Also Called Traumatic Grief—It's a Problem When It Doesn't Go Away

Losing a loved one is always extremely hard, particularly when it's someone very close to you, such as a spouse. Everyone grieves differently, but acute grieving takes about six months or so. The pain usually becomes less intense over time, although feelings of sadness may never go away completely.

So how do you know when things have taken an unhealthy turn—when grief has become too debilitating or gone on for too long? How do you know when you (or someone else) are not grieving normally but are suffering from what’s known as complicated grief?

Beyond Sadness

If grieving lasts longer than six months and you're unable to accept the loss or adjust to life without your loved one, you are likely experiencing complicated grief. Sufferers will try to deny the loss as well as the pain and life changes that it has caused. They also have difficulty regaining a satisfying life.

Complicated grief (also called traumatic grief) occurs in approximately 10 to 20 percent of people who lose a loved one, which means more than one million Americans each year. Key features include:

  • a sense of disbelief or anger and bitterness over the death
  • intense yearning for the deceased preoccupation with thoughts of the loved one
  • avoidance of situations or activities that serve as reminders of the loss
  • presence of these symptoms for a long period of time, often several years

Complicated grief may also cause physical symptoms that mimic the illness or injury of the person who died, alcohol or drug abuse, problems sleeping, thoughts of suicide, and an inability to carry out normal tasks.

Not Depression or PTSD

Although complicated grief may seem similar to depression or post-traumatic stress disorder (PTSD), there are some major differences. In fact, the 2012 edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V) may recognize complicated grief as a separate condition.

While depression involves a pervasive sad mood and a lack of interest or pleasure in all aspects of life, sadness in complicated grief is focused solely on missing the person who died and a preoccupation with pleasurable memories of the loved one. Someone with complicated grief may over-idealize the dead person or express unrealistically positive recollections of the relationship, while people with depression usually ruminate about past failures and misdeeds.

Meanwhile, in PTSD, the primary emotion is fear in the aftermath of a physical threat. Nightmares are common, and any painful reminders are specifically linked to the traumatic event. In complicated grief, the primary emotion is sadness after a loss. Nightmares are rare, and painful reminders can occur in any context.

However, it is common for complicated grief to co-occur with either depression or PTSD. Estimates of this overlap vary, with rates ranging from 20 to 50 percent.

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

Published: 20 Aug 2013

Last Modified: 07 Jan 2015