Complicated Grief

Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement go through a period of sorrow, numbness, and even guilt and anger. Gradually, these feelings ease, and it's possible to accept the loss and move forward. However, for some, the feelings of loss are debilitating and do not improve over time. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long-lasting and severe that you have trouble recovering from the loss and resuming your own life.

The Grieving Process

Grief is a deeply personal and individual experience. People follow different paths through the grieving process, and the order and timing of these phases may vary from person to person. Generally, the grieving process includes:

1. Accepting the reality of the loss: Coming to terms with the fact that the loved one is gone.
2. Allowing yourself to experience the pain of the loss: Facing and feeling the emotional pain rather than avoiding it.
3. Adjusting to a new reality in which the deceased is no longer present: Finding new ways to live daily life without the loved one.
4. Having other relationships: Continuing to engage in relationships and activities that bring comfort and meaning.

These differences in the grieving process are normal. However, if you find that you are unable to move through these stages more than a year after the death of a loved one, you may be experiencing complicated grief. In such cases, seeking treatment is crucial, as it can help you come to terms with your loss and reclaim a sense of acceptance and peace.

Symptoms of Complicated Grief

During the first few months after a loss, many signs and symptoms of normal grief are similar to those of complicated grief. However, while normal grief symptoms gradually start to fade over time, those of complicated grief linger or worsen. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.

Signs and symptoms of complicated grief may include:

• Intense sorrow, pain, and rumination over the loss
• Focus on little else but the loved one's death
• Extreme focus on reminders of the loved one or excessive avoidance of reminders
• Intense and persistent longing or pining for the deceased
• Problems accepting the death
• Numbness or detachment
• Bitterness about the loss
• Feeling that life holds no meaning or purpose
• Lack of trust in others
• Inability to enjoy life or think back on positive experiences with the loved one

Complicated grief may also be indicated if you continue to:

• Have trouble carrying out normal routines
• Isolate yourself and withdraw from social activities
• Experience depression, deep sadness, guilt, or self-blame
• Believe that you did something wrong or could have prevented the death
• Feel life isn't worth living without your loved one
• Wish you had died along with your loved one

When to Seek Help

If you experience intense grief and problems functioning that don't improve at least one year after the passing of your loved one, it's important to contact your doctor or a mental health professional. Early intervention can help manage symptoms and prevent further complications.

If You Have Thoughts of Suicide

At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Causes and Risk Factors

The exact cause of complicated grief is not well understood. As with many mental health disorders, it may involve a combination of environmental factors, personality traits, inherited characteristics, and the body's natural chemical makeup.

Risk Factors

Complicated grief occurs more often in females and with older age. Factors that may increase the risk of developing complicated grief include:

• An unexpected or violent death, such as a car accident, murder, or suicide of a loved one
• Death of a child
• Close or dependent relationship with the deceased
• Social isolation or loss of a support system or friendships
• Past history of depression, separation anxiety, or post-traumatic stress disorder (PTSD)
• Traumatic childhood experiences, such as abuse or neglect
• Other major life stressors, such as significant financial hardships

Complications

Complicated grief can affect you physically, mentally, and socially. Without appropriate treatment, complications may include:

• Depression
• Suicidal thoughts or behaviors
• Anxiety, including PTSD
• Significant sleep disturbances
• Increased risk of physical illness, such as heart disease, cancer, or high blood pressure
• Long-term difficulty with daily living, relationships, or work activities
• Alcohol, nicotine use, or substance misuse

Prevention

Preventing complicated grief isn't always possible, but certain strategies can help, especially for those at increased risk:

Counseling

Early counseling after a loss can be beneficial. It allows you to explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative thoughts and beliefs from becoming so entrenched that they're difficult to overcome.

Support Systems

Talking about your grief and allowing yourself to cry can help prevent you from getting stuck in sadness. Trust that, in most cases, your pain will start to lift if you allow yourself to feel it. Family members, friends, social support groups, and faith communities can all provide valuable support. You may be able to find a support group focused on a particular type of loss, such as the death of a spouse or a child. Your doctor may also recommend local resources.

Bereavement Counseling

Through early counseling after a loss, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative thoughts and beliefs from gaining such a strong hold that they're difficult to overcome.

Conclusion

Grieving the loss of a loved one is a painful and deeply personal process. While most people gradually adjust and find ways to move forward, some experience complicated grief, where the pain is prolonged and debilitating. Understanding the symptoms, seeking timely help, and leveraging support systems are crucial steps in navigating this challenging journey.

Sources

1. Mayo Clinic Staff. "Complicated Grief." Mayo Clinic, 2023. Mayo Clinic
2. American Psychological Association. "Grief: Coping with the Loss of Your Loved One." APA, 2022. American Psychological Association
3. National Institute of Mental Health. "Coping with Traumatic Events." NIMH, 2021. NIMH