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Complicated grief

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.

Symptoms Causes Risk factors Complications Prevention

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:

  • Depression
  • Anxiety
  • 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

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.
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