Disease: 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 have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.
For some people, feelings of loss are debilitating and don't improve even after time passes. 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.
Different people follow different paths through the grieving experience. The order and timing of these phases may vary from person to person:
- Accepting the reality of your loss
- Allowing yourself to experience the pain of your loss
- Adjusting to a new reality in which the deceased is no longer present
- Having other relationships
These differences are normal. But if you're unable to move through these stages more than a year after the death of a loved one, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.
During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade over time, those of complicated grief linger or get worse. 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 of your loved one
- Focus on little else but your 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 your 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 your loved one
Complicated grief also may be indicated if you continue to:
- Have trouble carrying out normal routines
- Isolate from others 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 see a doctor
Contact your doctor or a mental health professional if you have intense grief and problems functioning that don't improve at least one year after the passing of your loved one.
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. Or call a suicide hotline number. In the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
It's not known what causes complicated grief. As with many mental health disorders, it may involve your environment, your personality, inherited traits and your body's natural chemical makeup.
Grieving is a highly individual process for each person, and determining when normal grief becomes complicated grief can be difficult. There's currently no consensus among mental health experts about how much time must pass before complicated grief can be diagnosed.
Complicated grief may be considered when the intensity of grief has not decreased in the months after your loved one's death. Some mental health professionals diagnose complicated grief when grieving continues to be intense, persistent and debilitating beyond 12 months.
There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Getting the correct diagnosis is essential for appropriate treatment, so a comprehensive medical and psychological exam is often done.
Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, complications may include:
- 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
It's not clear how to prevent complicated grief. Getting counseling soon after a loss may help, especially for people at increased risk of developing complicated grief. In addition, caregivers providing end-of-life care for a loved one may benefit from counseling and support to help prepare for death and its emotional aftermath.
- Talking. Talking about your grief and allowing yourself to cry also can help prevent you from getting stuck in your sadness. As painful as it is, trust that in most cases, your pain will start to lift if you allow yourself to feel it.
- Support. Family members, friends, social support groups and your faith community are all good options to help you work through your grief. 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. Ask your doctor to 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.
Coping and support
Although it's important to get professional treatment for complicated grief, these strategies also may help you cope:
- Stick to your treatment plan. Attend therapy appointments as scheduled and practice skills learned in therapy. If needed, take medications as directed.
- Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
- Take care of yourself. Get enough rest, eat a healthy diet and take time to relax. Exercise regularly. Physical activity can help relieve stress, depression and anxiety. Don't turn to alcohol or recreational drugs for relief.
- Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
- Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
- Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate, positively reminisce or acknowledge your loved one that provide you comfort and hope.
- Learn new skills. If you were highly dependent on your loved one, for example, to handle the cooking or finances, try to master these tasks yourself. Ask family, friends or professionals for guidance, if necessary. Seek out community classes and resources, too.
- Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.
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 death from a car accident, or the murder or suicide of a loved one
- Death of a child
- Close or dependent relationship to the deceased person
- 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 major financial hardships
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