Coping with Complicated Grief | Symptoms and Treatment

There is a really touching segment in the Disney movie ‘Up’ in which Carl’s life story is revealed. We learn of his beautiful relationship with Elle - its ups and downs - and the deep love he had for his wife. The audience understands how heartbroken Carl must’ve been when his wife died. Almost instantly, his antics and irritable nature can be justified and we can empathise with him. He was grieving, after all.

Grief comes in many forms and can last from a few days to a lifetime. Perhaps we have noticed certain changes in a friend or relative’s behaviour and are concerned about their wellbeing, although they claim to be “fine”. Unfortunately, we can’t have an animated sequence to explain these changes and they may easily go unnoticed. While there are different kinds of grief (source: National Hospice), Complicated Grief (CG) is one mental health disorder that is less widely known and more likely to be misidentified as depression or a ‘normal response’ to loss. As a result, it may be left unaddressed, putting individuals at high risk of stress-related illnesses and even suicide (source: American Cancer Society). Therefore, knowing the signs of CG is the crucial first step towards helping someone cope with it.

What is Complicated Grief?

"Complicated grief is a persistent form of intense grief in which maladaptive thoughts and dysfunctional behaviours are present along with continued yearning, longing and sadness and/or preoccupation with thoughts and memories of the person who died." (Source: The Center for Complicated Grief).

It is difficult to define a fixed time frame after which “normal” grief becomes CG as everyone’s experience is unique. However, the key difference is that with normal grief, feelings of sorrow or anger seem to dissipate with time and people start returning to their routines. With CG, a person may feel trapped, unable to recover or return to life as it was before, indefinitely. CG also usually occurs as a result of someone’s death while grief is the natural response to the loss of anything meaningful; even a job or relationship (source: Shear et. al., 2011).

Difference between complicated grief and depression

Studies show that the two conditions share a lot of similarities. Both are psychological disorders related to grief that last for prolonged periods of time. However, in order to receive appropriate treatment, they must be diagnosed correctly. As per the Journal of the Norwegian Medical Association:

Emotional: A key differentiating factor is that in CG, a person’s thoughts and emotion predominantly circle around the deceased whereas in depression feelings of loss or hopelessness are more general.

Mental: In CG people often have thoughts about things they could have said or done to “save” their loved one. “Brooding, such as «if only», «if only I had» done something different, this person would still be alive (counterfactual thinking), is also common.” In depression, people often express feelings of worthlessness or “being a burden” to others which are not characteristic of CG.

Behavioural: In depression, people exhibit an overall loss of interest in everyday activities they would have enjoyed previously. On the other hand, in CG people demonstrate a persistent preoccupation with the deceased, which may be accompanied by positive emotions or an intense longing for example, by using the deceased’s clothes to feel their smell or listening to their voice on a phone. Another difference is that whereas a person living with depression may exhibit overall withdrawal from social situations, a person with CG will tend to avoid specific places or things that remind them of their loved one.

Sleep: Disturbances and suicidal thoughts feature in both disorders. However, “pronounced weight loss, slowness in thinking, speaking and moving (psychomotor retardation) and difficulty in making decisions are prominent in depression but absent in CG.” Suicidal tendencies in depression often revolve around the idea of “escaping” or “ending” a situation with no other alternatives. In CG, suicidal thoughts are based on the idea of “reuniting” with a loved one.

Symptoms of complicated grief

Persistent longing - As mentioned above, CG occurs primarily after the passing of someone. However, it may occur in caregivers or relatives of people living with a terminal illness before their passing. Thus it is important not to rule out CG as a possibility simply on the basis of whether death has occurred. It is important to be able to identify the symptoms instead. Some examples according to Mayo Clinic are:

• Intense sorrow, pain and rumination over the (potential) loss of your loved one
• Extreme focus on reminders of the loved one or excessive avoidance of reminders
• Intense and persistent longing or pining for the deceased
• Problems accepting the death
• Numbness or detachment
• Lack of trust in others
• Inability to enjoy life or think back on positive experiences with your loved one

Ways to address complicated grief?

Counselling - While grief may often be resolved on its own, CG like depression is a disorder that is best addressed with professional help. Left untreated, it may manifest through harmful or abusive behaviours. According to Harvard Health, psychotherapy is one option which can “help people to identify incompletely mourned losses of the past and draw connections to the present loss.” A complicated grief treatment is another example where “the therapist provides information about the grieving process, along with an explanation of a "dual process" in which patients concentrate on both mourning (adjusting to the loss) and improved functioning (restoring a satisfying life).”

Care - Preventative approaches can also help someone cope with loss and reduce their risk of developing CG. Mayo Clinic suggests the following approaches to coping better:

• Take care of yourself. At a time when everything might seem hopeless, it is more important than ever to ensure that you take the time to get relax and eat well. Exercise can be helpful in relieving stress and anxiety and protect against alcohol and drug abuse.
• Reach out to your faith community. If you are religious, it might be helpful to reach out to your religious group for emotional support and guidance. If you aren’t religious, reach out to friends and socialise as much as possible; even if that means having a shoulder to cry on.
• Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate, positively reminisce or acknowledge your loved one that provide comfort and hope.
• Join a support group. When you feel ready to start transitioning back into your routine again, it may be a good idea to join a support group to find comfort and advice from people who are in similar situations.

No matter the kind of life you lead, loss and grief are inevitable. We all react to loss differently, whether it’s something small like losing your wallet or a life-changing event like the death of loved one. Grief is the body’s natural response to meaningful loss and can manifest in different ways. However, it is important to be aware of our (or somebody else’s) emotions and behaviours and be able to distinguish a “normal” response from something which might indicate an underlying problem. Mental illnesses like depression and complicated grief are not uncommon. However, it is crucial that anybody going through such an experience receives the right kind of support and treatment to avoid any grave outcomes.