Losing a loved one is one of the most distressing things that most people face. That experience is complicated when the death is sudden, unexpected or “out of order” such as a child dying before a parent. During normal grief and bereavement people go through a set of phases: denial, anger/frustration, bargaining, and depression followed by a gradual fading of these feelings as they accept the loss and move forward. For some people, though, this normal grief reaction becomes much more complicated, painful and debilitating, or complicated. In complicated grief, painful emotions are so long lasting and severe that the person has trouble accepting the death and resuming their own life. Some estimates suggest that as few as 6 percent or as many as 20 percent of bereaved people develop complicated grief.

It is important to note that, during the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually start to fade within six months or so, those of complicated grief get worse or linger for months or even years. Symptoms of complicated grief can include:

    Constant focus on the loss and reminders of the loved one
    Intense longing or pining for the deceased
    Problems accepting the death
    Numbness or detachment
    Bitterness about the loss
    Depression or deep sadness
    Difficulty moving on with life and carrying out normal routines
    Withdrawing from social activities
    Feeling that life holds no meaning or purpose
    Irritability or agitation
    Lack of trust in others

Exactly why two people can go through the same situation and one develops complicated grief while the other does not is not clearly known. We believe that the following risk factors make a person more prone to developing severe symptoms:

    Current or prior history of depression, PTSD or substance abuse
    Lack of a support system or friendships
    Number and degree of stressors in the 6 months prior to the loss
    A sense of responsibility for the death
    An unexpected or violent death
    Suicide of a loved one
    Close or dependent relationship to the deceased person
    Being unprepared for the death
    In the case of a child's death, the number of remaining children
    Lack of resilience or adaptability to life changes

Additionally, people who experience complicated grief often lack continued support after a few months. Friends and family tell them to “get over it,” or “move on.” If they could they would. In treatment we often find that people with complicated grief symptoms feel an extreme lack of control over everything. They benefit from a combination of narrative and cognitive behavioral therapy to help them make sense of their life and the world again.