Although anyone can experience complicated grief, the presence of one or more of these risk factors increases the likelihood:

  • a death that is sudden, unexpected, traumatic, violent, or random
  • death from an overly long illness, such as Alzheimer's disease or cancer
  • the loss of a child
  • the mourner's belief that the death could have been prevented
  • a relationship with the dead person that was angry, ambivalent, or overly dependent
  • the mourner having an illness that coincides with the death
  • the mourner's experience of multiple losses within a short time
  • lack of social support for the mourner

Brain Activity at Work

New research suggests that people who suffer from complicated grief may have increased activity in the part of the brain that gives emotional "rewards." Researchers recruited 23 women who had lost a mother or sister to breast cancer in the past five years. Eleven of the women were experiencing complicated grief, and 12 of them had grieved in a more healthy way. The researchers performed magnetic resonance imaging (MRI) scans on all of the women to see which parts of the brain were active when they looked at pictures of either their lost loved ones or strangers.

The pictures were superimposed with words that reminded the women of the death. In all of the women, looking at pictures of their loved ones caused activity in the parts of the brain connected with physical and emotional pain. But in the women with complicated grief, these same pictures also stimulated activity in the nucleus accumbens, which is central to the brain's reward system.

Although it may seem strange that the brain would provide a reward for grieving too much, the researchers offer one possible theory: Constantly thinking about and remembering the deceased is pleasurable—it's a form of addiction to your happy memories—but it also prevents you from letting go.

This finding could also help explain why antidepressants have mixed success in treating complicated grief. The most widely used antidepressants, selective serotonin reuptake inhibitors (SSRIs), affect the neurotransmitter serotonin, but different neurotransmitters, such as dopamine, act on the nucleus accumbens.

Publication Review By: Karen L. Swartz, M.D.

Published: 20 Aug 2013

Last Modified: 20 Aug 2013