Complicated Grief

Overview

Complicated grief, sometimes referred to as persistent complex bereavement disorder, is a condition in which an individual experiences long-lasting and severe emotional pain following a significant loss. This type of grief is characterized by a failure to adapt to the loss and resume a normal life, leading to persistent and debilitating emotions such as sorrow, pain, and rumination. Complicated grief can have physical, mental, and social complications if left untreated, including depression, suicidal thoughts, anxiety, sleep disturbances, increased risk of physical illness, and difficulty with daily living, relationships, or work activities.

Understanding the disease

Symptoms

Symptoms of complicated grief may include intense sorrow, persistent longing or pining for the deceased, problems accepting the death, numbness or detachment, bitterness about the loss, feeling that life holds no meaning or purpose, lack of trust in others, inability to enjoy life, and difficulty carrying out normal routines. Complicated grief may also be indicated if you continue to isolate from others and withdraw from social activities, experience depression, deep sadness, guilt, or self-blame, believe that you did something wrong or could have prevented the death, or feel that life isn't worth living without your loved one.

Risk Factors

The risk factors for developing complicated grief include:

1. An unexpected or violent death, such as death from a car accident or the murder or suicide of a loved one.
2. Death of a child.
3. Close or dependent relationship to the deceased person.
4. Social isolation or loss of a support system or friendships.
5. Past history of depression, separation anxiety, or post-traumatic stress disorder (PTSD).
6. Traumatic childhood experiences, such as abuse or neglect.
7. Other major life stressors, such as major financial hardships. It's important to note that not everyone who experiences these risk factors will develop complicated grief, and some people without these risk factors may still develop the condition.

Development

Complicated grief develops when a person experiences severe, long-lasting, and debilitating grief symptoms that prevent them from recovering from the loss of a loved one and resuming their normal life. The exact cause of complicated grief is not known, and it may involve a combination of environmental, genetic, and chemical factors. Risk factors for developing complicated grief include an unexpected or violent death, death of a child, close or dependent relationship to the deceased, social isolation, past history of depression or other mental health disorders, and other major life stressors. Complicated grief can lead to various complications, including depression, suicidal thoughts, and social, mental, and physical issues. If someone is unable to move through the stages of grief (accepting the reality of the loss, experiencing the pain, adjusting to the new reality, and having other relationships) more than a year after the loss, they may have complicated grief. Seeking treatment can help individuals with complicated grief come to terms with their loss and find acceptance and peace.

Assessment and Diagnosis

Triage

If you are experiencing symptoms of complicated grief that persist for an extended period and are impacting your daily life, it is important to seek professional help. You should consider seeing a doctor if you:

1. Have symptoms of depression, such as persistent sadness, loss of interest in activities, and difficulty sleeping or eating.
2. Exhibit signs of anxiety or panic attacks.
3. Experience thoughts of self-harm or suicide.
4. Find it difficult to carry out your daily routines or socialize with others.
5. Have difficulty accepting the loss or experiencing guilt and self-blame.
6. Notice a significant change in your overall functioning, such as problems at work, school, or in your relationships. It's important to consult a mental health professional, such as a psychologist or therapist, who can help you work through your grief and provide appropriate treatment.

Diagnosis

To diagnose complicated grief, mental health professionals consider the intensity of grief, which has not decreased in the months after a loved one's death. Some professionals diagnose complicated grief when grieving remains intense, persistent, and debilitating beyond 12 months. It's important to note that there's currently no consensus among experts about how much time must pass before a diagnosis can be made. A comprehensive medical and psychological exam is often done to determine the correct diagnosis and appropriate treatment.

Management and Treatment

Complications

Complications of complicated grief may include depression, suicidal thoughts or behaviors, increased anxiety, significant sleep disturbances, increased risk of physical illness, long-term difficulty with daily living, relationships, or work activities, alcohol or substance misuse, and social isolation. Without appropriate treatment, these complications may persist and worsen over time.

Treatment

Treatments for complicated grief may include:

1. Bereavement counseling: Working with a mental health professional trained in bereavement counseling can help you explore your emotions, develop coping skills, and work through the grieving process.
2. Cognitive-behavioral therapy (CBT): CBT is a form of psychotherapy that focuses on identifying and changing negative thought patterns and beliefs associated with grief. This can help you manage your emotions better and improve your overall well-being.
3. Psychotherapy: A variety of talk therapies can be helpful in treating complicated grief. These may include interpersonal therapy, which focuses on improving relationships and communication, or supportive therapy, which aims to provide emotional support during difficult times.
4. Support groups: Joining a support group for people with similar experiences can help you feel less isolated and provide you with a sense of community. Group members can offer understanding, encouragement, and practical advice.
5. Medications: In some cases, medications may be prescribed to help manage symptoms associated with complicated grief, such as depression, anxiety, or insomnia. Antidepressants, anti-anxiety medications, or sleep aids may be recommended. Remember that recovery from complicated grief takes time, and seeking professional help is essential. With appropriate treatment and support, it is possible to heal and eventually reach a place of acceptance and peace.

Preparing for medical consultation

Preparing for an appointment for complicated grief involves several steps. Here's what you can do:

1. Make a list of your symptoms: Before your appointment, create a list of any symptoms you've experienced since your loved one's death, including how long you've been experiencing them and how they've impacted your daily life.
2. Gather personal and medical information: Prepare to share your key personal information, any additional major stress or change you've experienced, and any pre-existing mental or physical health conditions. Also, make a list of all the medications, vitamins, herbs, or supplements you're taking, including dosages.
3. Prepare questions for your doctor: Write down a list of questions to ask your doctor or mental health professional, such as whether your symptoms are more severe than typical after a loved one's death, whether psychotherapy would be helpful, and whether medications could improve your symptoms.
4. Be ready to discuss your loved one: If your loved one gives permission, be prepared to share their health history, any behaviors that cause concern, and their personal history, including any abuse or trauma they may have experienced.
5. Bring a support person: Consider asking a trusted family member or friend to attend the appointment with you, if possible, to help you remember important information and provide emotional support.
6. Be open and honest: During the appointment, be honest and open with your doctor or mental health professional about your experiences and feelings. Don't hesitate to ask questions and express your concerns. Remember that seeking help for complicated grief is an important step in your healing process.