Complicated grief - Bereavement and grief - HSE Library at Health Library Ireland @ HSE

What is complicated grief?

For a small number of people, the reduction in their feeling of grief over time does not happen. Their grief becomes stuck and they experience disabling and persistent symptoms that don’t improve. Strong feelings of yearning and distress continue to be experienced, often coupled with feelings of anger, guilt, bitterness, and an inability to re-engage with their life. This phenomenon is called Complicated Grief.

Complicated Grief (CG) is now recognised as a diagnosable disorder, with up to 10% of bereaved people at risk. CG can be diagnosed following a thorough clinical assessment as early as six months post-bereavement.

Who is likely to get stuck in grief?

We don’t know for sure who is going to get stuck in their grief, but we do know some of the factors that can make someone vulnerable to developing prolonged grief.

These include: an unexpected or violent death, a death that you feel could have been prevented and the death of a child. Other aspects also plan a role.

What are the signs of prolonged grief?

Prolonged Grief resembles the early acute stage of grief. Rather than changing, the grief remains as intense as it was in the early days of grief. The table below explains the difference between grief that’s integrating and grief that’s stuck.

Intergrated vs. prolonged grief

Integrated grief	When grief gets stuck
Pangs of grief lessen over time	Pangs of grief are persistent, prolonged or very intense
Acceptance of the death	Difficulty accepting the finality of the death
Feelings of longing & yearning are still there, but not constantly	Intense yearning/longing
Still having thoughts of the loved one, but able to think about other things too	Preoccupation with thoughts of the person who died
Able to enjoy the company of others	Avoiding or having difficulty in social situations
Able to experience moments of joy	Feeling numb, empty, no joyful moments

The International classification of diseases (ICD 11) lists prolonged grief disorder as a recognised difficulty.

What to do if you suspect you, or someone you care about, might be stuck in grief?

Talk to someone who is trained in prolonged grief. These therapists use a way of working that has been shown in several studies to be more effective for people struggling with prolonged grief than traditional therapy, but it’s not the only way to work with it. You can access a list online here or call Irish Hospice Foundation (01) 679 3188 for the name of trained therapists in your area.

Before beginning any therapy, it’s important to have a thorough consultation to make sure that prolonged grief is the difficulty (prolonged grief is sometimes confused with depression). It’s also important to feel comfortable with the therapist. Ask for a clear outline of how you’ll work together and what the cost will be.

Grief never goes away, but you can heal from grief, even when it gets stuck. You can get to a place where you remember loved ones with love rather than with pain.

Websites about complicated grief

The Center for Complicated Grief
Columbia University's Center for Complicated Grief aims improve the lives of CG sufferers through fostering continued innovative research and through public outreach that includes raising awareness of CG, reducing stigma and other misconceptions, and training professionals.
Mayo Clinic: Complicated Grief
This site is an introduction to Complicated Grief by the staff of the Mayo Clinic. It is written to help bereaved people understand what CG is and whether they are suffering from it.
Healthline: Depression v. Complicated Grief
This site provides a brief overview of complicated grief and explains how it differs from clinical depression. It covers the causes and symptoms of CG and explains treatment options.

Videos about complicated grief

Books about complicated grief

Complicated Grief by Margaret Stroebe (Editor); Henk Schut (Editor); Jan Van Den Bout (Editor)
ISBN: 041562505X
Publication Date: 2012-08-28
Complicated Grief provides a balanced, up-to-date, state-of-the-art account of the scientific foundations surrounding the topic of complicated grief. In this book, Margaret Stroebe, Henk Schut and Jan van den Bout address the basic questions about the concept, manifestations and phenomena associated with complicated grief. They bring together researchers from different disciplines, providing a broad range of cultural and societal perspectives, to enable the reader to access the scientific knowledge base regarding complicated grief, on both theoretical and empirical levels.
Treatment of Complicated Mourning by Therese A. Rando
ISBN: 0878223290
Publication Date: 1993-01-01
This is the first book to focus specifically on complicated mourning, often referred to as pathological, unresolved, or abnormal grief. It provides caregivers with practical therapeutic strategies and specific interventions that are necessary when traditional grief counseling is insufficient. The author provides critically important information on the prediction, identification, assessment, classification, and treatment of complicated mourning.
Complicated Grief Treatment Manual by Dr. M. Katherine Shear, The Center for Complicated Grief
Publication Date: 2015
Complicated Grief Treatment (CGT) is a 16-session, evidence-based approach that helps resolve grief complications and facilitate the natural adaptive process. By following the instructions in this manual and using other training supports as needed, you can learn to administer a simple, highly eﬀective treatment that can change the lives of people caught in a seemingly endless cycle of grief.

When Grief Gets Stuck

Grieving is difficult.

In early grief, many people experience strong emotions and feelings of loneliness, worry and upset. This grieving is sometimes called acute grief. Most people find their own way through their grief with the support of friends and family.

Some people benefit from talking to trained listeners who can provide some space and time for the bereaved person to process all that has happened.

The purpose of grieving is to find a way to stay connected to that person you loved, while being able to pick up the pieces of your life again.

We don’t get over loss, but grief naturally changes and reshapes in time and finds its rightful place in our hearts. When this happens, it’s called integrated grief. We still miss the person, we may still get upset at reminders of them or as certain significant dates approach, but we are functioning and have again found meaning in our lives.

However, the work of grief doesn’t always progress, and we now know people can get stuck in their grief.

When the symptoms of grief remain very intense and get in the way of everyday life, this is called prolonged grief. It’s sometimes known as complicated grief or persistent complex bereavement disorder. It’s a red flag that some more specialised help may be needed.

If we use the metaphor of the journey of grief being like a train journey, then prolonged grief would be the train overturning with its wheels spinning.

Prolonged Grief is a recognised difficulty, but it’s not well understood, and bereaved people with prolonged grief can be left feeling they’re not trying hard enough to get on with life or they are looking for attention or sympathy. The truth is dealing with unrelenting grief is very challenging and no one would choose to feel like this.

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Bereavement and grief: Complicated grief