Complicated Grief: Definition, Symptoms, Causes, and Treatment

Wondering ‘what is complicated grief’? Or how does it differ from other types of grief? You should know that grief is a normal part of life. Losing loved ones is often followed by a period of grieving. It takes time for us to come to terms with our loss as we try to navigate moving forward in our new normal. And with that comes different ways of grieving.

In cases of “normal” grief, there will generally be a period of sorrow or sadness, numbness, guilt, anger, and eventually, acceptance. As time goes on, whether it’s on your own or through grief counseling, you’ll eventually begin to be able to accept your loved one’s death and find a way to continue on with your life. Hopefully, you’ll find peace at the end of this experience. 

Complicated grief, however, is different. When you’re experiencing complicated grief, your feelings are substantial and often debilitating.  

What is Complicated Grief?

Complicated grief, also known as persistent complex bereavement disorder, results in feelings and emotions that are so painful, moving forward seems impossible. The pain is long-lasting, and there’s definitely no timeline that all grief follows. However, if you’ve been experiencing a deep sense of grief for longer than a year and you simply cannot see a way to regain the life you lived before your loss, you may have complicated grief. 

The difference between normal & complicated grief

Although normal grieving and complicated grieving both have similar symptoms and signs in the beginning phases, there’s a significant difference between the two. Normal grief will fade very gradually over time. The process to heal, and the feelings you’ll experience, are the same in both cases. But when your grief is categorized as normal, you’ll begin to notice that your days become more bearable and your symptoms lessen over time. 

If you have complicated grief, you will not begin to feel better over time. Rather, your pain and symptoms will either stay the same or perhaps even worsen, despite more and more time passing. 

It’s very important to point out, though, that there isn’t a standard timeframe for grief. There’s no “one way” that we go through the grieving process. Healing from any loss takes time, and you should be kind and patient with yourself (or someone you love) throughout the grieving period. 

Is complicated grief a DSM diagnosis?  

Complicated grief is referred to as Persistent Complex Bereavement Disorder, or Prolonged Grief Disorder, in the DSM-5. The Diagnostic and Statistical Manual of Mental Disorders, fifth ed, defines diagnoses, and includes persistent complex bereavement disorder as an area that “needs further study.” 

“Someone that cares about you may be able to see the signs of complicated grief before you are aware of it.” 

Talkspace therapist Dr. Karmen Smith LCSW, DD

Symptoms of Complicated Grief

Complicated grief symptoms are often very similar to what someone would experience as they move through the process of normal grief but there are some significant differences. Remember, those who are experiencing normal grief will begin to feel relief from symptoms over time. Complicated grief symptoms, by contrast, are more intense, and are lasting or persistent.

Symptoms of complicated grief to be aware of include:

• Thinking obsessively about a loss
• Experiencing a sense of loss of purpose for life
• Having suicidal thoughts  
• Having extremely intrusive, near-constant, persistent thoughts about a loss
• Intensely and purposefully avoiding anything that reminds you of your loss
• Feeling an extreme longing for the person who passed away or whom you’ve lost
• Seeking things that remind you of the person you lost (often in an excessive manner)
• Feeling an inability to accept your loss

A complicated grief diagnosis can be made by a trained mental health professional or your doctor. You should seek help if you’re experiencing extreme grief and are having difficulty functioning. If you’ve been trying to move through your grief for longer than a year, it may be time to consider talking to someone. 

If you’re feeling any of the following common symptoms, you should think about getting help:

• Isolating from others around you
• Having difficulty maintaining your normal daily routines
• Withdrawing from social activities you once enjoyed
• Believing that you did something wrong
• Feeling like you could’ve prevented a loved one’s passing
• Feeling depressed, or having very deep sadness that’s intensifying
• Wishing you had passed away at the same time as your loved one
• Feeling like your life isn’t worth living any longer

Complications of complicated grief

There are a number of complications that can stem from a complicated grief diagnosis. Avoiding effective treatment means you may further suffer from complications, such as:

• Anxiety or PTSD
• Depression
• Suicidal thoughts and/or behaviors
• Sleep disruption 
• Difficulty with daily routines
• Enhanced risk for other physical illness like high blood pressure or heart disease
• Substance abuse including alcohol or drug use
• Difficulty dealing with relationships
• Difficulty performing work or normal function activities

“Complicated grief could come from an enmeshed and/or codependent relationship and the loss of it could signal an absence of the grievers identity.”

Talkspace therapist Dr. Karmen Smith LCSW, DD 

Causes of Complicated Grief

While complicated grieving is a fairly common mental health condition, we still don’t truly understand what causes it. Like many other conditions, the cause of complicated grief could be related to your individual personality, the environment you’re in while you’re working through your grief, or traits you inherited. Even your natural chemical makeup may ultimately contribute to experiencing complicated grief. 

While there isn’t any one identifiable cause for complicated grief, there are several risk factors that potentially make someone more susceptible. Some of these may include:

• History of mental disorders
• Death of a child
• Unusually shocking or violent death
• A completely unexpected death
• A history of substance abuse
• Social isolation
• Being absent when the loss occurred
• Encountering other additional major life stressors (for example, extreme financial hardship)
• Multiple deaths occurring in a very short period of time
• Being witness to the death or loss

How to Treat Complicated Grief

Fortunately, there is treatment available for complicated grief. Some treatments have been shown to be extremely effective in helping people recover. Typically, complicated grief treatment focuses on helping you live a healthier life as you begin to heal from loss throughout the grief process. 

• Bereavement Therapy: One therapy that’s notable and common in treating complicated grief is bereavement therapy. Also called grief counseling, bereavement therapy offers help so you can move through the grieving process. This is typically done by helping you get in touch with your feelings, accept a loss, and/or work through trauma and guilt you might be experiencing. 

• Psychotherapy: A type of psychotherapy known as complicated grief therapy is also often used to treat complicated grief. It can be done both individually or in a group setting. Complicated grief therapy techniques can teach you how to explore and process the thoughts you’re having and improve your coping skills, so you can move past the unresolved grief. 

• Medication: While there isn’t a lot of research about using psychiatric medication to help treat complicated grief, sometimes antidepressants might be helpful. This might be the case if you’re diagnosed with clinical depression in addition to complicated grief.

“Creating ways to incorporate the loved one into your life that is beneficial to you and their memory is a part of the grieving process.” 

Talkspace therapist Dr. Karmen Smith LCSW, DD 

Seeking Help for Your Grief

Whatever form of treatment you decide on, if you’re experiencing complicated grieving, it’s important you seek help. Whether it be through a support group or individualized therapy with a licensed professional, you deserve to learn how to manage grief. This way, you can heal and continue living a fruitful, healthy life. 

Loss is always difficult and painful, but with the right support, you can find your way through it. If you want to learn more about the stages of grief or are ready to start treating your own grief, reach out to Talkspace today.

Sources:

1. Diagnosis | Center for Complicated Grief. The Center for Complicated Grief. https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/diagnosis/. Published 2021. Accessed August 21, 2021.
   
2. Nakajima Satomi 2018 Complicated grief: recent developments in diagnostic criteria and treatment Phil. Trans. R. Soc. B3732017027320170273 https://doi.org/10.1098/rstb.2017.0273 Accessed August 21, 2021.
   
3. Complicated Grief Treatment (CGT). Suicide Prevention Resource Center. https://www.sprc.org/resources-programs/complicated-grief-treatment-cgt/. Published 2017. Accessed August 21, 2021.
   
4. What Is Complicated Grief? Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/complicated-grief/. Published 2021. Accessed August 21, 2021.