What Is Complicated Grief?

Complicated grief, also known as prolonged grief disorder, is a condition that can occur in some people who have just lost a loved one or are experiencing grief for another reason. It is characterized by feelings of intense grief that last a year or longer and interfere with the healing process.

Grief is a person’s natural response to losing a loved one. It’s accompanied by feelings of hurt, loss, and sadness. 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. About 7% to 10% of bereaved people might experience complicated grief.

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Symptoms of Complicated Grief

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. Some people believe that if you are still experiencing feelings of acute grief six months to a year after a loss occurs, then you might have complicated grief. But this isn’t a hard and fast rule.

Categorized as a trauma- and stressor-related disorder, prolonged grief disorder is characterized by intense distress and longing for a loved one a year or longer after their death. These symptoms create distress, preoccupation with the loss, and disruptions in a person's ability to function in their daily life.

However, intense grief that is disruptive and lasts longer than you would expect may indicate complicated or prolonged grief. Symptoms of prolonged grief disorder include:

• Intense emotional pain
• Disruptions in identity
• Feelings of disbelief about the death
• Avoidance of reminders that the person is dead
• Difficulty reintegrating with daily life
• Emotional numbness
• Intense loneliness
• Feeling like life is meaningless

In addition to these symptoms, bereavement must last longer than one would expect based on the individual's religious, cultural, or social norms.

Complications of Complicated Grief

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 of Complicated Grief

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.

Treatment for Complicated Grief

The treatment of complicated grief focuses on helping people living with the condition begin their healing process. Your doctor will determine the best treatment plan for you. A combination of medication and therapy might be used to treat complicated grief.

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.  

Types of therapy that can be helpful include:

• Bereavement therapy: This approach, also known as grief counseling, involves talking about the loss and the emotions you are experiencing. A bereavement counselor will encourage you to monitor your grief, to gain a better understanding of where you are at emotionally.
• Cognitive-behavioral therapy (CBT): This type of therapy can help you identify the negative thought patterns that are contributing to complicated grief. Your therapist can help you work on developing more realistic, hopeful ways of thinking and processing your emotions in a way that will promote healing.
• Psychodynamic therapy: 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: This approach can be effective for complicated grief. Here a therapist uses behavioral methods and interpersonal techniques to help you overcome your loss.

Coping With Complicated Grief

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.