Grieving is a natural and deeply human process that follows the loss of someone or something meaningful. However, not all grief unfolds in a healthy way. In some cases, the emotional pain becomes so intense, prolonged, or disruptive that it turns into what psychologists refer to as a pathological duel, also known as complicated grief or prolonged grief disorder.
This type of grief goes beyond what is considered a normal grieving process. It can interfere with a person’s ability to function, maintain relationships, and find meaning in life. In this article, we will explore what pathological duel is, how it manifests, the symptoms to look out for, how long it lasts, and what treatment options are available.
A pathological duel is a form of dysfunctional mourning in which the person experiences persistent, intense emotional pain long after the typical grieving period has passed. It differs from healthy grief because it doesn’t gradually diminish with time or support. Instead, it can worsen or remain stuck, trapping the individual in a cycle of despair, guilt, and isolation.
This condition is recognized in psychology under terms such as Complicated Grief (CG) or Prolonged Grief Disorder (PGD), and it is now included in diagnostic systems like the DSM-5-TR and the ICD-11.
Why Does Grief Become Pathological?
Several factors can contribute to the development of pathological grief, including:
Sudden or traumatic loss (e.g., accidents, suicide, murder)
Loss of a child or partner, which often produces a deeper emotional rupture
Unresolved issues with the deceased person
Lack of support system
Previous mental health disorders (depression, anxiety, PTSD)
History of childhood trauma or attachment issues
While grief is a personal and nonlinear process, when it becomes chronically overwhelming and prevents reintegration into life, it may be considered pathological.
Symptoms of Pathological Duel
The symptoms of pathological duel are intense, persistent, and emotionally crippling. Unlike normal grief, which ebbs and flows, pathological grief tends to persist and worsen over time without treatment.
Here are the most common and clinically recognized symptoms:
Persistent Yearning and Preoccupation with the Deceased
The person constantly thinks about or longs for the lost loved one, often unable to focus on other areas of life. This yearning dominates their emotional life.
Avoidance of Reminders
They may actively avoid places, people, or objects that remind them of the deceased, fearing the pain it evokes. Alternatively, they might cling excessively to mementos or refuse to change anything in the home.
Emotional Numbness or Detachment
Many individuals feel disconnected from others, emotionally numb, or unable to experience joy. This numbness is a way of self-protection but also a symptom of unresolved grief.
Intense Sadness, Despair, or Hopelessness
Unlike normal sadness that lessens over time, the sadness in pathological grief is profound and unrelenting, often leading to feelings of hopelessness or worthlessness.
Guilt and Self-Blame
People may obsess over what they could have done differently or blame themselves for the death. This can lead to crippling guilt, especially in sudden or preventable losses.
Desire to Die or Be Reunited
Some individuals may express suicidal thoughts, not necessarily because they want to end their lives, but because they feel the only relief would come from being reunited with the deceased.
Social Withdrawal
They may stop engaging in social activities, isolate themselves, or withdraw from relationships that were once meaningful.
Physical Symptoms
Grief can also manifest physically, with symptoms such as:
Insomnia or hypersomnia
Fatigue
Appetite changes
Weakened immune response
Headaches or body aches
These symptoms often persist well beyond the typical acute mourning phase and begin to interfere with daily life, work, and health.
How Long Does Pathological Duel Last?
There is no one-size-fits-all timeline for grief. Normal grief can last months or even years depending on the person, the relationship, and the nature of the loss. However, when symptoms remain intense and unchanged for more than 6 to 12 months, mental health professionals begin to consider a diagnosis of pathological duel.
According to the DSM-5-TR, the diagnostic criteria for Prolonged Grief Disorder require that symptoms persist for at least 12 months in adults (6 months in children) and are accompanied by clinically significant distress or functional impairment.
However, some people may continue to suffer from pathological grief for many years without treatment. It becomes a kind of emotional stasis, in which the bereaved person feels unable or unwilling to move forward.
Differences Between Normal Grief and Pathological Grief
Not everyone who experiences a deep loss will develop complicated grief. However, certain factors can increase vulnerability:
Sudden, violent, or unexpected loss
Lack of opportunity to say goodbye
Poor coping strategies
Multiple recent losses
Pre-existing depression or anxiety
Insecure attachment style
Lack of social or spiritual support
Understanding these risk factors can help identify who may need early intervention and more intensive grief counseling.
How Is Pathological Duel Treated?
Treatment for pathological grief aims to process the pain, restructure the loss, and help the individual reconnect with life in a meaningful way. The following therapeutic approaches are most commonly used:
1. Complicated Grief Therapy (CGT)
CGT is a targeted form of psychotherapy specifically developed to treat prolonged grief disorder. It combines elements of cognitive-behavioral therapy (CBT) with attachment theory and has been shown to be effective in clinical trials.
2. Cognitive Behavioral Therapy (CBT)
CBT helps individuals identify and challenge unhelpful thought patterns, such as guilt, self-blame, or catastrophic thinking. It also promotes behavioral activation to re-engage with life.
3. Eye Movement Desensitization and Reprocessing (EMDR)
Originally developed for trauma, EMDR is increasingly used to treat grief that involves traumatic memories or unresolved emotions.
4. Medication
While there is no medication specifically for pathological grief, antidepressants may be prescribed to manage co-occurring depression or anxiety. However, medication alone is usually not sufficient.
5. Group Therapy and Support Groups
Being around others who are grieving can offer validation, connection, and emotional safety. Many people find group therapy to be an essential part of their healing.
6. Mindfulness and Compassion-Based Therapies
These therapies help clients tolerate painful emotions without judgment and develop self-compassion, which is often lacking in those with pathological grief.
Can Pathological Duel Be Prevented?
While not all cases can be prevented, early intervention, social support, and open conversations about grief can mitigate the risk. When someone experiences a major loss, friends and family should encourage open dialogue and monitor for signs of persistent distress.
Encouraging professional help early on—especially in high-risk situations—can prevent the grief from becoming embedded and resistant to change.
FAQs About Pathological Duel: What Is, Symptoms and How Long Does
How do I know if my grief is pathological?
If your grief is still as intense after 6 to 12 months as it was at the beginning—and it’s interfering with your ability to function, feel joy, or maintain relationships—you may be experiencing pathological duel. A mental health professional can assess your symptoms and recommend treatment.
Can you recover from pathological grief?
Yes. With proper treatment—such as Complicated Grief Therapy, CBT, or support groups—many individuals can find relief, gain insight, and return to a fulfilling life. The grief may never disappear completely, but its grip can be loosened.
Is pathological duel a mental illness?
Yes, it is now recognized as a mental health disorder under terms like Prolonged Grief Disorder (PGD). It is distinct from depression or PTSD, though it can co-occur with those conditions.
Are certain losses more likely to lead to pathological grief?
Yes. The loss of a child, spouse, or sudden death tends to increase the risk. Deaths involving violence, suicide, or unresolved conflict with the deceased also carry a higher likelihood of complicated grief.
How long does it take to treat pathological duel?
The length of treatment varies, but 12 to 20 weeks of targeted therapy can be effective for many people. Those with complex trauma or co-occurring conditions may require longer-term therapy.
Should I use medication for pathological grief?
Medication may help manage symptoms of depression or anxiety, but it is not a cure for grief. The emotional work of therapy is essential for true healing.
Can children experience pathological grief?
Yes. Children and adolescents can also develop complicated grief, though it may present differently. Professional evaluation is critical, especially if they withdraw, regress developmentally, or exhibit behavioral issues.
This article is merely informative, in Psychology-online we have no power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
If you want to read more articles similar to Pathological duel: what is, symptoms and how long it lasts we recommend that you enter our category of clinical psychology.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition). Arlington: Pan -American Medical Editorial.
Echeburúa, E., Herrán Boix, A. (2007). When is the duel and how do you have to treat it? Magazine Analysis and Modification of Behavior, 33 (147), 31-50.
Levy Yeyati, E. (2022). Prolonged duel disorder: a new diagnosis in the DSM-5Tr. VERTEX ARGENTINE MAGAZINE OF PSYCHIATRY, 33 (156), 50-54.
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This article has been reviewed by our editorial team at PsychologyFor to ensure accuracy, clarity, and adherence to evidence-based research. The content is for educational purposes only and is not a substitute for professional mental health advice.
