Complicated Grief

Complicated grief, sometimes called persistent complex bereavement disorder is a condition in which symptoms of bereavement like sorrow, numbness, guilt and anger do not subside even after a long period of time, usually six months. These distressing symptoms are common after you lose a person you love.

For most of the people, these symptoms ease gradually with time as they learn to accept the reality and decide to move forward in life. But people with this disorder are in continual state of denial and the symptoms become severe and debilitating, often impairing normal life. People go through various emotional phases after the loss of a loved one.

The phases are:

• State of Denial
• Accepting the reality of your loss
• Allowing yourself to experience the pain of your loss
• Adjusting to a new reality in which the deceased is no longer present
• Having other relationships

These phases occur sequentially and it takes time to move from one phase to another. If you are not able to move from one phase to another with the passage of time, you may have complicated grief. Talk to your doctor if these symptoms don’t resolve and interfere with your day to day life.

Normal grief and complicated grief may not be differentiated during the first few months after a loss as many signs and symptoms are common for both the conditions. In people with normal grief, the signs gradually fade away as the time passes by but in people with complicated grief, the signs linger or may worsen.

Signs and symptoms of complicated grief may include:

• Extreme sorrow and pain at the thought of your loved one
• Focus on your loved one's death
• Extreme focus on reminders of the loved one or excessive avoidance of reminders
• Intense and persistent longing for the deceased
• Continual state of denial
• Numbness or detachment
• Hopelessness
• Irritability or agitation
• Marked disbelief
• Pessimistic outlook of Life
• Deep sadness
• Guilt and self-blame
• Suicidal ideation

When to see a doctor

Call your doctor if you have been experiencing any of the symptoms of complicated grief after the loss of your loved one. People with complicated grief may consider suicide.

If such suicidal thoughts cross your mind, talk to a friend you trust or call 911 or your local emergency services number right away. Or call a suicide hotline number.

In the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.

The exact cause behind complicated grief is still a mystery.

However, a combination of your inherited traits, your personality traits, environment influences and body’s natural chemical balance is thought to be the major causative factor.

Your doctor may refer you to a mental health provider after initial consultation to make a diagnosis of complicated grief. Prepare yourself for the visit to make the conversation clear, concise and more fruitful.

What you can do

• Make a list of any symptoms, duration, severity and influencing factors.
• Write down your key personal information, mention any major stress or changes you've experienced since your loved one died, such as serious illness or financial problems.
• Write down medical information and include details of other physical or mental health conditions.

Make a list of questions to ask your doctor. Some typical questions include:

• Are my symptoms more severe than normal?
• Can counseling help me feel better?
• Can any medications improve my symptoms?
• What self-care steps are most likely to help me?
• Are there local support groups or online support groups that you recommend?
• Will I be the same me again?

What to expect from your doctor

A doctor or mental health provider may ask you questions like:

• How often do you think about your deceased loved one?
• Do you believe you could have prevented your loved one's death?
• Do you ever wish that you had died along with your loved one?
• Have these feelings affected your daily life, such as work, household maintenance and relationships?
• Have you experienced sleep problems since your loved one died?
• Do you have a history of other psychiatric symptoms or mental illness?
• Do you have any feeling of self-destruction or self-hatred?
• Do you drink alcohol or use illegal drugs?

It is quite normal for a person to go through this distressing phase after loss of a loved one. The feelings of bereavement and sadness are highly individual and generalizations are often difficult to make. What’s the exact duration for bereavement is almost impossible to answer. It depends upon an individual and other contributing factors like relation with the deceased one. However, the proposed criteria for complicated grief suggest the normal duration of bereavement is six months.

The essential criteria for complicated grief are:

• The death of someone close to you
• A lack of any improvement in your symptoms over time
• A significant impact on your ability to function in daily life

Talk to your doctor or healthcare provider to determine which treatmen method for complicated grief is the best for you.

Some treatment approaches are:

Psychotherapy

Complicated grief therapy is a psychotherapy aimed at counseling the patients with complicated grief. It's similar to psychotherapy techniques used for PTSD (post-traumatic stress disorder).

Psychotherapy may help you to:

• Explore new ways to redefine your life's goals.
• Explore and process emotions.
• Improve coping skills.
• Reduce feelings of blame and guilt

Medications

Only a few studies have been carried out to evaluate the effectiveness of psychiatric medications for treating complicated grief. However, antidepressants may be helpful in people with combined complicated grief and clinical depression.

There is no specific way to prevent complicated grief.

A few factors can minimize the risk and effect of grief:

• Counseling or psychotherapy: Psychotherapy may be given immediately after a loss reduce the risk of complicated grief. Early counseling can help you better cope with the situation. You may be able to learn how to reduce negative feelings, explore emotions surrounding your loss and learn healthy coping skills.
• Talking: Sharing the pain inside your heart with the ones you trust and cleaning your soul with tears could help you release the emotional baggage and feel better again.
• Support: Socialize and stay close to your family members and friends. You may also join a specific support group to share the pain among the people similar to you.

Lifestyle modifications are necessary in order to cope with complicated grief.

Every individual has his/her own way to cope with the harsh situations. Talk to yourself to find out what works the best for you or a friend, family member or your doctor may help.

Here are some tips that prepare you to better cope with the situation:

• Strictly follow your treatment plan
• Exercise regularly: Physical activities help ease depression, stress and anxiety symptoms. It may also distract your mind from the cause of pain.
• Take care of yourself: Get enough rest, eat a healthy diet and take time to relax.
• Don't turn to alcohol or illegal drugs for relief.
• Go to a faith community: If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
• Manage stress: Learn different stress management techniques like deep breathing exercises, cardio exercises and other relaxation techniques.
• Socialize: Stay close to the people around you like your family and friends.
• Find new ways to celebrate or acknowledge your loved one that provide you comfort and hope.
• Learn new skills: Learning a new skill takes a significant effort from you which in turn may distract you from the source of pain.
• Join a support group

There are several risks and complications associated with complicated grief.

Risks

• An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one
• Death of a child
• Close or dependent relationship to the deceased person
• Lack of a support system or friendships
• History of depression or other mental illnesses
• Traumatic childhood experiences, such as abuse
• Lack of resilience or adaptability to life changes

Complications

• Depression
• Anxiety
• Suicidal thoughts or behaviors
• Increased risk of physical illness, such as heart disease, cancer or high blood pressure
• Significant sleep disturbances
• Long-term difficulty with daily living, relationships or work activities
• Post-traumatic stress disorder
• Alcohol or substance abuse