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. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the loss and resuming your own life.
If you have complicated grief, 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 a few months, those of complicated grief linger or get worse. Complicated grief is like being in a chronic, heightened state of mourning.
Signs and symptoms of complicated grief can include:
When to see a doctor
Specifically, you may benefit from professional help if you:
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.
It's not known what causes complicated grief. As with many mental health disorders, it may involve an interaction between inherited traits, your environment, your body's natural chemical makeup and your personality.
Researchers used to believe that all people moved through five specific stages of grief, in order. Today it's accepted that different people follow different paths through these experiences of grieving:
You may accomplish these in a different order or on a different timeline than another person grieving a similar loss. 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.
While it's not known specifically what causes complicated grief, researchers continue to learn more about the factors that may increase the risk of developing it. These risk factors may include:
Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, these complications can include:
Preparing for your appointment
Call your doctor if you've recently lost a loved one and are feeling 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.
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, and know what to expect from your doctor.
What you can do
Questions to ask your doctor or mental health provider include:
In addition to the questions that you've prepared in advance, don't hesitate to ask for more information at any time during your appointment.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
Complicated grief isn't a clear-cut disorder. It's not clear on exactly which signs and symptoms indicate a diagnosis of complicated grief. There are also many similarities between complicated grief and major depression, and researchers are working to clarify the key differences between these conditions. In some cases, clinical depression and complicated grief occur together.
Some factors that may help identify complicated grief include:
These symptoms sometimes occur during the normal process of grieving. In complicated grief, however, they show no signs of improvement over time.
There's currently no consensus among mental health experts about how much time must pass, exactly, before complicated grief can be diagnosed. Some experts recommend diagnosing complicated grief when two or more months have passed without any improvement in symptoms, while others recommend waiting six or more months. While researchers continue to try to pin down a time frame for this diagnosis, their work is made challenging by the fact that grieving is a highly individual process.
Rather than looking at the exact time period, a mental health provider is more likely to diagnose complicated grief based on:
Treatments and drugs
Complicated grief treatment hasn't been standardized because mental health providers are still learning about the condition. Your doctor or mental health provider will determine what treatment is likely to work best for you based on your particular symptoms and circumstances.
Other counseling approaches also may be effective. Therapy can help you explore and process emotions, improve coping skills, and reduce feelings of blame and guilt.
Coping and support
Although it's important to get professional treatment for complicated grief, you can take steps on your own to cope, including:
It's not clear how to prevent complicated grief. Participating in a brief course of 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.
Through early counseling, you can explore emotions surrounding your loss and learn healthy coping skills. This may help prevent negative beliefs about your loss from gaining such a strong hold that they're difficult to overcome. Talking about your grief and allowing yourself to cry also will 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.
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.
Last Updated: 2011-09-29
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