Understanding Complicated Grief

The important thing to know about grief, is that while it can feel awful, it is a healthy adaptive process of healing. It is your brain’s way of making sense of the loss and it helps us to learn what we value and leads us to reach out for comfort and relationship. In a way, grief is really just a helpful tool for processing the loss.

Complicated grief on the other hand, can feel similar to grief, but it is in fact, very different from it. Complicated grief, also known as the persistent complex bereavement disorder, which is characterized by unshakeable grief that does not follow the general pattern of improvement over time; instead, individuals continue to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of functioning, or that cause extreme distress, (Shear, Simon, Wall, Zisook, Duan, Reynolds, 2011). While grief is an adaptive process of making sense of a loss, complicated grief is actually a disruption of the grief process – it keeps you from processing a loss (i.e. like a roadblock). Grief involves positive feelings and memories, and complicated grief generally makes it tough to be able to access the memory or loss in a way that enables you to have positive and honoring feelings. Also, grief is a reaction to losing something you value. Grieving is the healthy process of that wound healing, it is the cleaning out of the wound to process and associate other losses to that wound, it is painful at first but can get better over time. The entire grief process is necessary if they want the wound to heal fully.

Complicated grief is a reaction to a negative narrative or cognition you have that has been surfaced by some element of the loss. This means reaction that complicated grief is born out of a negative belief or experience that is attached to the loss. It could be a negative belief we have about ourselves, or possibly the relationship we had with the person who has died or is no longer in our lives. Instead of processing the loss, Complicated Grief keeps us stuck in the process, unable to do the healing work of grieving. Complicated grief is like the example previously of the wound healing, the pain and confusion, but it is caused not by the wound itself – but the infection that has gotten into the wound.

Complicated grief is the interruption of the grief process, instead of honoring the person or thing that was lost, some narrative is going to distract and stop that process. So rather than the grief narratives that come normally with the grieving process (i.e. “I don’t want to do this without them, why did this happen to me?”), a complicated grief narrative would stop that process (i.e. “People who cry are babies, I deserved this, I’m so weak”). Instead of a happy thought or story we tell ourselves about the grief, complicated grief prevents and almost makes it personal, where we did something to cause it. There are potential causes for complicated grief. This includes unresolved past grief or trauma, loss you feel responsible for, invalidated loss, delayed grief, ambiguous/hidden loss, compounded losses, or sudden, lingering or violent loss. Although there are many potential causes for complicated grief, identifying it can be tricky – as it is similar to the regular grieving process. Complicated grief is a condition in the DSM that is needs further study precisely because it is so complicated.

Here are some helpful links:




Complicated grief is a unique and different experience for those suffering from bereavement. Become a member of The American Academy of Bereavement today to find more resources on grief and its many facets.

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