Grief is a normal, often unpleasant emotion that is triggered by a major loss or change. We often associate grief with the loss of a loved one, but grief can be tied to any big change, even changes that we expected to happen.
Grief may occur after the death of a loved one, contraction of a serious illness, loss of a job or relationship, or loss of something dear to us, like a pet. Grief is a normal process. However, in some cases, grief may last for an extended period of time or feel like it will not go away. If your grief has not lifted for some time, you may be suffering from prolonged or complicated grief. Counseling and other supports can help.
Normal Grief vs. Complicated Grief
In the late 1960s, Swiss-American psychologist Elizabeth Kübler-Ross developed a way for us to understand grief that is still used today. Known as the “five stages of grief,” this method examined grief through five steps. What most people don’t know is that Kübler-Ross did not develop this method by studying grief associated with death, but rather, it was research around how people accept a difficult medical diagnosis.1
The five-stage model still remains popular, but researchers now understand that grief does not always follow such a specific path. However, these five stages are understood to be part of the process of normal grief.
- Denial. Grief-stricken individuals often do not accept the cause of their grief and may feel numb or deny that anything happened. This is a way our brain protects itself from sudden shocks. This is usually the first stage of grief.
- Anger. When faced with the reality of what has happened, the person may become frustrated, irritable, or even angry at themselves or others.
- Bargaining. During this stage, a person may try to make a deal with their Higher Power and say things like, “If you bring back my loved one, then I will do good things,” or, “If I recover from this cancer, then I will never smoke again.” If the loss is a job or a relationship, the person may try to negotiate a way to make it work again, or to reunite.
- Depression. Grief will cause sadness and decrease one’s desire to do things they once enjoyed. Usually, this stage is prolonged in patients who suffer from complicated grief. This phase of sadness is healthy, but it should not last longer than a year.
- Acceptance. When you come to acceptance, you will come to terms with whatever initially caused the grief and hopefully move on from the traumatic event. This does not mean that you forget your loved one, or that you no longer miss that person, place, or thing that you love. It simply means that you are able to move forward. Once you reach a state of acceptance, there is a smaller chance that you will struggle with complicated grief.
Not everyone experiences each of these stages, and some people may experience one or more stages at the same time. You do not have to experience these symptoms in a specific order to be classified as experiencing a normal grieving process.
Normal grief should cause no lasting impairment on your functional capabilities. However, in cases of prolonged or complicated grief, you may have the more severe symptoms of grief – such as emotional numbness and depression – for at least six months, while also suffering from some form of functional impairment.
Functional impairment refers to a situation where the grief causes a person to be unable to perform basic tasks. If you have functional impairment, you may suffer from a decrease in work performance, self-imposed seclusion, or other relationship problems. Complicated grief may even lead a person to use drugs or alcohol to self-medicate. Over time, chronic symptoms of complicated grief can even be potentially life-threatening.
Are You at Risk for Complicated Grief?
Medical research has not identified what causes complicated grief or who may be more susceptible. However, there are some established situations where a person is more likely to develop prolonged grief.
- An unexpected or violent death
- Lack of a support system – lack of either family or close friends
- A history of personal trauma
- Suicide of a loved one
- Childhood separation from parents or loved ones
- Dependent relationship with the deceased loved one
- Being unprepared for the loss
- Experiencing multiple losses within a short period of time
These factors may indicate a situation where prolonged grief can occur. However, some people will not experience prolonged grief even when they are exposed to one or more of these situations. The best way to diagnose complicated grief is to consult with an experienced, licensed counselor and make sure that the symptoms of grief subside over time.
The Symptoms of Complicated Grief
As mentioned previously, the initial symptoms of complicated grief are similar to those of normal grief. For the first few months, normal grief and complicated grief are often indistinguishable. The difference occurs because the symptoms of normal grief begin to disappear over time while the signs of complicated grief often linger or worsen.
- Obsessive focus on the loss or on reminders of the lost loved one
- Intense yearning for the person, job, home, or health that was lost
- Numbness or detachment from the outside world or from inner emotions
- Preoccupation with personal grief
- Bitterness or anger
- Inability to find pleasure in life
- Inability to carry out normal routines
- Lack of trust in others
- No motivation to attend social events
- Feeling that life has no meaning or purpose
How Complicated Grief Can Cause Other Problems
Prolonged grief is a mental illness that affects a person physically, mentally, and socially. As grief continues to linger, a person may become more likely to slide into a deep, profound depression. They may become unmotivated to perform any task and would rather not interact with the people around them. In the worst cases of depression, the bereaved individual will turn to thoughts of suicide.
Without treatment, truly depressed individuals are at a high risk for attempting to harm themselves. Prolonged grief places a great amount of stress and tension on the affected person. High levels of stress can also cause physical illness. People who suffer from prolonged grief are more likely to suffer from high blood pressure and heart disease. Cancer rates are also elevated in people who suffer from complicated grief.2
Grief & Substance Use
Unbearable grief can drive people to substance abuse. At first, they turn to mild substances such as alcohol or nicotine, but as the grief lingers, patients graduate to more powerful substances like heroin or cocaine. Initially, that person may turn to further substance abuse to alleviate the symptoms of grief. Unfortunately, over time, that person may also become addicted to the substance.
Addiction to any substance or behavior is a whole other disease that brings its own set of complications and usually exacerbates the effects of a grief disorder.
Prolonged Grief Disorder
Complicated grief is also known as “prolonged grief disorder.” The most telling complication of prolonged grief disorder (PGD) is the inability to deal with daily living. Even the most mundane chores seem daunting to someone who suffers from PGD. People who struggle with this condition can truly benefit from the support of other people, including a licensed psychotherapist who can help increase coping skills. In some cases, mild antidepressant medications may help a great deal. If the grief is not treated, the person who suffers will slowly deteriorate physically and psychologically.
This disorder also adversely affects the friends and relatives of a person who suffers from PGD. They often feel hurt and helpless when they are unable to help their loved one. Some people react with anger or frustration. In most cases, complicated grief places a massive burden on all of that person’s relationships. Prompt, comprehensive treatment helps prevent any long-term damage to that person’s future.
What is the Treatment for Complicated or Prolonged Grief?
There is no set treatment modality that works in every case of prolonged grief disorder. Most medical professionals will design a treatment plan that best suits the patient’s specific symptoms and life situation.
The best treatment plans use a mix of psychotherapy and medications.
In psychotherapy, therapists guide the patient into the basis and foundation of their grief. Patients are encouraged to explore their reaction to grief, their symptoms and their personal goals. Therapy should provide the patient with coping mechanisms that reduce feelings of blame and grief.
Group therapy can help a person connect to other people and feel less isolated. Targeted treatment around any surrounding issues, such as depression or substance use, can make a huge difference.
Antidepressants are the most often used medications in prolonged grief, as they help patients deal with the symptoms of grief-associated depression. In most cases, pharmacological treatment is secondary to psychotherapy. However, even just a short-term (approximately 6 months to a year) treatment of antidepressant medication may help the grieving person gain enough energy and strength to use other supports and begin to connect with other people again.
How to Offer an Intervention for a Grieving Person
In the midst of intense grief, most people are unable to even consider treatment. The longer the grief lasts, the less likely they are to seek treatment for their depression. If left alone, people with prolonged grief are likely to suffer severe complications. Luckily, most grief-stricken individuals are surrounded by friends and relatives who are willingly to support and help them.
If grief is not healing over time, loved ones may recognize the symptoms of prolonged grief disorder and suggest the subject seek medical help. This is usually enough, but in some cases, the patient is resistant to treatment.
A deeply grieving person in the throes of complicated grief may believe that such intense, unrelenting grief is normal, that they deserve to suffer or that the grief is the best way to hold on to what initially caused the grief. Overcoming this resistance can be too difficult for some families, especially if their loved one has resorted to unhealthy coping skills such as substance use.
Sometimes, instead of approaching the patient on their own, families will employ a professional interventionist and stage a loving family intervention. During the intervention, the family will be able to vocalize their care and support, along with the adverse effects that the prolonged grief has caused. Ideally, the grieving person will then consider the presented information and agree to undergo treatment.
1 Feldman, D. Why the Five Stages of Grief Are Wrong. Psychology Today. 07 Jul 2017.
2 Mayo Clinic. Complicated Grief. 05 Oct 2017.