The Holidays After a Loss: When Grief Needs More Support

Thanksgiving starts a stretch of the year that is built around gatherings, and after a death those gatherings can make the absence hard to miss. The recipe nobody else knows how to make, the call that no longer comes, the seat at the table that someone else now fills. If the loss feels louder in November and December, that by itself does not mean anything is wrong with you.

Most grief softens, even when it still hurts

The American Psychiatric Association (APA) says most people's grief eases over time, and that most grief does not require mental health treatment. Easing is not the same as ending. A song on the radio or an old photo can still bring tears long after a loss, and that is part of having loved someone.

When grief stays stuck

For a small group of people, the APA explains, the symptoms stay severe and disabling. The DSM-5-TR uses the name prolonged grief disorder for intense, persistent grief that causes problems and interferes with daily life, and a qualified clinician is the one who makes that diagnosis.

In plain words, the APA describes eight symptoms:

• Feeling as if part of you died along with the person
• Marked disbelief that the death really happened
• Staying away from reminders that the person is gone
• Intense emotional pain, such as anger, bitterness or sorrow
• Trouble getting back to friends, interests or plans for the future
• Emotional numbness
• A sense that life has no meaning without the person
• Deep loneliness

For an adult, the APA's time frame is a death at least one year earlier, with three or more of these symptoms nearly every day for at least the last month, and grief that runs longer than the person's social, cultural or religious community would predict. By the APA's estimate, between 4% and 15% of bereaved adults have persistent symptoms.

The one-year mark is not a waiting period

That year belongs to the definition of the disorder. It is not a rule about when support is allowed. If grief is keeping you from sleep, from work or from the people still in your life, asking for help three months or eight months after a death is reasonable, and counseling does not require a diagnosis first.

Who may need a closer look

The APA lists risk factors on two sides. Some belong to the death itself: a sudden, unnatural or violent cause, a death in an intensive care unit rather than at home, or the loss of a child, spouse or partner. Others belong to the person grieving, such as older age, female sex, an anxious attachment style, lower socioeconomic status, a history of depression, very high grief even before the death, being emotionally dependent on the person who died and having little social support.

Getting through the gatherings

• Choose ahead of time which traditions to keep this year, and tell one person you trust what you decided.
• Give yourself an exit, such as driving your own car so you can leave early.
• Plan a small way to remember the person, such as a toast, a photo on the table or their favorite dish, if that feels right.
• Keep sleep, regular meals and a short walk on the calendar, even on the heavy days.
• Spend time with people who understand. The APA says bereavement support groups and peer support reduce isolation and give people social connection.

What treatment can look like

The APA says evidence-based treatments exist. Approaches built on cognitive behavioral therapy (CBT) reduce symptoms, and prolonged grief therapy centers on accepting the loss and rebuilding a life without the person. The APA also mentions narrative disclosure and approaches that target avoidance, and it notes that online programs where mourners write notes to the person who died have helped. CBT can also address insomnia that comes along with grief.

According to the APA, no medication currently treats grief symptoms specifically, and research is underway. Your provider also checks for depression and sleep problems, which are treated in their own right. If depression turns out to be part of the picture, medication may be an option when indicated, and that choice is one you and your provider make together.

If grief brings thoughts of suicide

The APA associates thoughts of suicide with more severe prolonged grief. Please do not wait for a scheduled visit if those thoughts show up.

Care at Hope Behavioral Medicine

We see adults for prolonged grief in person in West Ashley and by secure video anywhere in South Carolina, which can help when leaving the house feels like too much. Our counseling is individual talk therapy, and your provider can coordinate a referral to a grief-specific program when that is a better match. Hope Behavioral Medicine is not an emergency service. Request an appointment.

Sources: American Psychiatric Association, Prolonged Grief Disorder (updated August 2025); American Psychiatric Association, DSM-5-TR (prolonged grief disorder).

This article is general information, not medical advice, and does not create a patient–provider relationship. Every situation is different, so see a provider who can evaluate yours and develop a plan of care. Any medication discussed here may not be right for you: the right choice depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. If you are ever in doubt about an emergency, call 911 or go to the nearest emergency room.