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Complicated grief

Medically reviewed by Drugs.com. Last updated on Dec 13, 2022.

Overview

Losing a loved one is one of the most distressing and, unfortunately, common experiences people face. 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. 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:

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.

Symptoms

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:

Complicated grief also may be indicated if you continue to:

When to see a doctor

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.

If you have thoughts of suicide

At times, people with complicated grief may consider suicide. If you're thinking about suicide, talk to someone you trust. If you think you may act on suicidal feelings, call 911 or your local emergency services number right away. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Causes

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.

Risk factors

Complicated grief occurs more often in females and with older age. Factors that may increase the risk of developing complicated grief include:

Complications

Complicated grief can affect you physically, mentally and socially. Without appropriate treatment, complications may include:

Prevention

It's not clear how to prevent complicated grief. 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.

Diagnosis

Grieving is a highly individual process for each person, and determining when normal grief becomes complicated grief can be difficult. There's currently no consensus among mental health experts about how much time must pass before complicated grief can be diagnosed.

Complicated grief may be considered when the intensity of grief has not decreased in the months after your loved one's death. Some mental health professionals diagnose complicated grief when grieving continues to be intense, persistent and debilitating beyond 12 months.

There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Getting the correct diagnosis is essential for appropriate treatment, so a comprehensive medical and psychological exam is often done.

Treatment

Your doctor or mental health professional considers your particular symptoms and circumstances in determining what treatment is likely to work best for you.

Psychotherapy

Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD, but it's specifically for complicated grief. This treatment can be effective when done individually or in a group format.

During therapy, you may:

Other types of psychotherapy can help you address other mental health conditions, such as depression or PTSD, which can occur along with complicated grief.

Medications

There's little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.

Coping and support

Although it's important to get professional treatment for complicated grief, these strategies also may help you cope:

Preparing for an appointment

You may start by contacting your doctor. After your initial appointment, your doctor may refer you to a mental health professional who can help diagnose your symptoms and provide a treatment plan.

You may want to ask a trusted family member or friend to be present for your appointment, if possible, to help you remember key information.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

Some questions to ask your doctor or mental health professional include:

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Questions may include:

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