What is Complicated grief?

Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve.
~Dr. Earl A. Grollman

You may have heard of the effort afoot to place “complicated grief” in the next issue of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-V), which is the most widely used psychiatric reference in the world. Mental health professionals and researchers have been working to agree upon specific criteria for identifying and assessing complicated grief – in order to get payment for treatment and funding for research, to identify those at risk, and to distinguish depression from complicated grief.

The concern among many experts and practitioners in the field of grief and bereavement is to what extent this effort to label complicated mourning as a psychiatric disorder “pathologizes” normal grief. Some believe that grief should not be a diagnostic category at all, because that in itself makes it a problem. Experience demonstrates that the distinction between uncomplicated grief and complicated grief is not clear, since most signs and symptoms occur along a continuum from less severe to very severe. Even in papers published in the professional literature, the terms that are used to describe it keep changing (e.g., complicated mourning, abnormal grief, pathologic grief, neurotic grief and traumatic grief) – and everyone agrees that a lot more research in these areas is needed. The condition is not limited to the loss of a person through death, either.

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 of Complicated grief

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

General characteristics of Complicated Grief may include:

Feelings:
Anger, sadness, guilt, despair, overwhelm, denial, betrayal, emptiness etc

Thoughts:
This is not real, This is unfair, I will never get over this, It’s my fault etc

Responses:
Withdrawal from social groups/events, addictive or reckless behaviour, avoidance of places and people or of being alone

General Health:
Fatigue, loss of motivation, sleeping problems, loss of appetite, pain and anxiety symptoms.

Risk Factors for Developing Complicated Grief

Any loss may trigger complicated grief, however the likelihood is increased if:

• the death of a loved one was either unexpected, sudden, traumatic, violent, or random
• the death was from a prolonged illness such as Alzheimer’s disease or cancer
• the loss was of a child
• the bereaved believed the death could have been prevented
• the relationship with the deceased person was overly dependent, angry, or ambivalent
• the bereaved was suffering from an illness that coincided with the death of the loved one
• the mourner suffered more than one loss within a short period of time
• the mourner lacks social support