Complicated grief is more difficult to cope with, experts say. Here's why.

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It's fair to say that grief is a complicated state in all its forms. People deal with it in different ways, and there's no "right" way to grieve. But one type of grief is actually called "complicated grief," and it's primarily seen in people who enjoyed a very rewarding and loving relationship with the deceased.

For these people, working through the sadness and loss may be even more difficult than grieving over someone they were not as close to, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's Child and Family Development Center in Santa Monica, California.

Complicated-Grief-Explainer
Credit: Getty Images / Photo Illustration by Jo Imperio for Health

"Extended grieving that does not lessen in intensity and continues beyond six months in a manner that significantly impairs functioning, thinking, social engagement, and self-care is termed complicated grief," Mendez tells Health.

Complicated grief vs. common grief: how to tell the difference

When someone experiences complicated grief, thoughts of the lost loved one are overwhelming, Mendez says.

"The natural process of grief allows for the loss to be understood and accepted," she explains. "The grieving process grows less intense, the pain of the loss decreases (but may not extinguish), and the time spent grieving reduces such that it is not all-consuming."

Mendez stresses that grief has no "normal" timeline. However, there is a natural process of working through the grief. As part of this process, the grieving person becomes less likely to react emotionally to reminders of their lost loved one, and sadness is gradually replaced by fond memories. "A healthy grief process results in mindful discovery of ways to use the memories of the relationship to promote continued psychological growth," she says. "In grief, pain for the loss is accompanied by positive emotions about the loved one and includes experiences of humor, relief, warmth, pleasure in closeness to others, responsiveness to being consoled, and preservation of self-esteem."

Complicated grief interferes with the positive coping processes that are part of normal grief, which can affect a person's day-to-day functioning and their ability to care for themselves, Leela R. Magavi, MD, a psychiatrist and regional medical director for Community Psychiatry in California. "Normal or common grief can be illustrated by a working woman taking care of her children and finishing her work for the day, but simultaneously grieving under the 'normal' exterior and day-to-day activities," Dr. Magavi says. "On the other hand, complicated grief may lead to withdrawal from social interactions and lack of interest in once loved activities, including exercise and wellness."

Are some people more prone to complicated grief?

If you have a history of depression, you may be more likely to experience longer-term grief when you have to cope with loss, Mendez says. Grief is frequently a trigger for a bout of major depression, she adds.

People who struggle with trauma are also vulnerable to experiencing complicated grief. "When grief intensity doesn't decrease, stress prevails, and the loss is experienced as a traumatic life event—one that ultimately triggers major depression that is more serious than you would typically experience with a normal grief response," Mendez says.

Other people who may develop complicated grief are those who have lost loved ones to suicide, experience multiple losses, or had a problematic relationship with the person who died, Dr. Magavi adds.

Signs of complicated grief

Someone experiencing complicated grief may engage in avoidant behavior, use alcohol or substances to numb their pain, or show little interest in spending time with family members and friends.

Some people may experience psychotic symptoms (such as hearing voices) or experience suicidal thoughts due to the severity of their depressive or anxiety symptoms, Dr. Magavi says.

Other signs of complicated grief include anxiety about the meaning of the loss, fear that the pain will continue indefinitely, worry that happiness is lost and will never be realized, feeling cheated, blaming others for the loss, and feeling anger toward the person who died.

Survivor's guilt—a common reaction to traumatic events and a symptom of post-traumatic stress disorder (PTSD)—may also be tied into complicated grief, Mendez says.

While it's common for people with complicated grief to experience relentless longing, yearning, sorrow, and overwhelming deep sadness, sometimes there's nothing but a sense of numbness.

Dealing with complicated grief

The best way to deal with complicated grief depends on each individual's circumstances, and it may be best to work it out with the help of a therapist or psychiatrist. Mendez advises seeking treatment from a professional who specializes in issues of death, dying, and coping with depression that stems from unresolved grief issues.

"Therapy techniques that follow a cognitive behavioral approach can help someone struggling with complicated grief to change faulty cognitive processes that reinforce depression and negativity," she says.

Dr. Magavi recommends scheduling your days in advance to keep yourself busy and divert your attention from your pain in a healthy way. "Composing a gratitude list could also prove beneficial," she says. "If you have lost someone, you could celebrate their life by recounting memorable moments, looking through photographs, partaking in their favorite activity, or perhaps even writing a letter."

While spending time with other loved ones can provide comfort and support, it's also important to pinpoint your own emotions and thoughts in the midst of collective grief. Sometimes you need time alone to process your own emotional response, voice, and needs in order to reduce stress and gain clarity, Dr. Magavi says. If you're an empath, you'll naturally absorb other people's emotions—which could lead to an emotional breakdown during a tumultuous time.

Small, daily efforts can make a big difference in your journey out of complicated grief. Dr. Magavi advises all her patients to simply name their feelings out loud, then describe what they are feeling, both emotionally and throughout their body. "They make a log of their emotions and identify any triggering factors (those that exacerbated their condition), as well as alleviating factors (those that helped them feel better)," she explains. "This activity helps us learn more about what we feel, why we feel, and what we can do to combat helplessness and take control during times of uncertainty."

It's also important to own your grief, Dr. Magavi advises. That means resisting the temptation to alter your grieving process to match other people's (or society's) expectations. "Embrace your feelings, which may shift on a day-to-day basis," she says.

Whatever you do, remember the things that are always true about grief. First of all, it's a normal response to loss. "It's expected, and generally an adaptive response to loss from various perspectives," Mendez says." Also, grief is not a permanent state—even if it takes longer to process.

Credit: Julia Bohan-Upadhyay

How to Be OK When You're Not OK  Check out Health's special series on life after loss.