COMPLICATED GRIEF – SYMPTOMS, CAUSES, AND TREATMENT

WHAT IS COMPLICATED GRIEF?

Losing a loved one is one of the most traumatic and, unfortunately, common experiences people face. Most people going through normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Slowly these feelings ease, and it is possible to accept the loss and move forward.

For some people, feelings of loss are debilitating and do not get better even after time passes. This is called complicated grief, at times known as persistent complex bereavement disorder. In complicated grief, painful emotions are so long-lasting and severe that you have difficulty recovering from the loss and resuming your own life.

Different people take different paths through the grieving experience. The order and timing of these phases might vary from person to person:

• Accepting the reality of your loss
• Allowing yourself to go through the pain of your loss
• Adjusting to a new reality in which the departed is no longer present
• Having other relationships

These differences are normal. But if you are unable to move through these stages more than a year after the death of a loved one, you might have complicated grief. If so, look for treatment. It could 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 of the signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms slowly 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 prevents you from recovering.

Signs and symptoms of complicated grief might include:

• Intense sorrow, pain, and rumination about losing someone you love
• Focus on nothing more than your loved one’s death
• Extreme focus on reminders of the loved one or too much avoidance of reminders
• Intense and persistent longing or pining for the departed
• Problems accepting the death
• Numbness or detachment
• Bitterness about your loss
• The feeling that life does not have meaning or purpose
• Lack of trust in others
• Not being able to enjoy life or think back on positive experiences with your loved one

Complicated grief also might be indicated if you continue to:

• Have difficulty carrying out normal routines
• Isolate yourself from others and get away from social activities
• Experience depression, deep sadness, guilt, or self-blame
• Believe that you did something wrong or could have avoided the death
• Feel that life is not worth living without your loved ones
• Wish you had died along with someone you love

WHEN SHOULD YOU SEE A DOCTOR?

Contact your doctor or a mental health professional if you have intense grief and problems functioning that do not improve at least one year after the passing of your loved one.

If you have thoughts of suicide

At times, people with complicated grief might consider suicide. If you are thinking about suicide, speak to someone you trust. If you think you might act on suicidal feelings, call 911 or your local emergency services number right away. Or call on a suicide hotline number. In the United States, call on the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.

CAUSES

It is not known what causes complicated grief. As with many mental health disorders, it might involve your environment, your personality, inherited traits, and your body’s natural chemical makeup

RISK FACTORS

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

• An unexpected or violent death, like death from a car accident, or the murder or suicide of a loved one
• Death of a child
• Close or dependent relationship with the departed person
• Social isolation or loss of a support system or friendships
• Previous history of depression, separation anxiety, or post-traumatic stress disorder (PTSD)
• Traumatic childhood experiences, like abuse or neglect
• Other major life stressors, like major financial hardships

COMPLICATIONS

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

• Depression
• Suicidal thoughts or behaviors
• Anxiety, including PTSD
• Significant sleep disturbances
• Increased risk of physical illness, like heart disease, cancer, or high blood pressure
• Long-term trouble with daily living, relationships, or work activities
• Alcohol, nicotine use, or substance misuse

PREVENTION

It is not clear how to prevent complicated grief. Getting counseling soon after a loss might help, particularly for people at increased risk of developing complicated grief. In addition, caregivers providing end-of-life care for a loved one might 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 could help prevent you from getting stuck in your sadness. As painful as it is, trust that in most cases, your pain will begin 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 deal with your grief. You might be able to find a support group focused on a particular type of loss, like the death of a spouse or a child. Ask your doctor to recommend local resources.
• Bereavement counseling – Through early counseling after a loss, you could explore emotions surrounding your loss and learn healthy coping skills. This might help prevent negative thoughts and beliefs from gaining such a stronghold that they are difficult to overcome.

DIAGNOSIS

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

Complicated grief might 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 twelve months.

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

TREATMENT

Your doctor or mental health professional considers your specific 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 known as complicated grief therapy. It is similar to psychotherapy techniques used for depression and PTSD, but it is particularly for complicated grief. This treatment could be effective when done individually or in a group format.

During therapy, you might:

• Learn about complicated grief and how it is treated
• Explore such topics like grief reactions, complicated grief symptoms, adjusting to your loss, and redefining your life goals
• Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by pictures and thoughts of your loved one
• Explore and process thoughts and emotions
• Improve coping skills
• Reduce feelings of blame and guilt

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

Medications

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

If you or anyone you know is suffering from complicated grief, our expert providers at Specialty Care Clinics will take care of your health and help you recover.

Call us on 469-545-9983 to book a telehealth appointment for an at-home check-up.