What is complicated grief? - signs & symptoms

When grief lasts longer and hits harder than usual, it’s called complicated grief.

In this article, you’ll learn what complicated grief looks like and what might cause it. We also share advice for coping with complicated grief or helping someone who is affected by it.

When is grief ‘complicated’?

It’s normal to grieve when someone close to us dies. We might feel sad, numb, overwhelmed or angry. These feelings can be very intense and painful.

However, grief usually fades over time. We don’t forget the person who has died, but we learn to cope with the reality of our situation and move forward with our lives.

Complicated grief doesn’t get easier with time. It may even get harder – and can last for many months or years.

This is what defines complicated grief. It shares many of the same symptoms as ‘normal’ grief but these symptoms don’t fade or go away. The grieving person may feel stuck in a state of grief or completely overwhelmed by difficult emotions.

Research suggests that complicated grief affects about 7% of bereaved people (NIH).

Complicated grief is sometimes known as ‘prolonged grief disorder’ or ‘persistent complex bereavement disorder’.

Is complicated grief an illness?

Complicated grief is real. There’s no doubt that people go through extremely difficult periods of grief that last an unusually long time.

However, no two cases of complicated grief are the same. Everyone experiences grief differently – and there are lots of things that could cause grief to last longer or feel more painful.

This is one reason why experts disagree on whether complicated grief is its own kind of illness. Some think it’s better to treat each person individually and focus on their personal thoughts, feelings and circumstances.

In any case, if you think you might be suffering from complicated or prolonged grief, it’s important to know that you can get professional help. Therapists aren’t concerned about whether complicated grief is an illness – they’re there to help you feel better and make sense of your emotions.

What are the signs and symptoms of complicated grief?

How can you tell if you or someone you know is going through complicated grief?

It’s hard to know for sure because everyone grieves differently. Some people need longer than others to process their loss or feel the loss more keenly. This is perfectly normal.

However, there are some signs you can watch for that suggest a person has moved beyond ‘normal’ (acute) grief and is experiencing complicated grief. Here are a few of them.

Not feeling better after a long time

There is no set time limit for when grief becomes ‘complicated’. Some sources say it’s when you’re still experiencing strong emotions after 6 months. Others say a year or more.

The important thing to look out for is whether these emotions get any easier. If it’s been months or years and you feel the same way – or feel worse – it might be complicated grief.

Not being able to cope with normal life

Complicated grief can completely take over a person’s life. They might be overwhelmed by their emotions and find it hard to do everyday things like shopping, work or socialising. Or they may feel emotionally numb and unable to enjoy the things they used to enjoy.

If someone you know is going through complicated grief, you might notice that the person has withdrawn from normal activities. Perhaps they don’t leave the house as often as they used to or they appear distant in social situations.

Struggling with very difficult emotions

When we grieve, it’s normal to feel shocked, numb, exhausted or sad. Some people also feel anger at the person who has died or guilt because of something they did or didn’t do.

In complicated grief, however, these symptoms are often heightened, persistent and repetitive. You may feel unable to stop thinking about the person who has died, no matter how hard you try. Difficult feelings and memories might crop up when you least expect them. And you may feel ‘stuck in a loop’, where you repeat the same thought patterns again and again.

Learn more about the symptoms of grief.

What causes complicated grief?

Complicated grief can affect anyone – and it may not have an obvious cause.

That said, some things appear to make it more likely. For instance:

Your closeness to the person who has died: complicated grief is more likely if you lose a very close relative, such as a spouse, parent or child.
The way the person died: grief may hit harder if the person died suddenly, unexpectedly or in a traumatic way.
Personal or family conflicts: if you were cut off from or in conflict with the person, it could make grieving more difficult.
Witnessing the death: perhaps you found the person or were at their bedside when they died.
Grief overload: this can happen when someone experiences lots of loss in their life. It might be caused by multiple bereavements or other forms of loss, such as divorce and redundancy.
Lack of sleep: poor sleep can increase the risk of experiencing complicated grief, which in turn can make sleep problems worse.
Mental health conditions: existing mental health issues such as anxiety and depression can make grief harder to cope with.

Complicated grief and depression

Complicated grief and depression are not the same. However, complicated grief shares many of the symptoms of major depression, such as feeling hopeless and overwhelmingly sad.

So how do you know if you’re suffering from depression or prolonged grief? It can be hard to tell – especially because complicated grief and depression can affect you at the same time.

One difference is that depression isn’t always linked to a real-life event. It’s often caused by a problem in the brain that affects our mood, whereas grief is tied to memories of the person who has died.

Another difference is that complicated grief sometimes comes in waves. You might feel OK for a while until something reminds you of your loss. Depression, on the other hand, feels more relentless and never seems to go away.

If you think you might be suffering from complicated grief or depression, you shouldn’t feel bad about reaching out for help. A trained professional like your GP can diagnose mental health conditions like depression and help you find a way forward.

Coping with complicated grief

How to help someone with complicated grief

Helping someone with complicated grief isn’t always easy. It’s common for the grieving person to feel guilty or ashamed about their emotions, which makes it harder for them to reach out for help.

One of the best things you can do is let them know that you’re willing to listen or talk. If they feel ready to discuss their grief, let them talk about their emotions and listen carefully to what they have to say.

You could also offer practical support. Complicated grief can make it harder to deal with everyday things, so a little help with grocery shopping or childcare might make a big difference.

The person may be suffering from a mental health condition like depression or PTSD. That’s why it’s really important that they know where to get professional help. You may want to provide contact details for a bereavement charity or encourage them to make an appointment with their GP.

Learn more about how to help someone who is grieving.

How to cope with complicated grief

Helping yourself

Prolonged grief can be very overwhelming and make things feel hopeless. However, if you can manage to make a few small changes to your routine, you may find that the symptoms get better with time.

Be kind to yourself

When grief takes over your life, it’s easy to feel guilty about experiencing happiness. However, it’s important to allow yourself little moments of joy. This might mean taking a hot bath, going on a long walk or rediscovering an old hobby.

Stick to a routine

Having a routine is good for mental health. Try to eat at regular times and keep a consistent sleep schedule.

Asking for help

Grief is often a lonely emotion – but it doesn’t have to be. Here are some ways you can reach out for help from others.

Friends and family

Just talking about grief can be a big help, so don’t be afraid to reach out to friends, relatives or community leaders. You might be surprised how many people are willing to listen – especially if they’ve gone through something similar themselves.

Bereavement charities

Charities like Cruse and Grief Encounter offer free bereavement support over the phone or online. Some charities can also put you in touch with specialist support in your area. Here’s a list of bereavement charities in the UK you can turn to.