What Is Complicated Grief?

Grief is a person’s natural response to losing a loved one. It’s accompanied by feelings of hurt, loss, and sadness. Complicated grief, also known as complicated bereavement disorder, is a condition that can occur in some people who have just lost a loved one or are experiencing grief for another reason.

While the intensity of grief usually fades with time for most people, these feelings don't improve for people with complicated grief. They might be so intense that they disrupt their day to day lives.

A person with complicated grief might also display certain dysfunctional behaviors and might experience irrational thoughts, such as thoughts that the person who has died might come back to life. It’s a chronic form of grief that could impair one’s life. When grief lingers, complicated grief occurs. About 7% of bereaved people might experience complicated grief.

Symptoms 

The signs and symptoms of complicated grief are similar to normal grief. However, whereas symptoms fade with time with normal grief, people with complicated grief experience them more intensely and persistently.

Some signs to look out for include: 

• Excessively avoiding reminders of their loss 
• Obsessively thinking about their loss 
• Intense longing for a person who has died 
• Feeling a sense of loss of purpose in life 
• Excessively seeking proximity to reminders of things that remind them of the person they’ve lost 
• Suicidal thoughts 
• Being unable to accept that the loss has occurred 
• Experiencing persistent and intrusive thoughts about the person you’ve lost 

Symptoms of complicated grief might also manifest physically. People with the condition might experience: 

• Loss of appetite 
• Insomnia 
• Stress 
• Weakened immune function 

How to Identify Complicated Grief

Grief is a normal reaction to losing a loved one. When it is persistent and accompanied by dysfunctional behaviors and nonadaptive thoughts, it becomes complicated. It's important to note that complicated grief isn’t listed by the American Psychiatric Association’s official diagnostic manual. But it is a real and potentially debilitating condition.

In a 1997 study, a team of mental health experts came up with a diagnostic standard for complicated grief. They proposed the following diagnostic criteria to help determine whether a person has complicated grief or not. These include:

• The loss occurred at least 6 months ago 
• Symptoms of persistent and acute grief, which might include a yearning for the person who has died, feelings of loneliness, preoccupying thoughts about the person who has died 
• At least two of any symptoms of shock, anger, difficulty trusting other people, inability to accept death. 
• Symptoms persist for more than a month 
• Symptoms cause significant impairment in a person’s life 

Other features of complicated grief might include: 

• Having trouble continuing with their regular routines 
• Avoiding places or activities that remind them of the person they lost
• Sleeping problems 
• Lack of interest in one’s self-care 
• Reckless, impulsive, and potentially self-destructive behavior

Complicated grief is sometimes misidentified as depression. While both might share some symptoms like feelings of sadness and hopelessness, depression is a mental disorder while complicated grief is not. 

Complications

Many symptoms of complicated grief might look like symptoms of depression. In certain cases, complicated grief might even evolve into depression. Depression can occur alongside complicated grief and worsen the symptoms of the condition. 

In cases where death is violent and sudden, a person might also experience PTSD. When complicated grief goes untreated some complications might develop including: 

• Suicide and suicidal thoughts 
• Anxiety 
• Substance abuse 
• Depression

Causes

There is no identifiable cause of complicated grief, but some people might be more at risk of developing the condition than others. Certain risk factors might make a person more susceptible to experiencing the condition, including:

• People who experience an unexpected or shocking death of a loved one
• People with a history of mental disorders
• People with a history of substance abuse 
• People who experience more than one death within a short period 
• Not being present when the loss occurred 
• Witnessing the loss in real-time 

Interference with the healing process of normal grief could also cause complicated grief. Some types of loss might also cause complicated grief—for instance loss of a child or a person’s significant other. Complicated grief has also proven to be more prevalent in older individuals. A 2011 study evaluated grief in 5,741 older adults and found a prevalence of complicated grief in older adults. 

Treatment 

Treatment of complicated grief focuses on helping people living with the condition to begin their healing process. Bereavement therapy is most commonly used as a treatment option for this condition.

Where complicated grief evolves or is accompanied by another mental health condition, it’s also important to treat this condition. For instance, where it’s accompanied by depression, antidepressants might also help to relieve symptoms of complicated grief. 

A bereavement counselor will encourage you to monitor your grief, to gain a better understanding of where you are at emotionally. Joining a bereavement support group can also help to cope with feelings of loss and sadness you might be feeling. Learning that you are not alone and there are people who understand and are experiencing the feelings you have can help you feel better.  You might also see a psychodynamic therapist. This therapist may help you identify past losses and their connection to your current loss. 

Traumatic grief therapy is another treatment option that has proven to be effective for complicated grief. Here a therapist uses behavioral methods and interpersonal techniques to help you overcome your loss. Your doctor will determine the best treatment plan for you. A combination of medication and therapy might be used to treat complicated grief.

Coping 

Grief is a difficult emotion to experience and in many cases, it’s harder to weather the feelings of loss and sadness that accompany it, on your own. Reaching out to friends and family who can understand what you are going through, is something you shouldn’t hesitate to do.

If you are the loved one of a person experiencing complicated grief, you can help by helping the bereaved to find the right treatment and therapy for their condition.