Complicated Grief: A Wound That Won’t Heal

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No words can describe the anguish of losing someone you love. Although it’s difficult to see at the time, the grieving process actually helps the mind adjust to the sorrow of the loss, accept its finality, and find a way to adapt to a new normal.

But for some people—including 10 percent of bereaved women older than 60—those feelings of loss don’t improve over time. For individuals experiencing what’s called complicated or prolonged grief, traditional grief counseling doesn’t always help, and experts are investigating other emerging types of therapy to relieve prolonged grief, with some success.

What makes grief complicated?

If grieving lasts longer than six months and you’re unable to accept the loss or adjust to life without your loved one, you’re likely experiencing complicated grief.

Complicated grief can be so overwhelming that it becomes impossible to carry on with day-to-day living long after a loved one is gone. Two to 3 percent of people worldwide experience complicated grief. People mourning the death of a child, younger person, or someone who died unexpectedly are more prone to complicated grief, as are people who had a particularly dependent relationship with the deceased.

Mental health history also plays a part—people who have suffered from depression or similar conditions in the past are more likely to develop complicated grief.

The difference between “normal” grief and complicated grief is intensity and duration. Complicated grief continues for a long time and interferes with the tasks of everyday living. It’s often mistaken for depression because of its similar symptoms, which can delay getting effective treatment, so it’s important that the correct diagnosis is made early on.

Complicated grief is a relatively new term, and clinicians don’t all agree on how to distinguish it from normal grief, or grief with concomitant major depression. Each condition has a somewhat different approach. In the extreme of grief with major depression, specific treatment for major depression should be the first step.

Complicated grief is typically diagnosed if you have intense yearning for the deceased and at least four of the following symptoms for at least six months:

• Difficulty moving on • Numbness/detachment • Bitterness • Feelings that life is empty without the deceased • Trouble accepting the death • A sense that the future holds no meaning without the deceased • Being on edge or distracted • Difficulty trusting others after the loss

You may also feel unable to re-engage with life and socialize with others. Complicated grief can cause physical symptoms that mimic the illness or injury of the person who died, alcohol or drug abuse, problems sleeping, thoughts of suicide, and an inability to carry out normal tasks.

Complicated grief therapy

Complicated grief shouldn’t be ignored. Individuals with the condition aren’t likely to get better on their own, plus they’re at risk for physical health problems and have a higher suicide rate.

Complicated grief is typically treated with psychotherapy and sometimes antidepressants, although evidence for drug use to relieve prolonged grief is weak. However, a more targeted therapy called complicated grief treatment is proving to be more beneficial.

Complicated grief treatment aims to restore function by helping the bereaved individual talk about his or her loss, which includes discussing the loved one’s death, engaging in imagined conversations with the person who died, and thinking about the death without intense feelings of anger, guilt or anxiety.

Therapists guide the individuals in developing goals for their future and concrete plans for putting those goals into action. Complicated grief treatment is based on principles similar to that of treatment for post-traumatic stress disorder and helps patients confront their loss through exposure.

In a study published in the November 2014 issue of JAMA Psychiatry, Columbia University researchers investigated the effectiveness of complicated grief treatment. They randomly divided 151 bereaved individuals into two groups, ranging in age from 50 to 91. Most were highly educated white women with complicated grief.

The average time of bereavement was about three years, although the range varied widely, from six months to 45 years. Most had lost a spouse or a partner (46.4 percent), followed by a parent (27.2 percent), a child (18.5 percent), or another relative or friend (7.9 percent). Slightly more than 13 percent of the losses were violent.

One group was assigned to a series of 16 weekly sessions of complicated grief treatment. The second group underwent grief-focused interpersonal therapy for the same length of time. Interpersonal therapy, commonly used to treat depression, focuses on an individual’s relationships with the deceased and others and helps him or her understand how bereavement and interpersonal events affect emotions and mood. While it can treat symptoms of depression in people who have complicated grief, it generally doesn’t relieve symptoms of grief. Both treatments were given as one-on-one, individual therapy.

After 20 weeks, 71 percent of the participants receiving complicated grief treatment were much better, compared with 32 percent of the participants who received interpersonal therapy. From a smaller sample of people evaluated six months later, benefits from both treatments were maintained for those who had responded well at 20 weeks.

Finding help

It’s important to find a mental health professional or grief counselor who knows how to recognize and treat complicated grief.

The Center for Complicated Grief at Columbia University maintains a list of clinicians who are knowledgeable about the condition and complicated grief therapy. The site also lists organizations that can help you find a licensed therapist if you can’t find a complicated grief therapist in your area.