What is complicated grief?
I know you are thinking: isn’t ALL grief complicated? Maybe you have heard about other labels such as prolonged grief disorder and persistent complex bereavement disorder. Yet none of these phrases really capture the feeling of deep and long-lasting grief.
Approximately 10% of bereaved people experience grief symptoms that persist intensely, beyond socially and culturally accepted time frames (most often 6-24 months).
Before we address complicated grief, lets see what “normal” grief looks like. (In last month’s blog, I covered “normal” grief in more depth.) This is not a checklist to be accomplished in a certain order, but instead can be considered a cycle of suffering and growth.
A typical grief process includes:
Accepting the reality of the loss and how important parts of your life, such as your personal identity, roles, and environment, has forever changed
Working through the pain as you address the painful emotions that come up, including sadness, anger, fear, shame, guilt, blame, and loneliness. This means not shoving them down deep into your consciousness and hoping they go away on their own.
Redefining your relationship with your loved one who died and thinking about how you can maintain a solid, enduring connection with them, even if they are not physically present
Establishing a foundation and seeing the possibilities for a positive future without your loved one, with a renewed sense of purpose.
Truthfully, grief never fully resolves, and our lives will never return to the “normal” we knew prior to our loved one’s death. But in the course of this grief process, grief becomes integrated, meaning your memories still feel bittersweet, but the occasional tears start to feel balanced with optimism for your future.
Stuck in Grief
Sometimes, even a few years after a death, the grief process gets derailed or interrupted and you feel stuck in the deep pain, unable to imagine a way forward. This is complicated grief. The folks who supported you when your loved one’s death first occurred have now moved on with their lives and seem to have no patience for your endless sadness. They keep telling you it is time to leave the past behind and simply move on.
What they don’t understand is that you would do just that if you could only find a way! With complicated grief, the acute pain of early grief does not seem to lessen over time. You might be having persistent thoughts of your loved one and how they died. These symptoms are so intense that they even interfere with your daily functioning.
You might worry that you are suffering from major depression on top of the grief. That is a possibility, especially if you have a history of depression prior to the death. But grief is distinguishable from depression. According to the Center for Complicated Grief at Columbia University, “Core symptoms of Complicated Grief are persistent yearning and preoccupation with the deceased, whereas core symptoms of depression are pervasive “free-floating” sadness and loss of interest and pleasure.”* Depression feels like a general gloomy hopelessness, and is usually not specifically related to a death.
If you are feeling like you want to end your life in order to join your loved one who died, please immediately call or text: The National Suicide Prevention Lifeline: 1-800-273-8255.
Symptoms of Complicated Grief
Grief is painful, stressful, and often feels overwhelming. How do you know if you are dealing with complicated grief? First, has it been longer than six months since someone you love died and you feel deep grief just as intensely today, and just about every single day since their death?
If you answered yes, take a look at this list of symptoms, to see if any of them match your experience:
Intense persistent, deeply felt, painful emotions, including yearning for your loved one
Avoidance of previously enjoyed activities or anything that reminds you of your loved one
Social isolation: you prefer to be alone more often than prior to the death
Impaired daily functioning: you can’t keep up with your usual routine
Feel weak, and ashamed of your perceived inability to cope with the death
Extreme thinking, such as “I will never feel better” or “I will never be able to have a life without my person” or “I deserve all this pain”
Preoccupation with the loss, intrusive thoughts about your loved one and how they died
Fear that if you don’t hold on tightly to the grief, you will lose control of yourself or your connection with your loved one
Risk Factors for Complicated Grief
You are at higher risk for complicated grief if your loved one’s death was violent or sudden, or your loved one was a child. A bereaved person with a history of trauma, depression, or anxiety is also at increased risk for complicated grief. The good news is there is an evidence-based treatment for the challenges of complicated grief. Typically, within 4-6 months of complicated grief therapy, grievers are able to integrate their grief in a healthier way that allows them to have hope for the future.
Treatment for Complicated Grief
This type of therapy is a loosely structured and customized mental health treatment based on your unique needs, lifestyle, beliefs, and your special relationship with your loved one who died. Here are the main issues addressed during therapy:
Education about the grief process and research-based theories
Learn skills for coping: work through the death story
Monitoring system for grief symptoms and intensity
Learn to regulate your emotions
Reconcile with support system and improve communication with family and friends
Look carefully at your thoughts and beliefs that are contributing to your symptoms, including your loss of control and any guilt or regrets
Practice self care techniques and formulate goals to prepare for the future
Deal with avoidance of situations related to your loved one and their death
Revisit memories in healthier, objective way
Prepare for and manage special days, anniversaries and other grief triggers
Where to get help
If you or someone you care about is living with symptoms of complicated grief, please reach out for help as soon as possible. Look for a local mental health professional who is trained in complicated grief therapy. An experienced grief specialist will have the skills and expertise to walk you through the confusion and struggles of complicated grief.
You can read more about complicated grief here: https://complicatedgrief.columbia.edu/for-the-public/complicated-grief-public/overview/
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