What is complicated grief?

When intense grief does not get better over time

• “Complicated grief,” also known as “prolonged grief disorder,” describes an acute state of grief that does not change, even months or years later.

• The fixation on your pain can make it difficult to handle everyday tasks and maintain relationships.

• Certain situations increase the likelihood of complicated grief, such as violent death, the loss of a child, or suicide.

• Seeking professional help as soon as you can is important.

• While complicated grief can be agonizing, it is treatable by a range of mental health professionals.

When a loved one dies, you may experience a range of emotions: sadness, longing, anger, resentment. You might feel regret over unresolved issues in your relationship with your loved one. You might surround yourself with things that remind you of them and immerse yourself in the loss.

These feelings and responses are all normal parts of grieving, and they typically change over time. Eventually they lose some of their intensity and allow you to assimilate your grief into the fabric of your everyday life. That does not mean you are no longer grieving, or that you no longer miss your loved one; it means, simply, that you are healing, and that your grief is coming more from a place of love than one of pain.

This lessening of the intensity of your grief is a natural process that makes it easier for you to continue to seek joy and live your life to the fullest. It is a path toward healing, and like all healing, it takes time.

But what happens if the intensity of grief does not abate, even after a long time? What do you do when bereavement so overwhelms you that you cannot move on and cannot maintain relationships or the daily tasks of living your own life?

While everyone grieves differently and everyone’s healing process takes its own amount of time, there is a line beyond which grief becomes a debilitating disorder, known as “complicated grief,” or “prolonged grief disorder.”  Recently acknowledged by the American Psychiatric Association in its official manual, complicated grief is thought to afflict up to 15 percent of mourners.

As vexing as it might be, complicated grief is not chronic, and if you know what to look for, you will be better able to help yourself or others around you who may be suffering from it.

Who’s at risk for complicated grief?

There are certain circumstances surrounding a loved one’s death that can make it more likely that those close to them will suffer from complicated grief. If they died in an accident, for instance, or through an act of violence, or by suicide. Those grieving for someone who died young, or for their own child no matter how young or old, also could experience complicated grief. 

Those who already suffer from mood disorders, depression, or anxiety are more likely to encounter complicated grief. Women are more vulnerable to it than men, and older women are more at risk than younger ones.

Other risk factors include childhood trauma, a pre-existing sense of isolation or a lack of a social network, and other hardships such as financial duress.

What are the symptoms?

People with complicated grief become fixated on their loss, and their fixation is persistent and long-lasting. This single-mindedness impedes their ability to function normally, even months or years later.

Thoughts about their loved one dominate their life. They might avoid places or things that remind them of their loved one; they might feel numb and have trouble with normal interactions. They might be overcome by a sense that everything is futile and feel intensely withdrawn, lonely, and inconsolable.

Although grief follows its own timeline for each person, and a normal, healthy grief process may take longer for some than for others, regular grief does lessen in intensity over time. There will be bad days and good days, but the trajectory is toward healing. Those with complicated grief, on the other hand, remain in an acute state of bereavement that does not get better no matter how much time has passed.

It is possible to confuse some forms of depression for complicated grief; the main distinction is that those who suffer from complicated grief specifically focus on and see everything through the loss of their loved one, rather than experiencing a more generalized malaise.

If untreated, complicated grief can lead to drug or alcohol abuse, depression, sleeplessness, and loss of appetite, which can in turn cause heart problems, high blood pressure, and more. In addition, complicated grief can weaken one’s relationships with family and friends and disrupt their ability to go to work. In the worst-case scenario, it can lead to suicide.

What help is out there for complicated grief?

It is always a good idea to seek help for grief, even if it is not as severe as complicated grief. If you think you or someone you know is struggling with complicated grief, do not delay in seeking help.

There are therapists who specialize in grief, but most mental health professionals will be able to help you. You might ask your family doctor for a referral or search online for local mental health advocacy groups who can point you in the direction of counselors who specialize in grief. The counselor or therapist can help you process your grief and walk you through your loss, your fears, needs, and desires.

You might also reach out to your local faith community or member of the clergy, to local support groups, or to empathetic friends and family who can offer you a warm embrace and a willing ear to share and process your feelings.

Above all, know that you are not alone. Your loss may feel titanic and overwhelming; the rupture in your life is real, as is your pain. But the sense of trauma you experience in grief can be eased, and that easing does not mean you love the deceased any less. It simply means you are healing. Once you get on the path to processing your grief through love rather than pain, your memory of your loved one will become a part of how you live a healthy, productive, and joyous life ●