When is grief “complicated” as opposed to “normal”?

“Complicated” grief is given various names, such as delayed grief, chronic grief, pathological grief, distorted grief, abnormal grief.

We have described the normal process of grief, but sometimes (Raphael suggests in as many as 1 in 3!!) the grief pattern is more complicated. Marris (1986) would say this is simply underlining that grief is a very personal process, and that only rarely can we call a person’s grief pattern truly “complicated”.

We have indicated in other questions that each person suffering a serious loss will be faced with a complex grief journey. We also believe it is not helpful to talk about “normal” VS “abnormal”. But it is an important fact that some people have a more difficult grief journeys than others. Therefore it may be useful for those wishing to help to recognise some pathways are “complicated”, and have a background understanding of the main patterns of difference. In these cases, the more complex grief reactions may require extra counselling or other interventions.

Some common “complicated” grief patterns are:

1. Delayed grief

Where for some reason the grief responses are put on hold for a long time. For example, total intellectual and emotional denial, forever or until the reality cannot be denied ( eg illness, depression, not coping). Or intellectual acceptance but emotions put on hold (beware the difference between real emotional denial, and the common practical need to just manage getting on with survival living such as keeping a young family together).
This may also be seen where people seem locked in or “mummified” in their grief. For example where they keep on expecting a dead loved one to reappear; or where they express very prolonged anger or guilt.

2. Distorted grief

Where one aspect of grief process is emphasised; other aspects suppressed. For example, where people show extreme, out of proportion or irrational expressions of strong feelings such as anger, guilt. Or where they express grief in terms of physical ailments (Children commonly do this). Or the extreme of showing no reaction to a loss.
What factors may lead to particularly “complicated” grief?

1. When the relationship between the bereaved and the lost object or person is problematic. For example it may have been a very ambivalent relationships, or a highly dependent relationships.
   
2. When there are problematic circumstances surrounding the death, such as when the loss is uncertain (as in separation), or when there are multiple losses (Rest of family killed), or where no body found (deaths at sea), or with very difficult deaths such as suicide, murder, or self-neglect deaths.
   
3. When the life history of bereaved person is problematic, which may include those with a life history of complicated grief reactions, or when they have experienced a series of big losses close together (husband cancer, son suicide, daughter O/S)
   
4. 4. When the personality of the bereaved is problematic. For example, those who see selves as “strong” & who “must not” break down, can experience a complicated grief journey.
   
5. Finally, those who have grown up with difficulties in their family and cultural worlds. For example where the death (such as suicide) is perceived as deeply shameful. Or where the loss is ignored by those surrounding the bereaved. Or where there is either an absence of any social support network, or what there is is unhelpful and negative (“Just put it behind you and get on with life”)
   

The above reply is very thorough and hopefully gives you some helful information around clinical descriptions.

One very simple observation would be that ‘normal’ grief is something that steadily reduces over time. The person, though still feeling their loss, starts to feel that things are moving again.

In ‘compicated’ grief, this does not seem to be happening. The ‘stuckness’ persists, mood is down and seems to stay there, energy is low. There may be other symptoms too.

Talking to a trusted GP would be a good start. Counselling with an experienced psychologist/counsellor may well be helpful. 

If you decide to try counselling as a support for grief, ring the counsellor and have a chat before making an appointment. It really is fine to ask a practitioner what their experience is in an area such as grief and loss.

Good wishes for your journey.

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The DSM V has proposed a category Persistent Complex Bereavement Disorder.

Essentially the thoughts, feelings and behaviours are similar for normal grieving as Persistent Complex Bereavement Disorder.

The DSM V has proposed the following criteria to diagnose when normal grieving has become complex:

Since the death the bereaved has experienced on more days than not and to a clinically significant degree the symptoms of complex bereavement persisting for at least 12 months after the death has occurred for a period of 12 months

There are many factors why people’s grieving may be complicated

• Relational factors
• Circumstantial factors
• Historical factors
• Personality factors
• Social factors

Importantly  people can get stuck and overwhelmed in the tasks of grief.