CG is a form of grief that takes hold of a person’s mind and won’t let go

It is natural to experience intense grief after someone close dies, but complicated grief is different. Troubling thoughts, dysfunctional behaviors or problems regulating emotions get a foothold and stall adaptation. Complicated grief is the condition that occurs when this happens. People with complicated grief don't know what’s wrong. They assume that their lives have been irreparably damaged by their loss and cannot imagine how they can ever feel better. Grief dominates their thoughts and feelings with no respite in sight. Relationships with family and friends flounder. Life can seem purposeless, like nothing seems to matter without their loved one. Others begin to feel frustrated, helpless and discouraged. Even professionals may be uncertain about how to help.  People often think this is depression but complicated grief and depression are not the same thing.

A mother shares her story and her struggle with CG after losing a child and discusses her CGT experience

Grief

Grief is a person’s response to loss, entailing emotions, thoughts and behaviors as well as physiological changes. Grief is permanent after we lose someone close though it’s manifestations are variable both within and between people. Still, there are some commonalities that can help you recognize complicated grief.

Acute grief occurs in the initial period after a loss. It almost always includes strong feelings of yearning, longing and sadness along with anxiety, bitterness, anger, remorse, guilt and/or shame. Thoughts are mostly focused on the person who died and it can be difficult to concentrate on anything else. Acute grief dominates a person’s life.

Integrated grief is the result of adaptation to the loss. When a person adapts to a loss grief is not over. Instead, thoughts, feelings and behaviors related to their loss are integrated in ways that allow them to remember and honor the person who died. Grief finds a place in their life.

Complicated grief occurs when something interferes with adaptation. When this happens acute grief can persist for very long periods of time. A person with complicated grief feels intense emotional pain. They can’t stop feeling like their loved one might somehow reappear and they don’t see a pathway forward.  A future without their loved one seems forever dismal and unappealing.

Complications get in the way of adapting to the loss

There are three key processes entailed in adapting to a loss: 1) accepting the reality, including the finality and consequences of the loss, 2) reconfiguring the internalized relationship with the deceased person to incorporate this reality, and 3) envisioning ways to move forward with a sense of purpose and meaning and possibilities for happiness.  Most people move forward naturally in this way and grief finds a place in their lives as they do. Sometimes there are thoughts, feelings or behaviors that interfere with adaptation. Complicated Grief Therapy (CGT) helps people identify and resolve these interfering issues.

Troubling thoughts: After a loved one dies, almost everyone has some unsettling thoughts about how things could have been different. People with complicated grief get caught up in these kinds of thoughts.

Avoidance of reminders: People with complicated grief often think the only way they can manage pain is to stop the emotions from being triggered. To do this they try to avoid reminders of the loss.

Difficulty managing painful emotions: Emotions are almost always strong and uncontrollable during acute grief and managing them is different than at other times in our lives. Most people find a way to balance the pain with respite by doing other things, being with other people or distracting themselves. People with complicated grief are often unable to do this.

Articles

A Grief So Deep it Won't Die

The New York Times - Paula Span

After a Death, the Pain That Doesn’t Go Away

The New York Times - Fran Schumer