• Lisa S. Larsen, PsyD

What Is Persistent Complex Bereavement Disorder & What Are the Signs It's Affecting You?

Updated: Jan 10

boots on seashore
Grieving takes a longer time and is stuck in perpetual pain with PCBD; photo by Margaret Polinder

Grief is a powerful mixture of emotions and bodily sensations that you go through when you lose someone or something important to you. In most cases, it is very painful for a while as you grieve that person’s death, but it gradually lessens over time. You can have fond and happy memories of the person towards the end of your grieving process.

Unfortunately, this is not the case with Persistent Complex Bereavement Disorder. When you suffer from this, your grief does not get resolved normally in the typical timeframe, which is usually 6-12 months. Of course, length of time and difficulty in grieving depends on many factors, including how well you knew the deceased and the nature of that person’s death. You may wonder, what is Persistent Complex Bereavement Disorder?

Professionals have used many different titles for Persistent Complex Bereavement Disorder, including pathological grief, traumatic grief, complicated mourning, or complicated grief. In the Diagnostic and Statistics Manual, Fifth Edition (DSM-5), the American Psychiatric Association designated Persistent Complex Bereavement Disorder as a condition that needs further investigation before it becomes an official diagnosis. However, there seems to be enough literature available to know what its signs and symptoms are, as well as what treatments are more effective for complicated grief resolution.

people grieving and crying together on couch
Grieving together; Photo by Ben White

How Does It Help to Know What Persistent Complex Bereavement Disorder Is?

If you know what it is and how it might affect you, you can have a better chance of knowing whether it’s affecting you and what to do about it. This article focuses on what it is and how you know it’s affecting you. Future posts will address how you heal from Persistent Complex Bereavement Disorder.

Persistent Complex Bereavement Disorder develops when you cannot grieve a death normally. There are many factors that interfere with normal bereavement. For example, a sudden or violent death, multiple deaths in a short amount of time, lack of social support, unusually close relationship with the deceased, and ambiguous loss can all make it hard for you to accept that the person has died. With Persistent Complex Bereavement Disorder, there are three main things that prevent you from functioning well.

Three Main Components of Persistent Complex Bereavement Disorder

First, there is an intense yearning for the deceased and pangs of grief that are emotionally overwhelming. Second, you might protest over the death; this fixes your attention on the death and not the deceased. In a way, when you have Persistent Complex Bereavement Disorder, you get stuck on the fact that the person is no longer here and accessible to you. Third, if the nature of the death was so awful that it traumatizes you, it can prevent you from accepting the death or internalize the deceased in a healthy, realistic way.

Here is a list of the symptoms listed in the DSM-5 for your reference. It becomes a disorder when these symptoms to cause significant problems in the your life functioning, such as social relationships, work, or school, or other activities of daily living, etc.

weaping man in suit and tie, black and white
When your emotional pain doesn't let up, it may be PCBD; photo by Tom Pumford

Let’s say you lost a person with whom you had a close relationship. Since your loved one’s death, you might experience intense sorrow and emotional pain when you think about your loved one. You might long for the person present again, or yearn for their company. It may be hard for you to think about anything other than deceased loved one, or the circumstances of their death.

In children and adolescents, this preoccupation may come in the form of how they play or behave, such as being very sensitive about hearing about death. The child might also be worried about other people in their lives dying in a similar way or imminently. You don’t have to have all of these symptoms present, but it needs to last 12 months or longer. For children, if they have struggled for at least six months, they meet the criteria for this condition.

More Symptoms of Persistent Complex Bereavement Disorder

Since the death, you may have struggled with at least six of these symptoms on a regular basis for at least 12 months for adults, (six months for children),

  • Disbelief that the person is dead or emotional numbness about it

  • Difficulty bringing up pleasant memories about the deceased

  • Bitterness or anger about the loss

  • Blaming yourself or others for the death

  • Avoiding reminders about the loss

  • Desire to die to be with the deceased

  • Difficulty trusting others

  • Feeling alone and detached from other people since the death

  • Life feels meaningless or empty without your loved one

  • Belief that you can’t function without the deceased

  • Confusion about your role in life, or who you are since the death

  • Feeling like you can't or don't want to pursue interests since the death

  • Difficulty planning for the future.

A Traumatic Subset of Persistent Complex Bereavement Disorder

There is a subset of symptoms within Persistent Complex Bereavement Disorder that acknowledges the traumatic aspect of certain types of loss. For instance, if you lost someone unexpectedly, to violence or murder, or if you are unable to mourn with social support, that can be traumatizing. People who have lost a loved one to HIV/AIDS, for example, did not have the same support as someone who lost someone to a heart attack.

When this happens, the traumatic nature of the loss takes over emotionally and mentally. It dominates your thoughts. You have nightmares or intrusive images, especially if you've suffered with anxiety, depression or PTSD in the past. With all your focus on the traumatic loss, it is hard to move on and gradually come to a place of acceptance that the person really is gone and won’t come back. You might withdraw from other people and feel lonely, yet also find it unbearable to be with others who are not touched by grief.

Dual Process Model of Grief: Shift Happens

Normally in grief, there is a vacillation between confronting or experiencing the pain of the loss and getting a reprieve from experiencing the pain. You can go back-and-forth between feeling fine, being able to function normally and get on with life, and then having intense waves of sadness, anxiety, anger, and confusion. In normal grief, this subsides over time in intensity and duration.

With Persistent Complex Bereavement Disorder, you have a hard time getting unstuck from the negative feelings. You may ruminate or think about the loss over and over again. It can affect your mind and body, especially the heart, the hormonal system, and immune system. In order to restore the body to its natural state of good health, you need to remove the impact of the traumatic aspect of the death show that you can attend to the tasks of everyday living. There are various treatments that can help you accomplish this.

Brief List of Treatments for Persistent Complex Bereavement Disorder

Psychoeducation about complicated or traumatic grief is helpful to understand what you’re experiencing. Exposure therapy through Cognitive Behavioral Therapy or EMDR therapy can be useful in treating the traumatic aspect. Group therapy as well as working with your internalization of the deceased through journaling, role-play, letter writing, etc. is also very healing. If you want help in healing from Persistent Complex Bereavement Disorder, please call me today at 661-233-6771.