Inventory of Complicated Grief (ICG): Items, scoring, and free template

Key takeaways

The Inventory of Complicated Grief is a validated 19-item self-report measure developed by Prigerson and colleagues in 1995.

Each item is rated 0 (never) to 4 (always), and the total is a straight sum ranging from 0 to 76.

No ICG item is reverse-scored, so a raw response of 4 always contributes 4 points to the total.

The measure has one validated cutoff, and a total of 25 or above signals clinically significant grief.

Pabau’s digital intake forms let practices send the ICG before the session, score it automatically, and flag high totals.

Complicated grief is prolonged, intense distress that lasts months or years after a death. It affects an estimated 7% to 10% of bereaved adults. Normal grief softens with time, while complicated grief keeps interfering with daily functioning, sleep, appetite, and emotional regulation. The mental health EHR systems practices use daily have made screening easier, but the measure itself has barely changed since 1995.

The Inventory of Complicated Grief (ICG) is a validated 19-item self-report measure. It helps therapists, grief counselors, and psychiatrists judge when a patient’s grief has crossed from normal bereavement into prolonged grief disorder (PGD). That condition is now formally recognized in the DSM-5-TR (code F43.81) and in ICD-11 (code 6B42).

This guide covers what the ICG measures and the exact wording of all 19 items. It then explains how to score and interpret the total, and how digital intake forms automate administration and flag referral thresholds.

What is the Inventory of Complicated Grief (ICG)?

The ICG is a 19-item self-report questionnaire developed by Prigerson and colleagues in 1995 to measure the severity of prolonged grief symptoms. Each item is rated on a five-point scale from 0 (never) to 4 (always).

The total is a straight sum of all 19 raw responses, so scores run from 0 to 76. A total of 25 or above indicates clinically significant complicated grief that warrants further evaluation and possible therapy.

The measure was designed for research. It is now a routine screening tool in psychology practice management settings, community mental health centers, grief counseling services, and palliative care teams. Clinicians usually read its items as two clusters. Separation distress covers yearning, longing, and difficulty accepting the death. Traumatic distress covers disbelief, avoidance, mistrust, and intrusive experiences tied to the loss.

Psychometric studies report strong internal consistency for the ICG (Cronbach’s alpha = 0.94) along with good discriminant validity. It separates complicated grief from major depressive disorder and from post-traumatic stress disorder. Both of those can co-occur with prolonged grief, but each is a clinically distinct condition.

How complicated grief differs from normal grief

Normal grief is a natural, adaptive response to loss. Bereaved people feel sadness, longing, intrusive memories, and difficulty concentrating, and those symptoms gradually lessen over weeks and months. By 6 to 12 months, most bereaved adults have resumed daily functioning. Sadness may still return on anniversaries or when something recalls the person who died.

Complicated grief stays intense beyond 12 months and interferes with work, relationships, and self-care. The DSM-5-TR defines prolonged grief disorder as yearning plus cognitive, emotional, or behavioral difficulty persisting at least 12 months after the death. The threshold is 6 months for children and adolescents. The World Health Organization’s ICD-11 classification aligns with that definition and treats PGD as a distinct condition.

• Normal grief: Sadness, yearning, and poor concentration at first, improving gradually over 6 to 12 months
• Complicated grief: Intense yearning and difficulty accepting the death past 12 months, with functional impairment and possible suicidal ideation
• Traumatic grief: Co-occurring PTSD symptoms such as hypervigilance, intrusive flashbacks about the death, and avoidance

The ICG quantifies where a patient sits on that spectrum, but the number is only half the assessment. Ask the qualitative questions alongside it. Can the patient work, hold relationships together, and look after themselves? Are they still ruminating about the death, or have they begun to integrate the loss? Do they have moments of meaning and pleasure, or does yearning fill every day?

Context matters just as much. A high score at six months post-loss does not establish PGD. Recency of the death, concurrent stressors, culture, and attachment style all shape the answers. That is why the ICG screens rather than diagnoses, and why clinical judgment stays central. Structured psychiatric evaluation frameworks can guide the differential assessment that follows a high total.

The 19 items and the response scale

Each of the 19 ICG items is a statement about the respondent’s experience since the death. Every item uses the same five-point scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often), and 4 (always). The list below follows the wording and order of the downloadable template above.

1. I think about this person so much that it’s hard for me to do things I normally do.
2. Memories of the person who died upset me.
3. I cannot accept the death of the person who died.
4. I feel myself longing for the person who died.
5. I feel drawn to places and things associated with the person who died.
6. I can’t help feeling angry about their death.
7. I feel disbelief over what happened.
8. I feel stunned or dazed over what happened.
9. Ever since they died, it is hard for me to trust people.
10. Ever since they died, I feel like I have lost the ability to care about other people or I feel distant from people I care about.
11. I have pain in the same area of my body or I have some of the same symptoms as the person who died.
12. I go out of my way to avoid reminders of the person who died.
13. I feel that life is empty without the person who died.
14. I hear the voice of the person who died speak to me.
15. I see the person who died stand before me.
16. I feel that it is unfair that I should live when this person died.
17. I feel bitter over this person’s death.
18. I feel envious of others who have not lost someone close.
19. I feel lonely a great deal of the time ever since they died.

Read as a set, the items split between separation distress and traumatic distress. Longing, emptiness, and being drawn to reminders belong to the first group. Mistrust, somatic symptoms, and hearing or seeing the person who died belong to the second. Nothing in the list asks about recovery or acceptance, which is why no response ever needs flipping at the scoring stage.

Wording matters more than clinicians expect. Paraphrased or shortened items break comparability with the validated measure and with the patient’s own earlier scores. Use the template wording exactly, whether you hand over paper, read the items aloud, or send a digital form. Most patients finish in 5 to 10 minutes.

Scoring and interpretation: What the numbers mean

Scoring the ICG means adding the responses to all 19 items together. Each answer counts as the patient marked it, from 0 for never to 4 for always. No item is reverse-scored, so nothing is recoded before you add the numbers up. Totals run from 0 to 76, and one validated cutoff turns that total into a clinical decision.

The cutoff of 25 comes from the original Prigerson et al. (1995) validation study and has been replicated across several populations and languages. Totals at or above it show strong sensitivity and specificity for prolonged grief disorder. A high total earns the patient a full diagnostic evaluation, billed under CPT code 90791. It does not hand you a diagnosis.

Two scoring myths are worth naming, because both circulate in secondhand summaries of the measure. The first claims that a positive-sounding item is reverse-scored. The published 19-item ICG contains no such item and no reverse-scored responses at all, so straight summation is always correct.

The second myth invents severity tiers at 30 or 35 points, often with a suicide-risk figure attached to the top one. The validated measure carries a single cutoff at 25. Above it, severity and referral urgency are matters of clinical judgment rather than of a published band.

How to fit grief screening into your workflow

Administering the ICG is simple. Embedding it into routine intake and follow-up takes planning. Below are five operational steps for putting the measure into your practice.

1. Identify the right patients at intake: Ask every new patient whether someone close to them has died in the past 24 months. Ask the same of existing patients presenting with mood, anxiety, or trauma symptoms. If the answer is yes, add the ICG to your counseling intake form or administer it in the first session. Record the type of loss and how long ago it happened.
2. Administer the 19-item questionnaire: Provide the ICG on paper or through a digital form. Self-report completion usually takes 5 to 10 minutes. Give the patient privacy to fill it in, or read the items aloud if literacy or vision makes that hard. Your consent wording should explain the purpose and note that a high total may lead to a referral.
3. Score and interpret straight away: Add all 19 raw responses together with no recoding, since none of the items are reversed. Compare the total against the 25-point cutoff above. Record the total and that comparison at the top of the assessment section in the patient record, where every team member can see it.
4. Share the result and plan care: Give the score back to the patient in plain, normalizing language. For example: “Your score of 28 tells us your grief is at a level that specific therapies help with.” At 25 or above, recommend grief-focused CBT, complicated grief treatment (a 16-session manualized protocol), or a specialist referral. Below 25, normalize the loss with a stages of grief worksheet and reassess in 6 to 12 months.
5. Track progress with repeat scores: Readminister the ICG after 8 to 12 weeks of grief-focused therapy. A drop of 5 points or more suggests the treatment is working, especially one that takes the total below 25. Use the trend to adjust intensity, or to refer to psychiatry for co-occurring depression or suicide risk.

Which clinicians use this measure?

Therapists, grief counselors, and psychiatrists use the ICG most, usually as a standard intake measure. It suits any setting where bereaved people seek mental health support. Psychologists in private practice, community mental health centers, and university counseling services build it into their assessment batteries.

Hospice and palliative care teams use it to find bereaved relatives at risk of prolonged grief, so support can start before symptoms entrench. Primary care physicians and nurse practitioners reach for it when screening for depression or anxiety, because complicated grief often presents as a mood disorder.

Occupational therapists and social workers use it to weigh the grief component in trauma and domestic abuse presentations. Substance use counselors pair it with a CAGE-AID questionnaire to map grief-related relapse triggers, since unprocessed bereavement is a common risk factor.

The measure also suits research, medical education, and therapist supervision, where it teaches trainees to assess and formulate grief presentations. At 19 items and under 10 minutes, it fits schedules that cannot absorb a longer battery.

Benefits of routine grief screening

Standardized assessment and objectivity: The ICG gives you a number instead of an impression. That objectivity sharpens assessment and makes progress over time measurable rather than remembered.

Early identification of at-risk patients: Screening every bereaved patient at intake surfaces the people heading toward prolonged grief before symptoms harden. Intervening 3 to 6 months after the death works better than starting treatment years later.

Care matched to need: A patient scoring 20 may do well with supportive counseling. A total of 25 or above calls for escalation, with the intensity of care set by clinical judgment. The score guides that triage, so your scarcest appointments go to the patients who need them.

Secure, compliant documentation: HIPAA-compliant patient assessment storage keeps completed ICG forms accessible to authorized staff only. That lowers the risk of a breach and of a regulatory finding at audit.

Outcome monitoring: Repeating the ICG after 8 to 12 weeks of therapy gives you objective evidence of response. A drop of 5 points or more suggests the plan is working, while a flat or rising total says change the approach.

How Pabau automates ICG scoring and follow-up

Most practices still run the ICG on paper. Someone adds up 19 numbers by hand, then files the total in a session note. Arithmetic slips happen, and a score of 32 can sit unread until the next appointment.

Practice management software like Pabau sends the ICG as a digital intake form before the appointment. The patient answers on their phone, the responses save straight into the clinical record, and the total is calculated for you. Straight summation with no reversed items is exactly the kind of arithmetic software should own.

From there you can act on the number rather than hunt for it. A total of 25 or above can raise a task for the treating clinician, and repeat scores line up in the same record. That gives you a documented before-and-after for grief-focused therapy without a separate spreadsheet.

Embed grief screening into your intake workflow

Pabau's digital forms score the ICG automatically and flag every total at or above the cutoff. A high score never gets lost in a session note, and your team sees the number and the trend in one place.

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Conclusion

The ICG earns its place in an intake pack because it turns a clinical impression into a number you can act on. Nineteen items, one five-point scale, and a single total from 0 to 76 are all it asks of the patient.

Two details decide whether that number is worth anything. Use the validated item wording rather than a paraphrase, and add the raw responses up without recoding any of them. Secondhand summaries that introduce a reverse-scored item quietly shift every total the practice records.

Remember that 25 is a screening threshold, not a diagnosis, and that no published tier sits above it. A high total tells you to look harder at duration, impairment, and risk before you plan care. Book a demo to see how Pabau scores the ICG automatically and flags patients who need specialist grief care.

Continue your research

Sorting grief from depression at intake? Depression self-assessment walks through PHQ-9 scoring, so you can see which symptoms belong to a mood disorder.

Is sleep the loudest symptom your patient reports? Insomnia test template adds ISI scoring when bereavement has wrecked a patient’s nights.

Need to document the wider clinical picture? Mental status exam template structures the observations that sit alongside a high grief score in the record.

Working with avoidance in grief therapy? Defense mechanisms worksheet gives patients a way to name the coping patterns that keep the loss at arm’s length.

Closing out a course of grief-focused therapy? Therapy termination letter covers what to include when you discharge a patient whose scores have settled.

Frequently asked questions