Complicated Grief

What is complicated grief?

Complicated grief is long-lasting grief that occurs after a loss. It causes intense emotions and consuming thoughts that don’t fade over time and can affect your daily life.

Grief is a natural way of coping with a loss. It can feel like you’re stuck in the mud, lost in a fog or trudging through water. You may experience pain, sadness and/or anger. Grief usually lessens over time — when you’re ready to continue forward at your own pace. But complicated grief doesn’t go away on its own. It can wear on you physically and emotionally, more than what’s usually expected after a loss.

If you have complicated grief, you may feel:

• Overwhelmed about the cause or circumstances of a loss.
• Worried about the consequences of a loss.
• Like you need to avoid or push away reminders of loss.

A healthcare provider may refer to complicated grief as:

• Prolonged grief.
• Chronic grief.
• Persistent complex bereavement disorder.

What is the difference between normal grief and complicated grief?

Grief can affect each person differently. What separates complicated grief from other types of grief is that it’s persistent for six months to a year after a loss. It affects your ability to function and go about your day as you would have before the loss happened.

Does each person have a different grieving process?

Yes. While people who experience loss grieve, the way that each person processes loss can vary based on their:

• Background.
• Beliefs.
• Relationship to what or who they lost.

Everyone you meet has their own personality that’s unique to them and their environment. This can influence how that person copes with a loss and processes grief.

How common is complicated grief?

Complicated grief affects an estimated 7% of all adults who experience grief. Complicated grief or prolonged grief disorder is a relatively new addition to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), so research is ongoing to learn more about it.

What are the signs and symptoms of complicated grief?

Indicators of complicated grief may include:

• Having overwhelming, intrusive or preoccupying thoughts about loss.
• Feeling intense longing or emotional pain.
• Denying, avoiding or ignoring reminders of loss or surrounding yourself with reminders of a loss.
• Feeling like you no longer have a purpose after a loss.
• Difficulty accepting that the loss happened.

In addition, complicated grief can cause:

• Suicidal thoughts.
• Insomnia.
• Stress.
• Loss of appetite.
• Difficulty socializing.
• Declining physical health.
• Challenges with interpersonal relationships or fulfilling personal responsibilities.

If you have suicidal thoughts, contact the National Suicide and Crisis Lifeline (United States) by dialing 988. If you or someone you know is in immediate danger, call 911 (or your local emergency services number).

What causes complicated grief?

Loss causes complicated grief. It could happen after the death of a loved one, a divorce or moving, for example. Loss affects people in different ways and it can have a prolonged effect on a person.

What are the risk factors for complicated grief?

You may be more at risk of developing complicated grief if you:

• Experienced unexpected loss (suicide or accident).
• Lost someone in your immediate family, like a parent, sibling, child or spouse.
• Had close personal relationships with someone you lost.
• Experienced trauma during the event of a loss.
• Have an underlying mental health condition.

What are the complications of complicated grief?

Complicated grief can affect you mentally and physically. Complicated grief can cause long-term physical and mental health concerns that could include:

• Depression.
• Anxiety.
• Malnutrition or dehydration.
• Post-traumatic stress disorder.
• Heart disease.
• High blood pressure.
• Substance use disorder or alcohol use disorder.

How is complicated grief diagnosed?

A healthcare provider will diagnose complicated grief if you experience symptoms of grief that:

• Affect your physical, mental and social health.
• Continue for at least one year after the loss happened for adults and six months for children or adolescents.
• Happen daily for at least the last month before a diagnosis.

Your healthcare provider will look for at least three of the following to confirm a diagnosis:

• You feel as if part of yourself died with your loss.
• You don’t want to accept that the loss happened.
• You avoid reminders of the loss.
• You feel intense emotional pain.
• You’re unable to engage in social activities with your family or friends.
• You don’t experience emotions in the same way you did before the loss or you feel emotionally numb.
• You feel that your life doesn’t have meaning after the loss.
• You feel lonely or detached from other people.

How is complicated grief treated?

Many people find comfort participating in cognitive behavioral therapy (CBT) as a treatment for complicated grief. CBT can help you:

• Accept the reality of a loss.
• Adapt to a loss.
• Reengage in activities or with people as you did before the loss.
• Work toward goals of feeling better mentally and physically.

In addition, many people also join bereavement support groups. These are social groups where you connect with others who’ve also experienced loss.

If complicated grief caused any complications, a healthcare provider may prescribe medications to help you feel better like antidepressants, for example.

How soon after treatment will I feel better?

There isn’t a set amount of time as to when you’ll feel better after getting help to treat complicated grief. Each person deals with grief in their own way. It may take months to years before you start to feel better. Your therapist will work with you to help you meet your personal goals during each session.

Can complicated grief be prevented?

There’s no known way to prevent complicated grief. You can reduce your risk of developing complicated grief by:

• Talking with a mental health professional after a loss.
• Building a support system of loved ones.
• Joining a bereavement group after a loss.

What can I expect if I have complicated grief?

Loss is difficult to go through. Your thoughts may be flooded with emotions that affect your physical well-being. When these thoughts and feelings take over your ability to live your life, you should reach out to a healthcare provider. It might not be easy to do this on your own, so you may want to ask a loved one to support you as you make your first appointment.

Treatment for complicated grief is possible through therapy and support groups. A primary care provider may make recommendations if you don’t know where to start. They can also offer treatment if your grief affects your physical health in addition to your mental health.

When should I see a healthcare provider?

Visit a healthcare provider if you feel grief up to a year after your loss. If grief affects your ability to function or go about your day as you used to before a loss, a healthcare provider can help you feel better.

If you have thoughts of suicide, reach out to a healthcare provider or contact the National Suicide and Crisis Lifeline at 988.

What questions should I ask my doctor?

• Can you direct me to bereavement resources?
• Should I talk to a mental health professional?
• Do I need to take medications and are there side effects?
• Will I have long-term effects from complicated grief?
• How can I get back to my regular activities?
• I’m having suicidal thoughts. Can you help me find care?

A note from Cleveland Clinic

Complicated grief may feel like an endless cycle of emotional pain, as if the loss put a weight on your chest. It can be difficult to remove this weight on your own without treatment. While your symptoms of grief may improve over time with cognitive behavioral therapy, your feelings surrounding loss may come and go throughout your life. Certain days of the year, like holidays and anniversaries, may be more difficult than others. Understand that you’re not alone in your journey. There are people who can support you through the most challenging moments.