Updated: Jan 10
What is complicated grief?
People experience complicated grief when their experience of mourning lasts for a long time, causes significant distress in their lives, and does not resolve gradually on its own, as normal grief does. There is often a preoccupation with the loss, as well as difficulty accepting that the loss occurred. When a person’s grief last more than six months and they have persistent, intense longing for the deceased, they are likely to have complicated grief.
An example of complicated grief is when a person does not have an opportunity to express or process their grief, and so the feelings persist without being attended to properly. A person's parents might die and they might be the executor of the will or be an only child, having to take care of all the details of settling the estate by themselves. Instead of taking time to take care of themselves emotionally, they might have to suppress feelings of grief and take care of all the physical and legal tasks of burial, selling the house, etc.
What Puts You at Risk for Complicated Grief?
Sudden, unexpected loss such as murder, suicide, car accident, or disappearance of a beloved person, can result in complicated grief or traumatic grief. With sudden or unexpected loss, there is no preparation time, and a lot of questions and unresolved issues about how and why this happened.
One example is people whose family members have to be deported to another country. The people who remain in the United States wonder if their family member is alive or dead, and if they arrived safely at their destination. The combination of not knowing and not being prepared for the awful loss can make it more challenging to heal from the experience.
Research shows that excessive avoidance of the emotions associated with grief can lead to depression or complicated grief. When a person does not have the time to examine and experience the feelings, the grief can persist longer and find it more difficult to handle the intense feelings later.
Other factors that contribute to developing complicated grief include an unusually close relationship with the deceased, and attachment to the deceased that is complicated or dysfunctional. Additionally, some people develop it when they had to be a caregiver for the deceased before they died. All of this can complicate grief.
What is Traumatic Grief?
Additionally, there is a type of complicated grief that is called Traumatic grief, which has many symptoms of PTSD as well as sadness and the traditional symptoms of grief. Traumatic grief usually has intrusive thoughts about the death that evoke fear. People with traumatic grief sometimes worry about dying in the same way that their loved one died, and they may have nightmares or other intrusive symptoms similar to posttraumatic stress, regarding the loss or death. Witnessing someone dying in front of you, as many soldiers in combat experience, can be one way that a person develops traumatic grief.
Socially Stigmatized Loss can Result in Disenfranchised Grief.
Disenfranchised grief is one kind of grief that happens when the loss is not socially sanctioned or is stigmatized, such as dying from a disease like HIV/AIDS. This can also result in a person developing complicated grief. When a person has no social support or ability to talk to someone comfortably about the death, there is a greater possibility for their developing complicated grief.
How is Complicated Grief Different from Acute Grief?
What distinguishes complicated or persistent mourning from acute grief is that it is more intense, debilitating, and takes a lot longer to resolve. While Dr. George Bonanno's research showed that approximately 60% of people are able to resolve grief in about six months, there are also people who have difficulty moving past the loss.
The person with complicated grief may have difficulty accepting the death, or feel as well they have lost a part of themselves when their loved one died. The grief is debilitating and interferes with everyday functioning. A person may withdraw from others for an extended period of time, or lash out in anger that is not appropriate to the situation.
There is an intense yearning for the lost loved one or object with complicated grief. In addition, there is a sense of protest at the loss, meaning that the person cannot accept it. The parts of the brain that are activated by grief are the amygdala, which is like the brain's alarm system, and the cerebellum, which is involved in balance and physical coordination.
Physical and Mental Impact of Complicated Grief
Grief affects people emotionally as well as physically. Specifically, complicated grief can affect cardiovascular health, the immune system, and increase levels of cortisol. When a person has complicated grief, the nucleus accumbens is also activated in the basal ganglia (the midbrain). This can explain the intense yearning people feel for the deceased loved one. Complicated grief can also lead to increased inflammation in the brain, similar to what has been seen in mood disorders. This might account for some of the similarities between grief and depression.
Grieving also affects the posterior cingulate cortex and medial prefrontal cortex. These parts of the brain are involved in mentalizing, remembering, and recognizing familiar faces. Complicated grief could possibly be a risk factor for cognitive decline over a longer period of time as well.
The amygdala is the part of the brain that helps mammals pay attention to potential threats. In one study, the intrusiveness of grief related thought was correlated with activation of the amygdala. When the emotional part of her brain is overstimulated, it is hard to calm ourselves down and solve problems in life. It's almost like a car alarm that is constantly going off. How do we know when to pay attention to it, and when to ignore it? Thoughts about the loss can become intrusive because they seem emotionally important to our survival, so we keep having negative thoughts and the amygdala will not let us be.
Depression and Complicated Grief
Depression shares many symptoms in common with grief and complicated grief. However, depression is a psychiatric illness in which there are more global negative emotions and thinking than just about the loss. Additionally, a person with clinical depression has ported coping skills that make grieving more difficult and may be more helpless and hopeless them a person who is just having grief from a loss.
Both depression and grief involve intense sadness, sleep and appetite problems, low energy, tiredness, difficulty concentrating, and lack of interest or pleasure in things that used to bring pleasure. In depression, people often withdraw from others in general. Depressed people also have difficulty having even brief periods of enjoyment. People who are grieving can sometimes laugh or have enjoyment in spite of the loss.
Sometimes, people experiencing complicated grief can become clinically depressed. If the physical symptoms of depression like fatigue, sleep disturbance, and difficulty making decisions last for two weeks or several months, and if the person's functioning overall is negatively impacted, that might start to become depression.
Depression also is characterized by global, persistent negative thinking about everything, including oneself. Complicated grief tends to center the negative thinking around the loss or the deceased.
Treatment of complicated grief
There are many approaches to treatment for complicated grief. Psychoeducation about death and mourning can help people normalize some of the experiences they have since the loss. Processing the unexpected or sudden nature of the death can also help get the person unstuck from their preoccupation.
Cognitive behavioral therapy and group therapy can provide support for the bereaved, and can challenge faulty thinking that interferes with healing. Interpersonal therapy can also help people with complicated grief establish healthier connections with living loved ones in their lives.
Complicated Grief does not have to be a permanent condition. It is something that, with professional and peer support, can be resolved. If a person never was able to express the grief, having a skilled professional to listen and process the grief with them can be very helpful.
Additionally, finding supportive and nonjudgmental people to talk to about it can be helpful. There are groups such as Compassionate Friends, which are led by peers, that deal specifically with losing family members or children.
Personal Work on Complicated Grief.
If a person has lost someone and thinks that they have complicated grief, they can use journaling, meditation, prayer, spiritual support, peer and professional support, and rituals to demarcate the significance of the loved one's passing.
Ultimately, finding meaning in the person's loss can be very helpful, so that it doesn't seem pointless and make a person feel helpless and hopeless. Healing is possible, it takes a proactive stance to connect with the resources that are likely to help resolve the complicated grief.
If you believe that psychotherapy could help you with your complicated grief, please call for an appointment today at 661-233-6771.