Complicated grief - how common is it? (2023)

Originally added on 24th September 2015
Last updated on 28th January 2016

I recently wrote a blog post"Grief is our natural human response to bereavement"where Isaid that mourning may well involve powerful feelings of yearning,disbelief, anger & depression. When we have lost someone who has been very important to us, we gradually need to learn to live without them. Reconfiguring our inner emotional lives and our outer activities can be such a challenge. Mostly though people manage. It may be hard, but like the body healing after injury, emotional pain also resolves as we hold our loved ones in our hearts butengage more fully again in our lives. Sometimes though after physical injury, wounds don't heal adequately. Maybe there is infection or non-union of fractures. In these situations the healing process may need help. In the same way, grief may sometimes not resolve naturally as it should. If the yearning, anxiety, pain & deep sadness are too extreme or are not showing signs of lessening six months or so after bereavement, then it's wise to consider seeking additional skilledhelp.

(Video) What is Complicated Grief? A Short Introduction

How often does the natural process of grieving get stuck in this way? What is "complicated grief" and how frequent is it? How often are health professionals likely to meet people struggling with this disorder? How can we recognise it and what can be done? Back in June, I went to an excellent two day workshop with Professor Kathy Shear on complicated grief. I wrote a couple of blog posts about the workshopand the second goes into a good deal of detail about how one can screen for and diagnosethe disorder- see"Kathy Shear workshop on complicated grief: identification". But how common is it? The simple answer is"Worryingly common". One of the best estimates isKersting et al's survey in Germany - "Prevalence of complicated grief in a representative population-based sample"- which assessed 2,520 people aged 14 to 95 years old face-to-face. They found an overall prevalence of 3.7%, rising to 6.7% in those who had suffered a major bereavement. The year before Fujisawa & colleagues had reported on a survey of969 Japanese adults aged 40 to 79 via self-administered questionnaire - "Prevalence and determinants of complicated grief in general population". They found2.4% with complicated grief and 22.7% with subthreshold CG symptoms, but theirsample involved a narrower age band and somewhat surprisingly,they excluded bereaved respondents who had lost a child. Concerningly they noted"Complicated grief was maintained without significant decrease up to 10 years after bereavement" andStammel et al have found persistence over even longer time periods. Unsurprisinglyin older populations who have suffered more bereavement, CG is more frequent, so Newson & colleagues reported a prevalence of 4.8% in a survey of 5,741Dutch people aged over 55 - see "The prevalence and characteristics of complicated grief in older adults". Interestingly they found that prevalence peaked at 7% in those aged 75 to 85. It was also noteworthy that, although prevalence of CG was higher in women than men, this seemed only to be because more women than men had suffered bereavement. Of the 5,741 surveyed, nearly 20% reported actively grieving ... and of this near 20%, over a quarter were diagnosed with complicated grief.

Of these various general surveys, the Kersting finding of an overall prevalence for complicated griefof 3.7% is probably the most useful. Compare this with a global point prevalence of 4.7% for major depression, a UK prevalence of 1.7% for panic disorder, and a US 12-month prevalence of 1.2% for OCD. Complicated grief is clearly a huge problem - a 3.7% prevalence rate translates to about2.4 million current CG sufferers in the UK and nearly 12 million current sufferers in the US. Here in littleScotland, we have approaching 200,000 people with CG - so the average general practice has approximately 200 current CG sufferers. I bet that very few have been identified and even fewer are likely to be receiving adequate treatment (Shear & colleagues recent large treatment trial - currently in press - found antidepressants were no better than placebo for CG treatment). Remember too the Fujisawa finding that complicated grief tends to be chronically persistent even 10 years after bereavement (see above), and the associated increases in suffering, additional psychological disorders, greater use of health servicesand increased death rates - see Prigerson's"Traumatic grief as a risk factor for mental and physical morbidity" and Stroebe's"Health outcomes of bereavement".

Unsurpisingly, surveys in more"at risk"populations show considerably higher rates of CG. So Guldin et al, workingin a palliative care unit, testedfor complicated grief in family caregivers six months after the death of a relative through cancer. They found 40% were suffering fromCG (with less than half receiving bereavement services). The problem is much bigger than this though - there are now a series of studies assessing CG prevalence in general psychiatric outpatients. One of the earliestpapers is a 2001 study from Canada -"Prevalence of loss and complicated grief among psychiatric outpatients" - which reported "About a third of all patients who came to the clinics met the criteria for either moderate or severe complicated grief. The average time since the loss was about ten years, indicating that these patients had long-term complicated grief." Naively I would have expected "death of a partner" to be the most important contributor to high CG prevalence. Far from it, the authors wrote "The types and proportions of the most troublesome losses were the death of a parent (110 patients, or 47 percent), a friend (33 patients, or 14 percent), a grandparent (23 patients, or 10 percent), a sibling (14 patients, or 6 percent), a partner (nine patients, or 4 percent), a child (seven patients, or 3 percent), or other (38 patients, or 16 percent)." In a later 2005 paper - "Screening for complicated grief: when less may provide more" - the same research group reported that just two questions identified nearly 90% of patients with and without CG. The questions were "Pictures about it popped into my mind"or"I tried not to think about it"- and I have included these queriesin a more general 15 item life events questionnaire, which is downloadable asa Word docand asa PDF file. More recent studies have found somewhat lower, but still worrying, psychiatric outpatient prevalence levels. Sung et al studied US depression patients to assess how many scored at or above 25 on the widely-used"Inventory of complicated grief"(downloadable here asa Word docand asa PDF file). They found 20% qualified as suffering withCG. More recently still, Pini & colleagues screened an Italian sample of psychiatric outpatients suffering from mood and anxiety disorders. They found a CG prevalence of 23% in this population. As the recent paper "Emotional response patterns of depression, grief, sadness and stress to differing life events" shows,other kinds of loss (like relationship break-up, serious illness & financial crisis) can result in grief responses, but bereavement definitely seems to be the most common cause of CG. So for those of us working as psychotherapists and counsellors, probably 20 to 25% of our clients are likely to be suffering from complicated grief - typically mixed in with other disorders, persistent over many years, and likely to involve losses of parents, grandparents & friends (rather than just partners).

(Video) Complicated grief

I plan to write again soon about helping people suffering with Complicated Grief. Antidepressants seem of little use, and more effective forms of psychotherapy currently include a trauma-focused approach.

  • anxiety
  • death
  • depression
  • grief
  • time factors
  • trauma

Prolonged grief disorder in recent mothers who lose a relative

Submitted by Alba Valderrama Martinez (not verified) on Sat, 14/03/2020 - 09:04.

(Video) Complicated Grief| Coping with Trauma and Loss

Hi there, I am really interested in this post, as I am doing my PHD in women during the perinatal period who go through grief of one of their relatives ( excluding their babies or kids) and need to deal with the postpartum period at the same time that the bereavement. I am a midwife, and I have seen these situations more frequently than I expected. They are in big risk of develop a PGD syndrome. I am finding difficult to find an estimation of how many women who through grief within a year of their perinatal period. Do you know who o which organisation I can contact to get these details? I am guessing than the closest prediction for me would be applying the 20% of PGD in the whole population in the amount of women delivering in my area in a year... but that is not completely accurated.

Thank you so much for all the information in the post, it was really useful.

(Video) Getting Help for Complicated Grief

Kind Regards.

FAQs

Is complicated grief common? ›

Complicated grief is a recently recognized condition that occurs in about 7% of bereaved people. People with this condition are caught up in rumination about the circumstances of the death, worry about its consequences, or excessive avoidance of reminders of the loss.

Is complicated grief real? ›

This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life. Different people follow different paths through the grieving experience.

Who is at risk for complicated grief? ›

There is no identifiable cause of complicated grief, but some people might be more at risk of developing the condition than others. Certain risk factors might make a person more susceptible to experiencing the condition, including: People who experience an unexpected or shocking death of a loved one.

What is the most intense type of grief? ›

Distorted Grief

Distorted grief can be defined as a very intense or extreme reaction to a loss. There typically will be a noticeable change in behavior overall, and self-destructive behavior is also common.

What is the most difficult death to recover from? ›

DEATH OF A SPOUSE *
  • The death of a husband or wife is well recognized as an emotionally devastating event, being ranked on life event scales as the most stressful of all possible losses. ...
  • There are two distinct aspects to marital partnerships.

How long is too long grieving? ›

There is no timeline for how long grief lasts, or how you should feel after a particular time. After 12 months it may still feel as if everything happened yesterday, or it may feel like it all happened a lifetime ago. These are some of the feelings you might have when you are coping with grief longer-term.

Is complicated grief a diagnosis? ›

The most recent versions of standard official diagnostic guidelines include a diagnosis of “Prolonged Grief Disorder" in DSM 5 and ICD11. This is the condition we have been calling complicated grief. ICD11: In 2018 the World Health Organization approved a new diagnosis of Prolonged Grief Disorder.

What are the three types of complicated grief? ›

a response to death (or, sometimes, to other significant loss or trauma) that deviates significantly from normal expectations. Three different types of complicated grief are posited: chronic grief, which is intense, prolonged, or both; delayed grief; and absent grief.

How long is a healthy grieving period? ›

It's common for the grief process to take a year or longer. A grieving person must resolve the emotional and life changes that come with the death of a loved one. The pain may become less intense, but it's normal to feel emotionally involved with the deceased for many years.

What percentage of mourners experience complicated grief? ›

4. About 10 percent of all mourners experience complicated grief, a type of grief that impedes the person's future life because of lingering sorrow or contradictory emotions.

What are the four types of complicated grief? ›

Complicated Grief

Refers to grief reactions and feelings of loss that are debilitating, long lasting, and/or impair your ability to engage in daily activities. Other types of grief such as 'Chronic Grief', 'Delayed Grief', and 'Distorted Grief' all fall under the blanket of 'Complicated Grief'.

What grief does to your brain? ›

Your brain is on overload with thoughts of grief, sadness, loneliness and many other feelings. Grief Brain affects your memory, concentration, and cognition. Your brain is focused on the feelings and symptoms of grief which leaves little room for your everyday tasks. and recognize it as a step towards healing.

Is complicated grief a disability? ›

In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is listed as a “Condition for Further Study.” But regardless of its official status, complicated grief, which is also known as complicated bereavement, is a real condition, and those who suffer from its debilitating effects ...

What is dysfunctional grief? ›

Abstract. Dysfunctional grieving represents a failure to follow the predictable course of normal grieving to resolution (Lindemann, 1944). When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping.

Can grief change your personality? ›

Profound grief can change a person's psychology and personality forever. The initial changes that occur immediately after suffering a significant loss may go unnoticed for several weeks or months after the death of a loved one or other traumatic experience.

Is it harder to lose a spouse or child? ›

Losing an only child resulted in 1.37 times the level of loneliness and 1.51 times the level depression as losing a spouse, and life satisfaction was 1.14 times worse for those who lost an only child vs. their spouse.

Can grief be fatal? ›

Summary: Grief can cause inflammation that can kill, according to new research. Grief can cause inflammation that can kill, according to new research from Rice University. The study, "Grief, Depressive Symptoms and Inflammation in the Spousally Bereaved," will appear in an upcoming edition of Psychoneuroendocrinology.

What does cumulative grief mean? ›

What is Cumulative Grief? Cumulative Grief may occur when an individual, experiences multiple losses either all at once or before processing an earlier loss. When you have experienced multiple losses within a short time period, you may begin to wonder how much more loss you can endure.

What is distorted grief? ›

Distorted grief.

You can think of distorted grief as the type of grief someone is feeling in the case they get stuck in the anger stage of the stages of grief. Those who have distorted grief are angry, at the world, at others, at themselves. There is likely hostility, fighting, and even self-harm happening.

When does intense grief become a mental disorder? ›

The new diagnosis refers to a situation in which many of grief's common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—last longer than six months.

How do you know if you have been grieving for too long? ›

The other eight symptoms are emotional numbness, intense loneliness and isolation, identity disruption (feeling like part of oneself has died), sense of disbelief about the death, avoiding reminders of the death, intense emotional pain (anger, bitterness, sorrow), difficulty reintegrating into daily life, and feeling ...

Can extreme grief cause psychosis? ›

Depression isn't the only connection between grief and mental illness. In rare cases, grief can cause psychosis or the development of psychotic symptoms.

What medication helps with grieving? ›

Common medications used in grief treatment regimens include antidepressants, anti-anxiety meds and medications to promote sleep.

How does complicated grief differ from normal grief? ›

Normal grief describes the typical feelings that people have in the first weeks or months after a loss. This type of grief will get better with time as people learn to cope with the loss. Complicated grief describes atypical feelings and responses that can be extremely intense and persistent.

What is considered a healthy type of grief? ›

Many people define normal grief as the ability to move towards acceptance of the loss. With this comes a gradual decrease in the intensity of emotions. Those who experience normal grief are able to continue to function in their basic daily activities.

Do you lose weight when grieving? ›

Studies show that appetites are often diminished, which can lead to serious weight loss. A common effect of grief on one's physical health is a loss of appetite and, in turn, significant (or at least mild) weight loss.

Does grief ever get better? ›

There's no time limit for grief, and anniversary reactions can leave you reeling. Still, the intensity of grief tends to lessen with time. If your grief gets worse over time instead of better or interferes with your ability to function in daily life, consult a grief counselor or other mental health provider.

Does grief get worse at 6 months? ›

21 -- The negative emotions of grief -- yearning, depression, and anger -- following the death of a family member from natural causes usually peak within six months.

What can trigger grief? ›

The answer is simple - anything that brings up memories of a loss that has happened to you. Sometimes, we think of obvious times of the year that such triggers will be the strongest - birthdays, Christmas, family occasions, holiday times and the like.

Why do friends disappear when you are grieving? ›

Grief tends to end friendships because of a lack of support when needed and expected and because many don't understand the depths of a suffering friend's despair. They lack the knowledge about how grief can affect a person and how you might reconnect with someone after a death.

How many people suffer from grief? ›

A recent study, done before this pandemic by Amerispeak and WebMD, found that 57% of Americans are grieving the loss of someone close to them over the last three years. That means every other person you see is grieving –– because grief never really goes away.

Is Delayed grief a thing? ›

Delayed grief can occur weeks, months, or even years after loss. Examples of loss that might trigger delayed or complicated grief include the death of a parent, spouse, child, grandparent, or other loved one. People can't heal from a loss of this magnitude until their feelings of grief are addressed.

What are 3 common reactions to death? ›

Physically: Headaches, feeling tired, achy muscles and nausea. Emotionally: Sadness, anger, disbelief, despair, guilt and loneliness. Mentally: Forgetfulness, lack of concentration, confusion and poor memory. Behaviourally: Changes to sleeping patterns, dreams or nightmares, or to your appetite.

How does the death of a spouse affect a person? ›

The grief of losing a spouse or partner affects not just emotional and mental health, but physical health as well. Numerous studies show that the surviving spouse or partner is likely to develop health problems in the weeks and months that follow.

Can you feel happy while grieving? ›

In fact, it's possible to feel conflicting emotions all at once — and yes, it is OK to feel happy while simultaneously grieving. It can be confusing sorting through all those emotions, which is why it helps to take part in bereavement services in Alameda County and elsewhere.

Can grief damage your heart? ›

Intense grief can alter the heart muscle so much that it causes "broken heart syndrome," a form of heart disease with the same symptoms as a heart attack.

Can the death of a loved one cause PTSD? ›

It is of course possible for someone to develop PTSD as the result of witnessing the death of a stranger; it is not just those who are bereaved that are affected. It is also possible for a sudden bereavement to affect a whole community, or even a country as in the case of the 2011 Norwegian shootings.

How long does brain fog from grief last? ›

The fog of grief is emotional, mental, and physical and can take time to unravel and release. In most cases, your memory loss and inability to concentrate should lift within a few months and aren't permanent. In some cases, it may take longer.

How does complicated grief differ from normal grief? ›

Normal grief describes the typical feelings that people have in the first weeks or months after a loss. This type of grief will get better with time as people learn to cope with the loss. Complicated grief describes atypical feelings and responses that can be extremely intense and persistent.

What are the three types of complicated grief? ›

a response to death (or, sometimes, to other significant loss or trauma) that deviates significantly from normal expectations. Three different types of complicated grief are posited: chronic grief, which is intense, prolonged, or both; delayed grief; and absent grief.

When does intense grief become a mental disorder? ›

The new diagnosis refers to a situation in which many of grief's common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—last longer than six months.

What percentage of older adults experience complicated grief when losing a loved one? ›

Approximately 7% of older adults will develop complications that derail the normal mourning process, however, resulting in the syndrome of complicated grief (CG), also called prolonged grief and persistent complex bereavement disorder.

What are the four types of complicated grief? ›

Complicated Grief

Refers to grief reactions and feelings of loss that are debilitating, long lasting, and/or impair your ability to engage in daily activities. Other types of grief such as 'Chronic Grief', 'Delayed Grief', and 'Distorted Grief' all fall under the blanket of 'Complicated Grief'.

How long is a healthy grieving period? ›

It's common for the grief process to take a year or longer. A grieving person must resolve the emotional and life changes that come with the death of a loved one. The pain may become less intense, but it's normal to feel emotionally involved with the deceased for many years.

Is complicated grief a disability? ›

In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is listed as a “Condition for Further Study.” But regardless of its official status, complicated grief, which is also known as complicated bereavement, is a real condition, and those who suffer from its debilitating effects ...

Can extreme grief cause death? ›

While the stress of grief may bring on general health impacts, there is a legitimate and specific medical condition called "taktsubo cardiomyopathy" — or heartbreak syndrome — that doctors say is dying of a broken heart. But it's incredibly rare.

What is considered a healthy type of grief? ›

Many people define normal grief as the ability to move towards acceptance of the loss. With this comes a gradual decrease in the intensity of emotions. Those who experience normal grief are able to continue to function in their basic daily activities.

Can grief change your personality? ›

Profound grief can change a person's psychology and personality forever. The initial changes that occur immediately after suffering a significant loss may go unnoticed for several weeks or months after the death of a loved one or other traumatic experience.

What happens to your brain when you are grieving? ›

When you're grieving, a flood of neurochemicals and hormones dance around in your head. “There can be a disruption in hormones that results in specific symptoms, such as disturbed sleep, loss of appetite, fatigue and anxiety,” says Dr. Phillips. When those symptoms converge, your brain function takes a hit.

How do you know if you have been grieving for too long? ›

The other eight symptoms are emotional numbness, intense loneliness and isolation, identity disruption (feeling like part of oneself has died), sense of disbelief about the death, avoiding reminders of the death, intense emotional pain (anger, bitterness, sorrow), difficulty reintegrating into daily life, and feeling ...

Is it possible to not recover from grief? ›

Accumulating research within psychiatry and psychology has shown that a significant minority of people – approximately one in 10 – do not recover from grief. Instead, the acute reaction persists over the longer term, leading to trouble thriving socially, mentally and physically.

What is dysfunctional grief? ›

Abstract. Dysfunctional grieving represents a failure to follow the predictable course of normal grieving to resolution (Lindemann, 1944). When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping.

What does cumulative grief mean? ›

What is Cumulative Grief? Cumulative Grief may occur when an individual, experiences multiple losses either all at once or before processing an earlier loss. When you have experienced multiple losses within a short time period, you may begin to wonder how much more loss you can endure.

Videos

1. Complicated Grief Impact and Interventions
(Doc Snipes)
2. Complicated Grief after Suicide Bereavement and Other Causes of Death: Results from the HEAL Study
(Virginia Mason)
3. Introduction to Prolonged Grief Disorder Therapy - Dr. M. Katherine Shear
(Grief: A Study of Human Emotional Experience)
4. Prolonged Grief Disorder in the DSM 5 TR
(Doc Snipes)
5. Grief, it's Complicated.....10% of the Time | Susan Delaney | TEDxUCD
(TEDx Talks)
6. Understanding Prolonged Grief Disorder and its Treatment
(NAMINYCMetro)
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