You are likely familiar with feelings of grief, but did you know that there are different variations of grief? Of course, the experience of grief is different from person to person, but sometimes “normal grief” can take a turn and become something a little different. The four most common variations are disenfranchised grief, complicated grief, compounded grief, and anticipatory grief. Today, let’s unpack complicated grief so that you have a better understanding of this potentially serious detour in the grieving process.

First, Let’s Define Normal Grief

Before we dive into complicated grief (also known as prolonged grief), it’s important that you understand what normal grief looks like. Put simply, grief is your natural human response to the loss of someone or something you love. The emotions of grief vary greatly – sadness, anger, guilt, relief, shock – but these are all normal responses to loss. As much as you may prefer not to feel or deal with these types of emotions, they are actually a healthy part of the grieving process.

Grief is often accompanied by age-old rituals that bring people together to grieve. We hold hands, offer words of support and love, send cards and flowers, make donations, and deliver hot meals to the grieving family. We stand together to support those who are grieving and give them emotional and physical support as they mourn. But what happens if nothing helps and you feel stuck in a downward spiral of grief and despair?

Enter Complicated Grief

As we move forward, we’re going to review several key aspects of complicated grief. We’ll start off with a definition before moving into the symptoms, who is susceptible, and how to get help.

A Quick Definition

When you lose someone or something you love, you’re going to experience grief. The initial period of time just after a loss, when your emotions are unpredictable and you can’t concentrate on anything but the loss, is called acute grief. It’s the hard beginning of loss. However, in most cases, after a period of time, you are able to move into integrated grief. This means that you have learned to accept the reality of the death, have found ways to cope and adapt to your new way of life, and have begun to hope again, finding renewed meaning and purpose in life. Moving from acute grief (initial feelings of loss) to integrated grief (a reconciliation to the loss) is a natural progression through the grief journey.

This movement or reconciliation takes time, but it’s characterized by a lessening of your grief feelings. You may bounce back and forth between sadness, shock, and anger for a little while, but then, your grief feelings gradually lessen until they become an ache that occasionally comes back to visit you (normally around special days and events).

However, sometimes acute grief doesn’t progress as it should. Instead of lessening over time, your feelings of grief intensify until all you can think about is the loss you’ve gone through. This is complicated grief. In most cases, complicated grief occurs following the loss of a person, but it’s not necessarily confined to that.

With complicated grief, the death becomes center stage in your life. Many of those suffering from complicated grief are unable to resume normal life and are stuck in a state of intense mourning.

Symptoms of Complicated Grief

As we’ve talked about, complicated grief is an extended time of intense grief when you are unable to move through the grieving process. The grief begins to take over your life and the future seems bleak and lonely.

At first, many of the symptoms of complicated grief look like normal grief. However, if grief indicators worsen as time passes, then it could be a case of complicated grief. Here are a few symptoms to look out for months and even years following the loss:

  • Intense sorrow, pain, or pining over the loss, focusing on little else
  • Problems accepting the reality of the death
  • Strong attachment to mementos/reminders or a strong avoidance of them
  • Numbness, detachment, bitterness, and/or easily irritated
  • Feeling that life holds no meaning or purpose
  • Trouble carrying out normal routines, including personal hygiene
  • Increasingly isolated and withdrawn
  • Denial and defensiveness when asked about the grief
  • Guilt over feeling that they did something wrong, could have prevented the death, or should have died along with the loved one

If six months or more have passed since the loss and grief feelings have only gotten worse, then it’s time to consider getting help. Six months is not a hard and fast rule as some losses will take years to recover from, but it is enough time to ascertain whether grief symptoms are lessening or worsening.

Who’s Susceptible?

While doctors and mental health professionals are still learning about complicated grief, it’s believed that as much as 20% of those who lose a loved one will experience complicated grief. Unfortunately, it’s not yet known exactly what causes complicated grief, though it’s considered another type of mental health disorder.

As with many mental health disorders, the cause may be related to your environment, personality, genetics, or chemical makeup. Complicated grief occurs more often in women and particularly those of an older age. Outside these factors, other circumstances may increase a person’s risk of experiencing complicated grief, including:

  • The death was shocking, unexpected, violent, or premature
  • There was more than one death in a short period of time
  • You witnessed the death or suffering with the deceased (as with a long illness)
  • You had a 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

Seeking Help

Just as with any other mental health concern, it’s best to seek professional support and care when dealing with complicated grief. If you find that you or a loved one have been unable to make distinct progress toward integrated grief and that your grief feelings are intensifying (no matter how long it’s been), consider whether now is the time to seek help so that you can come to terms with your loss and reclaim a sense of acceptance and peace.

At first, you may think you can handle things, but over time, complicated grief can affect you physically, mentally, and socially. Without the proper treatment, complications could arise, including:

  • 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 abuse

At this point in time, it’s not clear how to prevent complicated grief. However, counseling and grief therapy soon after the loss (especially for those in an at-risk group) is thought to help curb the severity of complicated grief and put you on the path to healing.

What Can Family and Friends Do to Help?

Because those suffering from complicated grief are susceptible to additional complications like depression, anxiety, or sleep issues, the best option is to speak with a professional, who can act as a guide through the entire journey toward recovery.

However, as family and friends, you can do something to help!

Offer your full and loving support to the person dealing with complicated grief. Be there to talk. Be encouraging. Bring small gifts or tokens of your love. Actively listen and don’t interrupt. Plan positive activities, like taking a walk or doing something they’ve always enjoyed.

They don’t need you to try to fix them; they need you to accept them where they are right now. Be there for them. Realize that complicated grief is difficult on both of you and the road to recovery may be long and difficult. But it is achievable! When we do the work of grief, we can find a way to reconcile ourselves to loss and find new hope and meaning for the future.

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