If you’re having a difficult time after experiencing a loss, know that you’re not alone and healing is possible.
Grief is one of the human experiences that binds us together universally. And yet, when we’re each called to face it, we go through it in our own way.
For those who live with complicated grief, the process can be particularly challenging and feel never-ending.
You may want to move forward, but you’re not quite sure how to do it. Or maybe you feel like there’s no purpose to life anymore.
Feeling this way is natural and not uncommon. While it may feel impossible right now, there are ways to manage your grief and find healing. You can do this.
Grief is a natural response to losing someone you love. But for most people, even when challenging and hurtful, grief is a temporary experience.
Temporary doesn’t mean short — it may take months and sometimes longer to process a loss. But typically, the pain subsides gradually.
Most people go through stages of grief after a loss until they reach a level of acceptance. For other people, however, grief may become more intense and persistent.
Maybe you lost your child, or the love of your life passed away from an illness. Or, perhaps more recently, you were separated from someone you love in their final moments due to COVID-19 restrictions.
All of these can lead you to experience intense emotions — which can last months or even years. You may believe you’ll never get over it; months have gone by and you still don’t feel any different.
Between 2.4 and 6.7% of people share this experience. It’s typically referred to as complicated grief.
Complicated grief is an official mental health diagnosis, even though it’s known by another name.
As of 2020, the American Psychiatric Association has approved its addition to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as prolonged grief disorder. The term will replace persistent complex bereavement disorder, which also referred to the complicated grieving experience.
The International Classification of Diseases, 11th revision (ICD-11) added prolonged grief disorder to the list of mental health diagnoses in 2018.
The causes of prolonged grief disorder are not yet clear, but many factors may be involved, including:
- environmental aspects
Some people may be more likely to grieve for longer.
For example, some research suggests that those with a history of substance use disorder may be more likely to develop prolonged grief disorder.
The amygdala is the “fire alarm” of your brain. When a stressful or traumatic event happens, it’s the area of the brain that sends out the signal to be on high alert, prompting a rush of stress hormones, like cortisol, throughout your body.
In essence, those who live with complicated grief have brain activity similar to those engaged in an active fight-or-flight response, making it difficult to adapt to changes and move forward after loss.
Research from 2015 has suggested that a potential cause of prolonged grief disorder is a lost sense of identity after losing someone so close to you.
This, however, doesn’t imply causality. More research is needed to understand what leads someone to develop symptoms of complicated grief.
Everyone experiences grief in a different and unique way. However, the DSM-5 does outline the formal criteria to receive a diagnosis of prolonged grief disorder:
The first criterion for diagnosis is that you’ve experienced the death of a loved one, felt significant distress, and experienced disruption in your home life, social life, at work, or other areas.
In the last month or more since your loss, your response has involved a daily intense longing for the departed person and persistent preoccupation with memories of them.
For at least 1 month, almost every day, you’ll have experienced at least 3 of the following symptoms:
- significant denial or disbelief about your loss
- feeling as if you’ve lost part of yourself or your identity
- difficulty thinking about the departed loved one to the point of avoiding reminders of them
- intense emotions related to the loss, including anger, despair, and irritability
- difficulty returning to your usual social, academic, leisure, or work activities
- feeling emotionally numb
- loneliness or a disconnect from others
- feeling as if there’s no purpose in life
You’ve experienced significant distress to the point that it’s difficult or impossible for you to function in social, occupational, and other aspects of your life.
The way you feel can’t be explained by cultural or religious norms, including how long you’ve been grieving.
Mental health conditions
Your response to the loss, and the symptoms you experience, can’t be explained by substance use or other mental health conditions.
It’s long been thought that we go through five stages of grief after facing a loss:
You may experience all these stages of grief after a loss, or only a few of them. Eventually, however, grieving fades over time as you reach acceptance on your own.
Sometimes, you may also experience anticipatory grief. This can happen before a loved one has died, like if someone has a terminal form of cancer or dementia, for example.
With complicated grief, you may find it more difficult to move through the different grieving stages.
You might feel stuck in one or more of them, unable to reach closure to get to acceptance. This can last for months or several years, and resolution typically requires the support of a health professional.
Complicated grief can sometimes be confused with depression because some symptoms overlap. Grieving and depression are not the same thing, though.
Depression may have a genetic component, thought to be a chemical imbalance in the brain related to neurotransmitters like serotonin. While it can be made worse by external stressors, they usually aren’t the primary cause.
Depression may also be related to unresolved trauma, abusive situations, and emotional dysregulation. There’s still not enough evidence to determine if these factors are also involved in prolonged grief disorder.
Complicated grief, on the other hand, is directly caused by a specific stressful circumstance: the death of a loved one.
From a clinical perspective, the symptoms vary as well. You can receive a diagnosis of depression after 2 weeks of symptoms like low mood, lack of motivation, and withdrawal from loved ones.
With grief, the process is naturally expected to take a while, so a diagnosis isn’t made until after a year. The core symptoms also focus around loss in a way that depression doesn’t, such as longing for your loved one or being preoccupied with memories of them.
Not being able to move on without the person you lost is a specific symptom of prolonged grief disorder and not depression.
With that said, it is possible to have complicated grief and depression at the same time.
Treatment for complicated grief looks different for everyone, but finding a safe space to process your feelings is the first approach that experts recommend.
Psychotherapy — aka talk therapy — may help you process the emotions surrounding the loss you’ve experienced. It may also help you develop coping skills to continue moving forward with your life.
Research in 2018 suggests that cognitive behavioral therapy (CBT), in particular, may help you manage symptoms of prolonged grief.
If you’re experiencing complicated grief along with anxiety or depression, medications may be an option to help you cope.
Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), are often used to treat symptoms of depression.
A doctor may also prescribe anti-anxiety medications like benzodiazepines (for example, Valium or Xanax).
Your doctor can help you figure out if your symptoms merit you taking medications and for how long.
There are several coping tools you can use to help you process grief.
One of the most important ones is to stay engaged in activities you value or enjoyed before your loss.
At a time when you may be having difficulty reaching out to others, self-care is essential.
There’s the good old trio of balanced nutrition, regular exercise, and 8 hours of sleep each night.
Some other self-care strategies include:
- spending time outside in nature
- practicing daily meditation
- spending time with friends and family even if you don’t feel like it at first
- watching a favorite movie or show
- practicing yoga
- journaling about your feelings
Grief is a natural response to loss. It’s a testament to how much you loved someone.
You’re allowed to feel this way — there’s absolutely nothing wrong with grieving.
Grieving takes time for everyone. But if it’s been going on for more than a month, you’re having a particularly hard time, and it’s significantly impacting how you see yourself and life in general, you may be developing symptoms of complicated grief.
Prolonged grief disorder is a formal mental health diagnosis, and it can be treated.
You may also find this Ted Talk by Nora McInery to be relatable. If nothing else, maybe it’ll give you a little comfort, knowing you’re not alone.
If you need a little more support, you can always find a professional who specializes in grief counseling. These resources can help:
- The Center for Complicated Grief’s find a therapist tool
- Hope for Bereaved’s free of charge services and helpline (315-475-4673)
- American Psychiatric Association’s Find a Psychiatrist tool
- American Psychological Association’s Find a Psychologist tool
- Asian Mental Health Collective’s therapist directory
- Association of Black Psychologists’ Find a Psychologist tool
- National Alliance on Mental Illness Helplines and Support Tools
National Institute of Mental Health’s Helpline Directory
- National Queer and Trans Therapists of Color Network
- Inclusive Therapists