Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward.
For some people, feelings of loss are debilitating and don't improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the loss and resuming your own life.
Different people follow different paths through the grieving experience. The order and timing of these phases may vary from person to person:
- Accepting the reality of your loss
- Allowing yourself to experience the pain of your loss
- Adjusting to a new reality in which the deceased is no longer present
- Having other relationships
These differences are normal. But if you're unable to move through one or more of these stages after a considerable amount of time, you may have complicated grief. If so, seek treatment. It can help you come to terms with your loss and reclaim a sense of acceptance and peace.
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 over time, those of complicated grief linger or get worse. Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.
Signs and symptoms of complicated grief may include:
- Intense sorrow and pain at the thought of your loved one
- Focus on little else but your loved one's death
- Extreme focus on reminders of the loved one or excessive avoidance of reminders
- Intense and persistent longing or pining for the deceased
- Problems accepting the death
- Numbness or detachment
- Bitterness about your loss
- Feeling that life holds no meaning or purpose
- Irritability or agitation
- Lack of trust in others
- Inability to enjoy life or think back on positive experiences with your loved one
When to see a doctor
Call your doctor if you've recently lost a loved one and feel such profound disbelief, hopelessness or intense yearning for your loved one that you can't function in daily life, or if intense grief doesn't improve over time.
Specifically, you may benefit from professional help if, over time, you continue to:
- Have trouble carrying out normal routines
- Withdraw from social activities
- Experience depression or deep sadness
- Have thoughts of guilt or self-blame
- Believe that you did something wrong or could have prevented the death
- Have lost your sense of purpose in life
- Feel life isn't worth living without your loved one
- Wish you had died along with your loved one
If you have thoughts of suicide
At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. Or call a suicide hotline number. In the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
It's not known what causes complicated grief. As with many mental health disorders, it may involve inherited traits, your environment, your body's natural chemical makeup and your personality.
Factors that may increase the risk of developing complicated grief include:
- An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one
- Death of a child
- Close or dependent relationship to the deceased person
- Lack of a support system or friendships
- Past history of depression or other mental health issues
- Traumatic childhood experiences, such as abuse or neglect
- Lack of resilience or adaptability to life changes
- Other major life stressors
Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, complications may include:
- Suicidal thoughts or behaviors
- Increased risk of physical illness, such as heart disease, cancer or high blood pressure
- Significant sleep disturbances
- Long-term difficulty with daily living, relationships or work activities
- Post-traumatic stress disorder
- Alcohol or substance misuse
- Nicotine use, such as smoking
You may start by contacting your doctor. After your initial appointment, your doctor may refer you to a mental health provider who can help diagnose your symptoms and provide a treatment plan.
Here's some information to help you prepare for your appointment.
What you can do
Before your appointment, make a list of:
- Any symptoms you've been experiencing and for how long. Your doctor will want to know the extent to which these symptoms are affecting your daily life, including work and personal relationships.
- Your key personal information, especially any additional major stress or change you've experienced since your loved one died, such as serious illness, significant family disruptions or financial problems.
- Medical information, including other physical or mental health conditions with which you've been diagnosed.
- All medications, vitamins or other supplements you're taking and the dosages.
- Questions you'd like to ask your doctor.
You may want to ask a trusted family member or friend to be present for your appointment, if possible, to help you remember key information.
For complicated grief, questions to ask your doctor or mental health provider include:
- Do you think my symptoms are more severe than what's typical after a loved one's death?
- Do you think psychological counseling would help me?
- Are medications available that could improve my symptoms?
- What are the possible side effects of those medications?
- What self-care steps are most likely to help me?
- Are there local support groups or online support groups that might help me?
- How long do you expect it will take me to feel better with treatment?
- Will I eventually feel like myself again?
Don't hesitate to ask questions anytime during your appointment.
What to expect from your doctor
A doctor or mental health provider who sees you for possible complicated grief may ask:
- How often do you think about your deceased loved one?
- Do you believe you could have prevented your loved one's death?
- Do you ever wish that you had died along with your loved one?
- How well are you functioning in your daily life, such as work, household maintenance and relationships?
- Have you experienced any other major stresses, changes or loss since your loved one died?
- Have you had trouble eating or sleeping since your loved one died?
- How much social support would you say you have, such as from relatives, friends or a church community?
- Have you been diagnosed with any medical conditions?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use illegal drugs? If so, how often?
The normal process of grieving can become complicated grief when your symptoms show no signs of improvement over time.
Grieving is a highly individual process for each person, and determining when normal grief becomes complicated grief can be difficult. There's currently no consensus among mental health experts about how much time must pass before complicated grief can be diagnosed.
Complicated grief may be considered when the intensity of grief has not decreased in the months following your loved one's death. Some mental health professionals diagnose complicated grief when grieving continues to be intense, persistent and debilitating beyond six months.
There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Getting the correct diagnosis is essential for appropriate treatment.
Your mental health professional may consider you to have complicated grief based on these criteria. You experience:
- The death of someone close to you
- A lack of any improvement in your symptoms over time
- A significant impact on your ability to function in daily life
Your doctor or mental health provider will determine what treatment is likely to work best for you based on your particular symptoms and circumstances.
Complicated grief is sometimes treated with a type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). Other counseling approaches also may be effective.
During therapy, you may:
- Explore such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life's goals
- Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by images and thoughts of your loved one
- Explore and process emotions
- Improve coping skills
- Reduce feelings of blame and guilt
There's little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.
Although it's important to get professional treatment for complicated grief, you can also take these steps on your own to help cope:
- Stick to your treatment plan. Attend therapy appointments as scheduled and, if needed, take medications as directed.
- Exercise regularly. Physical exercise helps relieve depression, stress and anxiety and can redirect your mind to the activity at hand.
- Take care of yourself. Get enough rest, eat a healthy diet and take time to relax. Don't turn to alcohol or illegal drugs for relief.
- Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
- Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
- Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
- Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate or acknowledge your loved one that provide you comfort and hope.
- Learn new skills. If you were highly dependent on your loved one, for example, to handle the cooking or finances, try to master these tasks yourself. Ask family, friends or professionals for guidance, if necessary. Seek out community classes and resources, too.
- Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.
It's not clear how to prevent complicated grief. Getting counseling or psychotherapy soon after a loss may help, especially for people 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.
- Counseling. Through early counseling, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative thoughts and beliefs from gaining such a strong hold that they're difficult to overcome.
- Talking. Talking about your grief and allowing yourself to cry also can help prevent you from getting stuck in your sadness. As painful as it is, trust that in most cases, your pain will start to lift if you allow yourself to feel it.
- Support. Family members, friends, group therapy and social support groups are all good options to help you work through your grief. You may be able to find a support group focused on a particular type of loss, such as death of a spouse or a child. Ask your doctor to recommend local resources.
Sept. 13, 2014
- Conditions for further study: Persistent complex bereavement disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Aug. 14, 2014.
- Block SD. Grief and bereavement. http://www.uptodate.com/home. Accessed Aug. 14, 2014.
- Shear MK, et al. Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety. 2011;28:103.
- Coping with the loss of a loved one. American Cancer Society. http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsideeffects/griefandloss/coping-with-the-loss-of-a-loved-one-intro-to-grief-mourning-bereavement. Accessed Aug. 4, 2014.
- Grief, bereavement, and coping with loss (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/HealthProfessional. Accessed Aug. 14, 2014.
- Shear MK. Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience. 2012;14:119.
- Simon NM. Treating complicated grief. Journal of the American Medical Association. 2013;31:416.