Processing Complicated Grief In Healthy Ways

Losing a loved one is a human experience, but that doesn't make it any less distressing or difficult. Most people who experience a significant loss will undergo a period of numbness, sorrow, and even anger or guilt afterward. Those feelings can ease with time, and moving forward with life becomes possible.

So what happens when you experience a loss that continues to feel especially heavy and painful over a long period? What about when that overwhelming feeling in the pit of your stomach lingers, making you think things will never be the same? What can you do to learn how to cope with the death of a friend or a loved one? You're not alone if you're familiar with these feelings or painful emotions. While grief is a normal and healthy emotional process, complicated grief is just that: a bit more complicated.

What is complicated grief?

The typical stages of grief

While everyone experiences grief differently, there are a few broad stages of the process that most people will pass through—though the order and duration of each one can vary widely and may impact daily life in different ways. The initial stage of grief is known as denial or shock. During this stage, many people describe feeling as though they are “emotionally paralyzed”. They may feel disconnected from what happened or even have trouble believing it's real.

After the initial shock of a friend or loved one’s death, the anger and bargaining stages often come next. For some, feelings of anger and frustration at the unfairness of it all can become so overwhelming that they impact their other relationships. In other cases, people may blame themselves for the loss or feel guilty about some part of their past with this person. Even in situations where death occurs due to chronic illness, individuals may experience “survivor’s guilt” about being alive while their loved one is not. 

In the next stage, known as “depression”, the reality of the loss typically sets in. It may be characterized by strong emotions, especially deep sadness and loneliness. It’s the process of coming to terms with the grief and moving toward the final stage as time passes, which is acceptance—at which the difficult and painful feelings begin to lift. The person starts to feel an improvement in their overall well-being and emotional stability and can better move forward with their lives. For people with complicated grief, however, getting to the acceptance stage is often delayed and may even be difficult or impossible to arrive at without professional support.

Developing complicated grief

Complicated grief happens in about 7% of individuals, and risk factors include having a history of diagnosed mood disorders such as major depression or separation anxiety, experiencing multiple traumas early in life, or having a particularly close relationship with the deceased person. As someone else experiencing the same loss begins to emerge from the most difficult parts of the grieving process, an individual with complicated grief can continue to experience intense grief. The effects or symptoms can become persistent and overwhelming, impacting the person's daily living and hindering progress toward life goals.

Signs and symptoms of persistent complex bereavement disorder

Some common complicated grief symptoms may include:

• Feelings of numbness and detachment

• Excessive avoidance of potentially painful reminders of the death

• An inability to think about positive memories with the lost loved one

• Sense of acute grief in the beginning

• Intense or persistent longing for the person lost

• Intense sorrow or pain due to the loss 

• An inability to focus on anything but the lost loved one

• Extreme focus on things that remind one of them

• Difficulty re-engaging with life and planning for the future

Additional signs that you are experiencing complicated grief can include feeling the need to isolate yourself from others, having trouble carrying out your normal routines or taking care of responsibilities, experiencing depression or self-blame, or wishing you had passed away with your deceased loved one or instead of them. Complicated grief can also manifest as physical symptoms in addition to emotional symptoms, such as weight loss or gain, extreme fatigue, nausea and vomiting, insomnia, and aches and pains for no apparent reason. Complicated grief may also coexist with or cause other mental health conditions such as substance abuse or drug abuse disorders, clinical depression, or post-traumatic stress disorder (PTSD). In some, these feelings may lead to suicidal thoughts, especially in older individuals experiencing complicated grief. 

If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7. You can also contact your local emergency services number if needed. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Note that for complicated grief to be present, some or all of the above are typically experienced over a term that’s longer than what might be expected for societal or religious norms—typically a year or more. One study estimates that approximately 10% of people experiencing grief will develop this complicated grief, which generally requires treatment to resolve.

Tips that may help you in processing grief

While there is no right or wrong way to grieve, some coping mechanisms are healthier than others for moving through the grieving process and dealing with the associated emotions. Remember, overcoming any type of grief is a journey that takes time. Some of the following tips may help.

Acknowledge and be gentle with your feelings

No one expects you to experience a loss and not feel pain. It’s okay to hurt, to cry, and even to be angry. Acknowledging and allowing your feelings is often an important step in the healing process. As you go, it’s usually helpful to avoid judging yourself and instead accept your emotions with compassion and gentleness. Try not to feel pressured to act or feel a certain way; your grieving process is your own, and it’s perfectly valid.

Take care of your physical health

It can be difficult to get the motivation to eat when grieving, much less concoct a healthy meal. Exercise and quality sleep can also be difficult routines to keep up when experiencing a loss. That said, grief is draining, and taking care of your body can help you have the energy you need to get through it. One study found that participating in physical activity, in particular, may provide benefits for both the “physical health and psychological well-being of those who have been bereaved”. If you’re having trouble taking care of yourself in these ways, finding a friend or loved one who can support you or perhaps even join you in exercising and eating well may be helpful.

Know when to seek help

Expressing your grief can often be a helpful part of processing and moving past it. While some turn to journaling or the listening ears of their support system, such as friends and family members, to process negative thoughts, others find it helpful to work with mental health professionals. Licensed therapists are mental health experts who can offer a safe space for you to impart whatever you’re feeling about the situation and teach you healthy coping mechanisms to manage your emotions. 

While professional treatment isn’t necessary in every case of standard grief, it is typically recommended for cases of complicated grief. This condition is a mental illness and typically won’t resolve on its own, and when left untreated, its effects can be detrimental to a person’s daily functioning, relationships, and overall well-being. Treatment for complicated grief, such as complicated grief therapy (CGT), may be tailored to address the circumstances of the death and facilitate the grieving process. 

How to find support

If you're living with the difficult emotions of complicated grief, especially after losing a loved one to a serious illness, joining a support group may be helpful. The success of your treatment plan, including ways to manage or even prevent complicated grief, is highly dependent on what you specifically need. Support groups offer a place to discuss your feelings, learn how to cope, and meet others who have gone through something similar, potentially making your journey through grief a bit easier.

If you feel you’d benefit from their physical presence through in-person sessions, you can search for a therapist in your local area. If many family members are affected by the death of a loved one, family therapy is also an option. Getting a list of covered providers through your insurance company, if applicable, or doing an online search for local resources can be potential places to start when seeking complicated grief treatment. 

If you’re interested in connecting with a therapist from the comfort of your own home, you might consider online therapy. A platform like BetterHelp can match you with a licensed provider who you can meet with via phone, video call, and/or online chat from anywhere you have a working device and an internet connection. Research suggests that online therapy is “no less efficacious” than in-person sessions for a variety of conditions and situations, so you can feel free to choose the format that feels appropriate for you.

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