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Stuck in Sorrow When Grief Becomes Complicated

Writer's picture: Cindy DavisCindy Davis

Elderly gentleman in sorrow with woman standing behind him with hand on the shoulder

Normally, grieving is a process where you gradually come to terms with your loss, allowing yourself to feel the pain, adjust to a new reality without your loved one, and eventually form new relationships. However, if you find yourself stuck in the depths of grief for more than a year after your loss, unable to move through these stages, you might be experiencing Complicated Grief.

 

According to a 2011 study, as many as one in four older adults may experience prolonged grief following a loss. Additionally, a 2014 study published in JAMA Psychiatry found that approximately 9 percent of bereaved women over the age of 65 suffer from prolonged grief.

 

Complicated Grief is a condition marked by an extended mourning period where you may find it nearly impossible to accept the loss. Symptoms of this prolonged grief can manifest as intense sorrow and emotional pain that don't seem to ease with time. You might find yourself unable to focus on the present or plan for the future because you are so preoccupied with the loss or the circumstances surrounding it. It's common to experience overwhelmingly negative emotions, feel a persistent longing for the deceased, or struggle to find any meaning or purpose in life post-loss.

 

This form of grief can feel like being trapped in a loop of despair, waking up each day as if the loss has just occurred, re-experiencing the initial shock and pain repeatedly. The intensity of Complicated Grief can make daily functioning difficult, affecting your ability to perform daily tasks or maintain relationships with others.


Understanding Prolonged Grief Disorder (PGD)

Complicated Grief shares many characteristics with Prolonged Grief Disorder (PGD). Recognized in clinical settings, PGD affects about 10% of those grieving, marking a severe interruption in the natural progression from acute to integrated grief.


Defining Prolonged Grief Disorder

While many bereaved persons gradually find their grief becoming less acute over time, approximately 7% to 10% find themselves unable to transition to a less intense phase of grief. This condition is especially prevalent among older adults, where the impact of PGD is notably higher than in younger populations. This ongoing, intense grief prevents individuals from adapting to loss and moving forward with life, effectively leaving them "frozen" in their grief state.

 

Prolonged Grief Disorder is a formal diagnosis used to describe individuals who remain in a state of intense mourning that disrupts daily functioning, well beyond typical societal or cultural timelines for grief. The ICD-11 suggests that symptoms persisting beyond six months may indicate PGD, while the DSM-5-TR sets this boundary at one year. Symptoms include persistent yearning, intense sorrow, and a preoccupation with the deceased, alongside an inability to engage in life meaningfully.


Diagnosing Prolonged Grief Disorder

Despite increasing recognition, Prolonged Grief Disorder often goes unnoticed within the medical community. Susan Block, a professor of psychiatry and medicine at HMS and a member of the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, notes that grief rarely receives attention in medical training. "Grief is often considered outside the scope of practice by most physicians," she explains, indicating a gap in medical education concerning end-of-life issues and grief management.

 

If you suspect that you might be suffering from PGD, often still referred to as Complicated Grief, it's crucial to discuss this with a healthcare provider who understands or is willing to explore the dimensions of grief. Proper recognition and intervention by informed healthcare providers can be life-promoting and, in some instances, lifesaving. If you find it challenging to manage your grief, reach out for help—there are resources and professionals ready to support you through this difficult time.


Identifying Who Is Susceptible to Complicated Grief

Complicated Grief is more likely to develop when a death is unexpected, sudden, or results from violent circumstances such as suicide, homicide, or an accident. These situations often leave little room for preparatory grief, making the shock and intensity of the mourning process more severe. Several factors increase the likelihood of experiencing Complicated Grief:

 

  • Deaths resulting from accidents, murder, or suicide can lead to more intense and prolonged grief reactions.

  • Losing a child or a spouse is particularly devastating and can greatly increase the risk of Complicated Grief due to the depth and intimacy of these relationships.

  • If you had a very close or dependent relationship with the deceased, the adjustment to life without them might be particularly challenging.

  • Lack of a support network or social isolation can exacerbate feelings of grief, making it harder to find relief from your sorrow.

  • A history of depression, anxiety disorders, separation anxiety, or post-traumatic stress disorder (PTSD) can predispose you to more severe grief reactions.

  • Childhood abuse or neglect can complicate the grieving process in adulthood.

  • Experiencing other significant stressors like financial hardship can intensify grief and make emotional recovery more difficult.

 

Without appropriate intervention, Complicated Grief can lead to a range of serious complications affecting your physical, mental, and social health:

 

  • The intense sadness of Complicated Grief can escalate to depression and suicidal ideation.

  • It heightens PTSD symptoms triggered by the traumatic nature of the loss.

  • Major disruptions in sleep patterns can affect overall health and well-being.

  • Increased susceptibility to illnesses such as heart disease, cancer, and high blood pressure is common.

  • Long-term challenges in managing daily activities, maintaining relationships, or performing at work.

  • Increased risk of alcohol, nicotine, or other drug use as means of coping with grief.


Recognizing the Signs and Symptoms of Complicated Grief

If you're struggling with Complicated Grief, the symptoms can be profound and all-consuming, impacting your emotional and physical well-being. Here’s how you can identify the signs that what you are experiencing may go beyond Conventional Grief responses:


  • Intense sorrow and rumination may find you in deep, persistent sorrow, constantly thinking about your loved one and the circumstances of their death.

  • Preoccupation with the deceased could lead to your focus being almost exclusively on your loved one's death, with little attention paid to other aspects of your life.

  • Extreme reactions to reminders might manifest as becoming overwhelmingly focused on reminders of the loved one or, conversely, going to great lengths to avoid anything that reminds you of them.

  • Longing and yearning could make you feel an intense, persistent desire to be reunited with the deceased, feeling as though you cannot continue without them.

  • Denial of the death might result in a substantial struggle with accepting that your loved one is gone.

  • Emotional numbness may cause you to feel detached or numb, unable to connect with emotions or with others.

  • Bitterness about your loss could lead to feelings of bitterness or anger about the circumstances of your loss becoming a big part of your emotional landscape.

  • Searching for meaning might have you questioning the purpose of life or feeling that life has no meaning without your loved one.

  • Distrust in others can develop from a lack of trust in people around you, often stemming from feelings of betrayal or disillusionment related to the loss.

  • Inability to enjoy life may result in losing the ability to feel joy or recall good times shared with the loved one.

 

Additionally, Complicated Grief might be indicated if you:

 

  • Struggling with daily life can manifest as having difficulty performing routines or tasks that used to be routine.

  • Withdrawing socially may involve isolating yourself and pulling away from friends, family, and activities you once enjoyed.

  • Experiencing severe emotional distress can be evident when symptoms of depression, deep sadness, guilt, or self-blame are prevalent, possibly leading you to feel you could have done something to prevent the death.

  • Feeling that life is unbearable might occur if you have thoughts that life is not worth living without your loved one, or if you wish you had died along with them.


Preventing Complicated Grief

While it's not entirely clear how to prevent Complicated Grief, there are strategies that may reduce the risk, particularly if you are considered at increased risk for developing this condition. Engaging in early intervention and support can be crucial.

Graphic listing Four Ways to Prevent Complicated Grief
Four Ways to Prevent Complicated Grief

Seek Early Counseling

Getting counseling soon after a loss can be particularly beneficial, especially if you're at increased risk of developing Complicated Grief. If you're a caregiver providing end-of-life care for a loved one, counseling and support before and after your loss can help you prepare for the death and its emotional aftermath. This proactive approach helps manage emotions as they arise rather than allowing them to build up unaddressed.


Talk About Your Grief

Talking about your grief and allowing yourself to express your emotions openly can be a powerful preventive measure. Crying and discussing your feelings helps process the sadness rather than letting it settle deeply within you. Although it's painful, trust that most often, your pain will begin to ease if you allow yourself to fully experience and express it.


Leverage Support Networks

Family members, friends, social support groups, and your faith community can all be invaluable resources as you navigate your grief. Engaging with others who understand and support you can provide comfort and practical help through tough times. Consider joining a support group focused on a specific type of loss, like the death of a spouse or a child. These groups can offer targeted support and shared experiences that make you feel less alone. Don't hesitate to ask your doctor to recommend local resources or support groups.


Participate in Bereavement Counseling

Bereavement counseling soon after your loss can provide a structured way to explore your emotions and learn healthy coping skills. This type of counseling can be instrumental in preventing negative thoughts and beliefs from becoming so entrenched that they are difficult to overcome later. By addressing your grief with a professional, you can learn to navigate your feelings in ways that foster healing rather than prolonging pain.

 

These preventative steps can help you manage your grief more effectively, reducing the likelihood of it evolving into a more complex, prolonged condition. Remember, seeking help early and often after a loss is a sign of strength, not weakness, and it can meaningfully improve your ability to cope with grief.


Seeking Help for Complicated Grief

If you're worried about the cost of seeking help, don't hesitate to ask your doctor or another healthcare provider about local professionals or programs that offer low-cost or free services. Treatment can help you come to terms with your loss and gradually reclaim a sense of acceptance and peace.

 

Remember, while Complicated Grief is a challenging and painful experience, it is also treatable. You don't have to navigate this path alone. Help is available, and it's okay to reach out for it. With the right support, you can start to make sense of your loss and slowly find your way back to a life marked by peace and new meaning.

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