame (Anderson, 1997). In some people, guilt results in a disruption of everyday routines and a diminished ability to function. People begin to make judgment errors, may reach a state of agitated depression, may expe­rience problems sleeping or eating, and may have intense recurring thoughts about the deceased per­son. Many of these individuals either seek profes­sional help voluntarily or are referred by concerned family members or friends.

Identifying traumatic grief is not always easy because cultural variations in the process of grief must be respected (Anderson, 1997). Nevertheless, there is some evidence that compared to European Americans, African Americans have a higher rate of prolonged grief (Goldsmith et al., 2008). Length of time after the loss is not a good indicator, as grief can still be quite strong 10 years after a loss (Derman, 2000). Prigerson and Jacobs (2001) report that the criteria listed earlier for prolonged grief can be used successfully to differentiate the typical grief of bereaved people, even when they are depressed, from prolonged grief.