Understanding Complicated Grief: Symptoms And Support Strategies

After the death of a loved one, it can be normal for a person to go through a grieving process. However, the difficult feelings associated with mourning tend to subside over time. Complicated grief, also known as prolonged grief or persistent complex bereavement disorder, is a type of intense grief that does not subside as time goes on. Individuals living with complicated grief may experience symptoms that interfere with their daily lives, presenting challenges at home, at work, and in interpersonal relationships. While this type of grief can be challenging to experience, it can often be treated with the support and guidance of a licensed mental health professional.

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Understanding complicated grief

Grief can be seen as a normal reaction to a loss. Normal grief patterns may include stages like denial, anger, bargaining, depression, and acceptance, although not everyone experiences each of these stages or goes through them in order. Those experiencing complicated grief may go through a longer and more intense version of these stages.

Prolonged grief disorder is a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The diagnostic criteria for prolonged grief disorder include the following: 

• Time: For adults, the death or loss must have occurred more than 12 months ago, and the deceased person must have been a person who was close to the bereaved. 
• Separation distress: Individuals with complicated grief usually develop an intense yearning for and preoccupied thoughts about the deceased person. 
• Cognitive, emotional, and behavioral symptoms: For complicated grief to be diagnosed, an individual must experience three of the following symptoms on a daily basis: identity disruption, a sense of disbelief about the death, excessive avoidance of reminders of the person they’ve lost, intense emotional pain, difficulty continuing interpersonal relationships, emotional numbness, loneliness, and the belief that life is meaningless.
• Functional impairment: Complicated grief symptoms must interfere with other areas of a person’s life, including their social and professional lives.
• Cultural considerations: Grief or bereavement usually extends beyond what is typical for a given culture in both time and intensity.
• Relation to other mental disorders: Prolonged grief disorder symptoms may not be better explained by another disorder, including major depressive disorder, post-traumatic stress disorder, or an anxiety disorder.

Symptoms of complicated grief

The symptoms of complicated grief may vary from person to person and may be similar to symptoms of typical grief. Symptoms can usually be divided into four categories. 

• Emotional symptoms: Complicated grief may involve intense sadness, despair, self-blame, and guilt, alongside a sense of numbness or detachment. 
• Physical symptoms: Individuals with complicated grief may experience physical symptoms, such as fatigue, exhaustion, physical aches and pains, and sleep disturbances. Complicated grief may also be associated with impaired immune system function and heart disease. 
• Cognitive symptoms: Cognitive symptoms may include persistent rumination about the deceased person or the circumstances surrounding their death, as well as difficulty concentrating. In some cases, a person with complicated grief may experience hopelessness or suicidal thoughts.
• Behavioral symptoms: Common behavioral symptoms for a person living with complicated grief can include the avoidance of reminders, overall social withdrawal, and impaired functioning in daily life. These changes can lead to strained interpersonal relationships and impacts at home and at work.

How can complicated grief impact mental health?

Individuals living with complicated grief may be more likely to develop major depressive disorder and experience anxiety. In an effort to self-medicate or manage negative emotions, a person experiencing complicated grief may also develop substance use disorder. These related disorders can exacerbate symptoms of grief and, without treatment, may increase the duration of prolonged grief. 

Individuals with complicated grief may also experience a strain on their social lives and interpersonal relationships. This can lead to increased social withdrawal, which may contribute to loneliness and social isolation. This, in turn, may lead to the development of other mental health disorders.

Support strategies for complicated grief

Treatment for complicated grief is often multifaceted, and it’s usually beneficial to develop a unique treatment plan for each individual to help them move forward. Below are a few strategies for managing complicated grief.

Build a support network

One way to manage complicated grief may be to build a strong support network. Surrounding yourself with friends and family members may help you combat the loneliness and social withdrawal often associated with grief. 

In addition to discussing complicated grief with your immediate social network, it may also be beneficial to join a support group specifically designed to address grief. Within these groups, you can learn from others experiencing similar situations and discover new emotional regulation and self-care strategies from people who understand what you’re going through. 

Employ self-help strategies

Mindfulness techniques, such as deep breathing exercises, meditation, and yoga, may reduce the impact of complicated grief and its associated symptoms. You may also find it beneficial to practice journaling or engage in creative outlets to express and reflect on your emotions.

Enacting a few lifestyle changes may also improve the symptoms of complicated grief. For example, you might develop a regular exercise routine, which can improve symptoms of grief. Prioritizing nutrient-dense foods, getting plenty of sleep, and staying hydrated can also be helpful.

Seek professional help

Professional help can be a way to manage complicated grief. Mental health professionals can draw upon a variety of therapeutic techniques to manage complicated grief, including complicated grief therapy (CGT), which is designed specifically for those living with prolonged grief disorder. 

Are you living with long-term grief?

Receive support in online therapy

It may be difficult for individuals living with complicated grief to make it to in-person therapy sessions. Online therapy may be a more accessible alternative, as it generally only requires an internet connection and a smartphone, tablet, or laptop, empowering people to attend therapy from the comfort of their homes. Seeking help through an online therapy platform can also make it easier to connect with a licensed therapist who specializes in helping individuals cope with grief and loss.

Research generally supports the use of online therapy for addressing grief. According to a 2021 systematic review and meta-analysis, online interventions can be “a safe and effective approach for treating symptoms of grief, depression, and posttraumatic stress after bereavement.”