Losing a loved one is one of humans’ most stressful and shared experiences. Most people experience normal grief, in which the phases described by Elizabeth Kübler-Ross are presented in no particular order: denial, anger, bargaining, depression, and acceptance.

People have periods of crying, grief, and guilt; gradually, these feelings disappear, and they can continue their lives.

However, for some others, the feelings of loss are devastating and do not improve over time. This is known as Complicated Grief. In this condition, the grief is so prolonged and severe that it prevents emotional recovery and moving on with their lives.

Signs and symptoms of complicated grief may include the following:

• Profound sadness, grief, and constant thoughts about losing a loved one.
• Lack of concentration on matters other than the death of the loved one.
• Extreme attention to memories of the loved one or excessive overriding of memories.
• Intense and persistent longing or yearning for the deceased.
• Problems accepting the death.
• Numbness or detachment.
• Resentment of the loss.
• Feeling that life has no meaning or purpose.
• Lack of trust in others.
• Inability to enjoy life or remember positive experiences with loved ones.

Complicated grief may also be diagnosed if you continue to exhibit the following:

• Having trouble carrying out daily activities.
• Isolate yourself from others and withdraw from social activities.
• Having depression, deep sadness, feelings of guilt or self-reproach.
• Thinking of being doing something wrong or that you could have avoided death.
• Feeling that life is not worth living without a loved one.
• Wishing you died with your loved one.

Risk Factors

Complicated grief occurs more frequently in women and older people. Factors that may increase the risk of complicated grief include:

• An unexpected or violent death, such as one caused by a car accident or the murder or suicide of a loved one.
• The death of a child.
• A close or dependent relationship with the deceased.
• Social isolation, or lack of a support system or friendships.
• A history of depression, separation anxiety, or post-traumatic stress disorder.
• Traumatic experiences during childhood, such as abuse or neglect.
• Other significant life factors that cause stress include major financial difficulties.

Complications

Complicated grief can affect physically, mentally, and socially. Without proper treatment, complications may include:

• Depression.
• Suicidal thoughts and behaviors.
• Anxiety, including post-traumatic stress disorder.
• Significant sleep disturbances.
• Increased risk of physical illnesses like heart disease, cancer, or high blood pressure.
• Difficulty coping with daily tasks, maintaining relationships, and performing long-term work activities.
• Alcohol and nicotine use or substance abuse.

Prevention

It is not clear how to prevent complicated grief. Counseling soon after a loss may help, especially for people at higher risk for complicated grief. In addition, psychological support and counseling may be helpful for caregivers of a loved one with a terminal illness, as it will help them prepare for the death and the emotional aftermath.

• Talk. Talking about grief and allowing yourself to grieve can also help keep you from becoming immersed in sadness. As painful as it is, trust that, in most cases, the pain will begin to go away if you allow yourself to feel it.
• Support. Family members, friends, social support groups, and the faith community are all excellent options to help you through the grief. You can find support groups that focus on a particular type of loss, such as the death of a spouse or child. Ask your doctor to recommend local resources.
• Grief therapy. You can explore related emotions and learn healthy coping skills by engaging in therapy soon after a loss. It can help prevent negative thoughts and beliefs from becoming ingrained and difficult to overcome.