Grief is a natural response to the loss of a loved one and there are recognized stages to grief that you must journey through. In time, the feelings associated with grief will lessen. However, with Complicated Grief, the grieving process is prolonged and gets worse, rather than better, as time goes on.
Complicated Grief (CG) can become a chronic and debilitating condition that affects mental and physical health and in most cases will not resolve without professional medical help and counseling.
What is Complicated Grief?Sometimes referred to as pathological grief, Complicated Grief is, according to Horowitz et al., (1980):
“the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behavior, or remains interminably in the state of grief without progression of the mourning process towards completion”
Complicated Grief has a profound effect on a person’s ability to function in their daily life and may lead to the loss of employment, chronic unemployment, relationship difficulties, and unhealthy coping mechanisms such as substance abuse.
William Worden (2008) has documented as many as four types of Complicated Grief:
- Chronic grief that continues for the lifetime of the sufferer, without resolution
- Delayed grief, where a person fails to grieve at the time of the loss, leading to intense and debilitating grief resurfacing months or years down the line
- Exaggerated grief, in which a person is totally overwhelmed by their feelings and takes part in behaviors that only exacerbate their situation
- Masked grief, where a person is experiencing Complicated Grief (often several years later) without recognizing that grief is causing their symptoms of depression, anxiety, and other mental health issues.
What Does Complicated Grief Look Like?If you are worried that you are suffering from Complicated Grief, or are concerned about a friend or family member whose grief is seriously impacting on their life, there are some signs of Complicated Grief to help you to identify the condition. These include:
- Extreme feelings of guilt, regret, bitterness, and anger towards self or others
- Self-destructive behaviors
- Excessive irritability and a tendency towards violent rage
- Suicidal thoughts, feelings, and plans
- Severe difficulties with concentration and memory problems
- Sudden and unusual changes in behavior, for example, cutting off contact with family members, dropping out of school, ending relationships, putting the house up for sale and planning to relocate, taking part in risky activities or behaviors, quitting your job
- PTSD-like symptoms
- Compulsive rumination
- Numbness and detachment, or even dissociation, from life
- Withdrawing from friends and refusing to take part in social activities
- Pining for your loved one
- Severe, debilitating depression, which may include feeling unable to get out of bed, uncontrollable emotions such as sobbing long after the bereavement
- Intense feelings of hopelessness or that life has no purpose
Who Gets Complicated Grief?
Complicated Grief is more common than you may think, with up 20% of people who have been bereaved experiencing symptoms of Complicated Grief.
Some people are more at risk of experiencing CG, with the most common risk factors including:
- Previous (or ongoing) mental health conditions such as clinical depression and generalized anxiety disorder
- The presence of learning or behavioral difficulties
- Having had an emotionally dependent relationship on the deceased person
- A history of alcohol abuse
- A history of drug addiction
While these risk factors can increase the likelihood of experiencing Complicated Grief, it’s important to remember that anyone suffer from this extreme and unrelenting form of grief – whether or not they have a pre-existing risk factor.
Hope and Healing for Complicated Grief
Since Complicated Grief is more intense than Simple Grief, it can be incredibly difficult to find hope. If you’re experiencing Complicated Grief, you may feel that the world is a bleak and hostile place, and you may also experience anger towards God.
However, there is hope to be found through faith in God and in the pages of the Bible. We know that God grieves with us for every loss that we experience and longs to comfort us in the midst of our unbearable pain.
Psalm 23:4 is one of the most often quoted verses about grief, and reminds us that when we are journeying through Complicated Grief, God is with us: “Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.”
Complicated Grief can cause you to feel that you are alone, that no one understands your pain, and that the emotional agony you’re experiencing will never end. The Bible, however, reveals God’s promise to help you get through this painful, lonely existence – offering hope that you will, one day, emerge on the other side.
…fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand. – Isaiah 41:10
Fear not, for I have redeemed you; I have called you by name, you are mine. When you pass through the waters, I will be with you; and through the rivers, they shall not overwhelm you; when you walk through fire you shall not be burned, and the flame shall not consume you. – Isaiah 43:1b-2
God longs to heal your broken heart and restore you to wholeness. That doesn’t mean that you will ever stop missing your loved ones, but it does mean that you can have hope that your life will not always be bleak and empty.
He heals the brokenhearted and binds up their wounds. – Psalm 147:3
God’s comfort is unlike anything that friends, family or even counselors can offer to those experiencing Complicated Grief. God sees the pain deep inside and He understands how tortorous it can feel. It can be difficult to allow God to comfort you when you are suffering from Complicated Grief and in that case, it can be helpful to seek out a Christian counselor to assist you on a journey of healing.
Christian Counseling for Complicated GriefIn many cases, people who experience Complicated Grief will need to seek professional help with their symptoms. In general, Complicated Grief does not tend to resolve on its own, and therefore it’s wise to seek the help of a trained Christian counselor to help navigate the journey toward recovery.
Bereavement is a type of traumatic event and it’s common for people with Complicated Grief to experience PTSD symptoms such as flashbacks, avoidance, and emotional sensitivity that can make the recovery journey seem even harder. A counselor can help by teaching coping skills, offering a safe space to talk and explore feelings and intense emotions, and giving support throughout the process.
Counselors may use a range of therapeutic techniques to aid in the recovery from Complicated Grief. With children and young adults, for example, play therapy may be used to help children communicate their feelings and fears. In adults, a more specialized form of psychological treatment is available.
Complicated Grief Therapy (CGT) was first proposed as a treatment protocol in 2012 and has been proved to be effective in helping people towards recovery. With roots in attachment theory, interpersonal therapy, and Cognitive Behavioral Therapy (CBT), it involves setting personal goals, building relationships, and techniques that have similarities with prolonged exposure techniques.
Christian counselors can also bring a faith aspect to the healing journey which can improve resilience and help people to find comfort in the arms of God. Complicated Grief is not something that anyone should suffer alone. Being able to depend on God in the midst of the loneliness of grief can significantly aid recovery.
Journeying Toward Healing
To someone experiencing Complicated Grief, the idea of ever feeling better or finding relief from their distress can seem impossible. While everyone’s experience of Complicated Grief is different and unique to them, there is treatment and there is hope for the future.
M.J. Horowitz, N. Wilner, C. Marmar, J. Krupnick, “Pathological Grief and the Activation of Latent Self Images,” American Journal of Psychiatry 137 (1980): 1157.
Worden, J. W. (2008). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th Edition). New York, NY. Springer Publishing Company
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