Complicated Grief: When Sorrow Is Overwhelming

By Jane Farrell

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; extreme focus on the loss and reminders of the loved one; intense longing or pining for the deceased; problems accepting the death; numbness or detachment; preoccupation with your sorrow; bitterness about your loss; inability to enjoy life; depression or deep sadness; trouble carrying out normal routines; withdrawing from social activities; feeling that life holds no meaning or purpose; bitterness about your loss; inability to enjoy life; depression or deep sadness; trouble carrying out normal routines; withdrawing from social activities; feeling that life holds no meaning or purpose; irritability or agitation; lack of trust in others.

When to see a doctor

It’s normal to experience grief after a significant loss. Most people who experience normal or uncomplicated grief can move forward eventually with support from family and friends. But if it’s been several months or more since your loss and your emotions remain so intense or debilitating that you have trouble going about your normal routine, talk to your health care provider.

Specifically, you may benefit from professional help if you can focus on little else but your loved one’s death; have persistent pining or longing for the deceased person; have thoughts of guilt or self-blame; believe that you did something wrong or could have prevented the death; feel as if life isn’t worth living; have lost your sense of purpose in life; wish you had died along with your loved one.

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.

Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, these complications can include depression; suicidal thoughts or behaviors; increased risk of physical illness, including heart disease, cancer and high blood pressure; anxiety; long-term difficulty with daily living; post-traumatic stress disorder; substance abuse and nicotine use.

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.

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 a lack of any improvement in your symptoms over time and a significant impact on your ability to function in daily life.

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.

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). You may explore such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life’s goals. You may also 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.

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.

Medications

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 take steps on your own to cope, including:

Stick to your treatment plan. Take medications as directed and attend therapy appointments as scheduled.

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 balanced 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, perhaps to handle the cooking or finances, for example, 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.

Reprinted with permission from mayoclinic.org.