Updated on June 29, 2023.
Grief is often born from loss, but it may look and feel differently from one person to the next. For some, it may come and go. For others, it may linger for months—even years. In some cases, those experiencing prolonged grief may need extra help to manage it, according to Marie Mitarotondo, a grief recovery specialist, hospice chaplain, and the spiritual director of Lourdes Health System in Collingswood, New Jersey.
Grief feels like something has been taken away from us, she explains, describing grief as the collection of strong and conflicting emotions we feel when we lose someone or something we love. “That feeling of loss can apply not only to the death of a loved one, but also to the end of a marriage or other relationship, or the loss of a pet, a prized possession, or even your financial status,” Mitarotondo says.
Acute grief usually subsides within 6 to 12 months. When grief persists and it is accompanied by other issues—like anger, inability to accept the loss, or inability to carry out daily activities— it may signal a more serious issue.
When grief becomes a heavy burden
Grief is a natural response to the loss of something close to you. That could be a family member, a pet, or in some cases, even a job or a home. Other traumatic experiences like pregnancy loss, car accidents, and divorce or separation from a partner can also bring about feelings of grief.
Acute grief eventually diminishes with time—usually within a year. Complicated grief, which is less common, tends to persist, and often involves severe symptoms.
Also referred to as persistent complex bereavement disorder or prolonged grief disorder, complicated grief is characterized by profound changes in one’s mental or emotional well-being. It often affects your ability to function from day to day, and may include feelings of intense worthlessness, loneliness, internal questioning of personal beliefs, a strong yearning for the person who passed, and an inability to accept the passing. In some cases, suicidal thoughts are also present.
In March 2022, prolonged grief disorder was officially classified as a mental health disorder for the first time in the American Psychiatric Association’s diagnostic manual, following years of debate. Its addition means insurance providers may now cover certain treatments for the condition. The diagnosis applies only to a small subset of people who are debilitated by their grief for an extended period. For adults, the loss must have occurred at least a year ago, or at least six months ago for children.
People with prolonged grief disorder experience at least three of the following symptoms almost daily for at least one month:
- Feeling as though part of themselves has also died
- Disbelief about their loss
- Avoidance of reminders about their loss
- Difficulty resuming normal activities and social interactions
- Feeling emotionally numb or detached from others
- Viewing life as meaningless
Some people may be at greater risk of developing prolonged grief disorder, including older adults and those with a history of depression or bipolar disorder. Caregivers are also at greater risk as are those who experience a sudden or traumatic loss.
The unpredictability of grief
Shortly after a loss, you can expect to experience feelings of sadness, confusion, and shock. There is no “normal” or predictable amount of time to grieve, and Mitarotondo says it’s important to realize that there are no set “stages” of grief, as conventionally understood. “That’s simply a myth,” she says.
“In a sense, grief is wild. It can circle back and hit us just when we think we've gotten everything under control,” she explains. “And the return of grief may be prompted by a scent, a song, or a phrase. It’s complex and can ambush us.”
The health effects of grief
Certain health conditions may occur at the same time as complicated grief or may be worsened by grief. These include:
Depression: Around 50 percent of those with complicated grief experience unipolar major depression. This can include prolonged symptoms related to the grief, such as:
- Mood fluctuations and irritability
- Sadness related to what has been lost
- Self-blame or guilt surrounding caregiving
- Difficulty concentrating
- Weight and appetite fluctuations
- Fatigue
Another common and more serious symptom of loss is suicidal thoughts or actions. Between 20 and 50 percent of those with complicated grief experience suicidal thoughts.
If you or anyone you know are having thoughts of suicide, reach out to the Crisis Text Line by texting ‘HELLO’ to 741741. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 or call, text, or chat 988.
If you’re with someone who is considering suicide, do not leave that person alone. Call 911 or go to the nearest emergency room.
Insomnia: This sleep disorder interferes with your ability to sleep through the night. It also affects how you function during the day. The condition can also cause sleep anxiety, the constant worry and obsessing that can come about when you can’t fall asleep, as well as concentration problems.
Anyone grieving (not just those with complicated grief) may experience sleep disturbances throughout the coping process, but insomnia is a common feature of complicated grief. In fact, sleep difficulties may worsen the symptoms of grief.
Post-traumatic stress disorder: Many people with complicated grief—an estimated 30 to 50 percent—have post-traumatic stress disorder (PTSD), a condition which may involve flashbacks and nightmares related to the loss lasting for a month or more. Additionally, those with PTSD may feel the need to avoid people, places, or things that remind them of the one who passed.
Anxiety disorders: Those who have complicated grief also have an increased risk of anxiety disorders. About 20 percent of those with complicated grief have generalized anxiety disorder, which is characterized by extreme and persistent worry over things like money, health, family, or work.
Roughly 10 to 20 percent of people experiencing complicated grief also have panic disorder, a condition in which one experiences spontaneous panic attacks.
Increased drug use: Substance abuse is common among those with complicated grief. This can include the harmful use of alcohol, tobacco, and illicit drugs to cope with the loss.
Physical illness: Many studies suggest that prolonged grief disorder is associated with a greater risk for medical issues, including heart disease, cancer, or high blood pressure.
Coping with complicated grief
The coping process can look different for everyone, but if you have complicated grief, experts generally recommend professional treatment. A psychiatrist, clinical social worker, or other healthcare provider (HCP) will walk you through the diagnosis process, which often includes an examination of your medical history and current symptoms, among other things. Your HCP will then recommend treatment options based on your symptoms and their severity.
The first line of treatment for complicated grief is often cognitive behavioral therapy, a treatment that can be done in a one-on-one setting with a therapist, in groups, or even online. This type of therapy usually involves working through ways to change thinking and patterns of behavior.
Whether you decide to pursue individual or group counseling, Mitarotondo says you can expect to discuss the myths about grief, confront the losses you’ve experienced in your life (both past and present), learn to articulate the things you may have wanted to do differently in those situations, and develop techniques that may be helpful in addressing future grief.
“We really focus on identifying and letting go of the negative, retaining the positive and sharing those feelings in a safe environment,” she says.
In addition to counseling or therapy, Mitarotondo also recommends a technique she uses in her programs called “memorializing the loss.”
“We use the creative arts to try to honor the person or other loss and make a positive concrete symbol of the relationship in all its goodness that people can carry forward,” she says. “Participants may create a collage, decorate a stone or a heart, create a small sculpture, write and share a letter, or use another medium to make a symbol to remember and honor their loved one.”
To address any other complications stemming from grief—such as PTSD, major depression, or substance abuse—your HCP may recommend more condition-specific treatment options such as medication or rehabilitation.
Healing doesn’t mean you’ve forgotten
If you’ve lost a loved one and you’re having a hard time understanding what life will be like once you do recover from the passing, it's important to understand that healing—even from complicated grief—does not mean that you have forgotten or that you are no longer affected by your loss. But it does suggest that you've gained acceptance, which can help protect your physical, mental, and emotional well-being.
