What Is Complicated Grief?

Complicated grief is a prolonged, intense form of grief that interferes with daily life and doesn't ease over time. It's different from the natural grieving process, in which pain tends to soften gradually, even when a loss is never forgotten. In March 2022, it was formally recognized in the DSM-5-TR as prolonged grief disorder. 

If your grief has felt stuck long after a loss, understanding what complicated grief is, why it happens, and how support may help may offer a gentle place to start.

What is complicated grief?

Complicated grief occurs when any factor interferes with a person's ability to manage their sorrow and find acceptance after loss. Instead of easing, the grief stays intense and preoccupying, often making it hard to function day to day. 

This differs from normal grief, where you still feel the loss deeply but may generally move through daily life and find moments of relief alongside the sorrow. Complicated grief involves persistent, intense emotional pain that doesn't lessen.

Some clinicians used to describe similar experiences using terms like Persistent Complex Bereavement Disorder. However, in March 2022, prolonged grief disorder was added to the DSM-5-TR, the reference guide published by the American Psychiatric Association (APA). This addition recognizes that when grief persists in this intense way, it's a real experience worth taking seriously, not a personal failing.

That said, it's important to remember that no single model fully captures the grieving process. You may have heard of the five stages, but grief rarely follows a tidy sequence. Everyone's timeline looks different, and there's no "right" way or set schedule for moving through a loss.

How is complicated grief different from acute grief?

In the early weeks and months after a loss, it's natural to feel acute grief, the immediate, intense wave of pain that may feel all-consuming. For most people, this normal response gradually begins to soften as time passes.

Complicated grief is different mainly in how long it lasts and how much it disrupts your life. Instead of easing, the pain persists well beyond and continues to interfere with daily functioning. Complicated grief keeps you from returning to work, relationships, or routines months or even years later.

What are the signs of complicated grief?

Grief looks different for everyone. Still, noticing certain patterns may help you understand what you're going through, such as:

• Intense yearning or longing: You might feel a persistent, preoccupying ache or intense longing for the person who died that doesn't fade with time.
• Emotional numbness: Some people feel disconnected from others or from life in general, making it hard to feel joy, closeness, or even sadness.
• Excessive avoidance: You may steer clear of reminders of the loss, like places, photos, or conversations, in a way that disrupts your daily routines.
• Difficulty resuming daily life: Returning to work, relationships, or everyday routines may feel impossible, even months or years later.
• Intense emotional pain: The grief may feel just as sharp and raw as it did in the very beginning, without softening.

Experiencing one or more of these signs doesn't automatically mean you're experiencing complicated grief, but it may be a signal that extra support could help. Options like online therapy may offer a space to explore what you're feeling and begin coping with the loss of a loved one at your own pace.

What causes complicated grief?

There's no way to predict who will experience complicated grief, and it's never a matter of grieving "wrong." Certain circumstances, though, may raise the chances of developing complicated grief. These may include:

• A sudden, unexpected, or violent loss: Research links unexpected death and violent or unnatural death to a higher risk of prolonged grief symptoms, since there's little chance to prepare.
• The death of a child or partner: One population study found that losing a child or a partner was a significant predictor of prolonged grief.
• A history of mental health conditions: The APA notes that a history of mental illness is a recognized risk factor, particularly prior depression.
• A limited support system: Medical research has identified low social support as a factor that may raise the risk of prolonged grief.
• Exposure to trauma: Traumatic circumstances surrounding a death may also contribute, especially when a loss overlaps with other painful experiences.

Understanding these risk factors isn't about assigning blame but recognizing when someone might benefit from extra care. And if any of these apply to you, it doesn't mean you're destined to experience complicated grief. 

How can therapy help with complicated grief?

When grief feels all-consuming, you don't have to carry it alone. Support may make a real difference. BetterHelp research shows that 85% of Americans agree that seeking support is wise, even though many still feel pressure to handle hard things on their own. 

Reaching out is never a sign of weakness. It's a step toward carrying your loss in a more manageable way.

While there's no guaranteed way to prevent complicated grief, talking with a mental health professional may give you a space to process intense emotions at your own pace. A therapist trained in grief may help you make sense of what you're feeling and gradually work toward acceptance.

Online therapy for complicated grief

Online therapy may make that support easier to reach during a difficult time. With BetterHelp, you may connect with a licensed therapist who understands grief and reach out through in-app messaging between sessions, all from the comfort of home.

Bereavement support groups may also be beneficial. For someone dealing with complicated grief, sharing space with others who understand loss may offer connection and a reminder that you're not alone in what you're feeling.