Complicated grief: Coping with a pain that doesn't end

Most of us know what it’s like to grieve the loss of a loved one.

At first, the pain is so intense we think we might not survive. Living without the person we’ve lost seems impossible. We experience a range of strong feelings, including sadness, pain, anger, and even guilt.

Over time, the feelings of bereavement usually begin to subside. We accept the reality of the loss and allow ourselves to feel the pain. We adjust to our new reality without the person we have lost.

But in some cases, the bereaved person finds that their feelings of sorrow do not improve over time. Their grief continues to impact their ability to function or accept their loss. This is known as complicated grief or CG.

Let’s explore the differences between normal and complicated grief. We’ll also take a look at complicated grief symptoms, risk factors, and treatment.

What is complicated grief?

Complicated grief is a prolonged grief disorder that prevents a bereaved person from overcoming a loved one’s death. 

It profoundly impacts the sufferer and limits their ability to live a full and satisfying life. Complicated grief is also known as complex grief.

This type of chronic grief can negatively impact the sufferer’s mental health and well-being. For this reason, complicated grief is also referred to as persistent complex bereavement disorder.

Complicated grief is most often caused by an unexpected or sudden death of a loved one, especially the death of a close family member, child, or friend.

Complicated grief symptoms include overwhelming emotional pain and a heightened focus on the lost loved one. Many people suffering from complicated grief experience feelings of bitterness about their loss. 

They lose the ability to enjoy their life.

Complicated grief can cause people to isolate themselves or struggle to follow their normal routines. They feel like life isn’t worth living without their loved one and experience sorrow and guilt.

These symptoms continue without improvement for a prolonged period of time following the death. Sometimes they can last for years and negatively affect the bereaved person’s health, work, and relationships.

What’s the difference between normal grief and complicated grief?

Acute grief is the experience of painful emotions and other symptoms of grief we all go through following the death of a loved one. 

This type of uncomplicated grief is normal, and it gradually recedes over time. Although the bereaved person will always miss their loved one, they eventually return to living a normal life.

But in some cases, extreme emotional pain and unresolved grief can result in a complicated grief disorder.

Psychiatry experts agree that prolonged grief is distinct from the normal grieving process. However, some disagree over the diagnostic criteria. 

Studies show that complicated grief activates different parts of the brain. 

One study showed that complicated grief causes avoidance behaviors. It affects the functioning of the amygdala, making it difficult for the person to accept their loss and move on.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) sets a working complicated grief definition. They decided on 12 months as the normal grieving period. After this, grief may become a persistent complex bereavement disorder.

They also noted that complicated or prolonged grief is a disorder that requires further study.

No one knows exactly what causes complicated grieving. Post-traumatic stress disorder and traumatic grief are among the possible causes. Examples might include the loss of a child or witnessing a violent death of a loved one.

6 complicated grief symptoms

The prevalence of complicated grief is in only about 7% of bereaved people. But it can cause profound impairment for the people experiencing it. 

If you or someone you love continues to experience prolonged grief after the death of a loved one, look for common symptoms of complicated grief. 

The prolonged nature of these symptoms can impair the individual’s ability to function and move on with their life.

Here are six of the most common complicated grief symptoms to look out for:

1. Intense and prolonged sorrow and pain over the loss of a loved one.
2. The inability to focus on little else other than a loved one’s death.
3. The inability to accept the death of the loved one.
4. Numbness or detachment from others.
5. Lack of trust in others.
6. Depression, deep sadness, guilt, or self-blame that does not resolve over time. This may include suicidal thoughts.

Complicated grief vs. Depression: What’s the difference?

Complicated grief has symptoms similar to other conditions, such as major depression. They are both marked by extreme sadness and hopelessness. 

So how can you tell the difference between the two? Let’s take a look at five of the main distinctions between complicated grief and depression.

1. They have different causes

Depression is a mood disorder that is caused by chemical imbalances in the brain. Complicated grief is caused by the death of a loved one.

2. Depression has different forms

Depression can take different forms, including psychotic depression and postpartum depression. There is only one type of complicated grief.

3. Sufferers’ behavior is different

Many people suffering from depression withdraw from others and don’t seek help.

People suffering from complicated grief are more likely to want to discuss their feelings and talk about the loved one they have lost.

4. Depression is more difficult to recognize

Depressive symptoms can be difficult to recognize in others. Complicated grief can be easier to identify because it is tied to a specific event.

5. Depression is relentless

People with depression find there is little they can do to change their feelings of extreme sadness and distance from others. 

With complicated grief, people may feel waves of happiness until a trigger reminds them of their loved one. This makes them return to their feelings of bereavement.

What are the risk factors and complications of complicated grief?

What can cause “normal” grief to escalate into complicated grief? And what other problems can it cause?

There are several risk factors and complications that occur:

• Childhood trauma. People who have had traumatic childhood experiences tend to be more prone to complicated grief.
• Anxiety. People suffering from an anxiety disorder are more likely to experience complicated grief after the loss of a loved one.

• Mental health conditions. Those who already have mental health disorders such as depression can develop complicated grief.

• Lack of sleep. Significant sleep disturbances can be both a risk factor as well as a complication of complicated grief.

• Chronic disease. Many individuals who suffer from complicated grief have an increased risk of illness. This includes heart disease, cancer, and high blood pressure.

• Substance abuse. If left untreated, complicated grief can also lead to alcohol or substance abuse. This can lead to long-term difficulty with daily life and relationships.

4 ways to treat complicated grief

If you or someone you love has been suffering from these symptoms for months or years, it’s essential to speak to a health care provider. They will present the options for the complicated grief treatment and support you through the healing process. 

Here are four of the most common treatments:

1. Talking

The first step toward working through your grief is to talk about your feelings with others and allow yourself to cry. 

Finding comfort from your loved ones can help you start to work through your feelings and accept the loss.

2. Social support

While complicated grief can cause you to lose trust in others, it’s an important time to stay connected to the people who care about you. 

This includes family members, friends, and your faith community. 

You can also find a bereavement support group. It can help you eliminate feelings of isolation and gain a different perspective. Some groups are for specific types of loss (e.g., a spouse, partner, child, etc.). 

You can search for local resources or ask your doctor for a recommendation.

3. Bereavement counseling

Psychotherapy can help you explore emotions that stem from the loss of your loved one and also learn healthy coping skills. 

Often, grief therapy involves retelling the story of the loved one’s death in order to help move toward acceptance. 

Grief counseling with a mental health professional can also focus on building your current personal relationships and reaching your personal goals.

4. Antidepressants

In some instances, your doctor may prescribe you antidepressants to help treat complicated grief. 

This is especially true if you already suffered from depression. The antidepressants help to relieve brain chemistry imbalances. 

Overcoming complicated grief

Grief reactions can look different for different people. There is no specified amount of time that defines when normal grief becomes complicated grief. 

In fact, for many people, the anniversaries of significant dates and events trigger feelings of grief long after the loss of a loved one.

But if you or someone you love is exhibiting some of the long-term characteristics described above, then it may be time to seek help.

Speak to your doctor for diagnosis and treatment. And if you need extra emotional support in moving on with your life, consider working with one of BetterUp’s expert coaches.