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List of All Topics
Complicated Grief
Introduction
Grief is the intense sorrow caused by loss of a loved one. Losing a loved one is one of the most distressing and emotional experiences people face. But because death is such a common life experience, virtually everyone deals with grief at some point. Despite the emotional difficulty, most people experiencing normal grief and bereavement endure a period of sorrow, numbness, and even guilt and anger, followed by a gradual fading of these feelings as they accept the loss and move forward.
For some people, though, this normal grief reaction becomes much more complicated, painful and debilitating, or what's known as complicated grief. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the death and resuming your own life.
Researchers are beginning to pay more attention to complicated grief because of the serious toll it can exact — possibly leading to depression and thoughts of suicide. Researchers have even developed a new treatment that may help people with complicated grief come to terms with their loss and reclaim a sense of joy and peace.
Signs and symptoms
Mental health experts are still analyzing how complicated grief symptoms differ from those of normal grief or other bereavement reactions. 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 within six months or so, those of complicated grief get worse or linger for months or even years. Complicated grief is like being in a chronic, heightened state of mourning.
Signs and symptoms of complicated grief can include:
- Extreme focus on the loss and reminders of the loved one.
- Intense longing or pining for the deceased.
- Problems accepting the death.
- Numbness or detachment.
- Preoccupation with your sorrow.
- Bitterness about your loss.
- Inability to enjoy life.
- Depression or deep sadness.
- Difficulty moving on with life.
- Trouble carrying out normal routines.
- Withdrawing from social activities.
- Feeling that life holds no meaning or purpose.
- Irritability or agitation.
- Lack of trust in others.
It's not known what causes complicated grief. As with many mental health disorders, it may involve a complex interaction between your genes, environment, your body's natural chemical makeup and your personality.
Some researchers believe in the five stages of grief theory, attributed to the late psychiatrist Elizabeth Kubler-Ross, M.D. Although she intended this process for people at the end of their lives, some researchers said that bereaved survivors also went through these stages in an orderly fashion:
- Denial, shock or isolation.
- Anger.
- Bargaining.
- Depression or sadness.
- Acceptance of the loss.
Treatment
Complicated grief treatment hasn't been standardized because mental health providers are still learning about the condition. Research studies testing various types of treatment have had mixed results. That isn't to say that treatment isn't helpful, though. More study is needed to help determine which treatment options may be best for complicated grief.
Psychotherapy
Some studies have shown big benefits from treating complicated grief with a newly developed type of psychotherapy called complicated grief treatment, also called complicated grief therapy. This form of psychotherapy, which borrows from cognitive behavior therapy and trauma therapy, is comprehensive and sometimes intense. You may learn about such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life's goals.
This therapy also includes holding imagined conversations with your loved one and retelling the circumstances of the death, perhaps several times to help you become less distressed by images and thoughts of your loved one. Although some people find this therapy painful, others find it ultimately rewarding and freeing after what may have been years of chronic mourning.
Other forms of therapy, such as interpersonal therapy or psychodynamic psychotherapy, also may be effective. Therapy can help you explore and process emotions, improve coping skills and reduce feelings of blame and guilt.
Medications
There's little solid research on the use of psychiatric medications to treat complicated grief. However, some research has shown benefits from using antidepressants in the class of selective serotonin reuptake inhibitors (SSRIs) to reduce complicated grief symptoms.
Prevention
It's not clear how to prevent complicated grief with any certainty. Some studies suggest that participating in a brief course of counseling or psychotherapy soon after a loss may help, especially for those 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.
Through early counseling, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative beliefs about your loss from gaining such a strong hold that they're difficult to overcome. People who themselves may be at risk of suicide following a loved one's suicide may especially benefit from grief counseling or other treatment.
Finding support from family, friendships, group therapy or social support groups after a loss can promote healthy grieving. You can also take steps to improve your resilience skills to help cope with hardships and loss.
Information obtained from National Institute of Health