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.
When grief does not improve over a significant period of time, 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 recovering from 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 these stages more than a year after the death of a loved one, 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.
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, pain and rumination over the loss 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
Lack of trust in others
Inability to enjoy life or think back on positive experiences with your loved one
Complicated grief also may be indicated if you continue to:
Have trouble carrying out normal routines
Isolate from others and withdraw from social activities
Experience depression, deep sadness, guilt or self-blame
Believe that you did something wrong or could have prevented the death
Feel life isn’t worth living without your loved one
Wish you had died along with your loved one
Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, complications may include:
Suicidal thoughts or behaviors
Anxiety, including PTSD
Significant sleep disturbances
Increased risk of physical illness, such as heart disease, cancer or high blood pressure
Long-term difficulty with daily living, relationships or work activities
Alcohol, nicotine use or substance misuse
Types of This Disorder
It’s not known what causes complicated grief. As with many mental health disorders, it may involve your environment, your personality, inherited traits and your body’s natural chemical makeup.
Contact your doctor or a mental health professional if you have intense grief and problems functioning that don’t improve at least one year after the passing of your loved one.
Getting counseling 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.
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, social support groups and your faith community 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 the death of a spouse or a child. Ask your doctor to recommend local resources.
Bereavement counseling. Through early counseling after a loss, 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.