What Causes Complicated Grief Disorder?

People suffering from complicated grief disorder are haunted by their memories and trapped by feelings of deep, unbearable sorrow. Grief is a normal human emotion and is expected to manifest in the early weeks and months following the loss of a loved one, but somewhere between 10 and 20 percent of those who experience such tragedies are unable to move past their initial devastation and will exhibit symptoms consistent with complicated grief.

Complicated grief, which is also known as complicated bereavement, does not at present have official status as a mental health disorder. It is likely to attain such recognition, however, in the very near future, as mental health professionals continue to learn more about the way it impacts people who cannot overcome the loss of a spouse, parent, child, grandparent, or close friend.

Anytime grief continues for longer than six months, with no diminishment in intensity, it may indicate the presence of complicated grief disorder.

While no system of diagnosis for complicated grief disorder has been universally accepted, mental health professionals have identified certain symptoms of complicated grief that should be included among any list of diagnostic criteria.

They symptoms include:

• Strong and persistent longing for the person who died
• Frequent intense feelings of loneliness, or a belief that life is meaningless without the departed person
• A recurrent urge to die, or a belief that it is unfair to have to continue without the lost loved one
• Repeated, intrusive thoughts about or memories of the departed person that interfere with normal functioning
• Replaying or revisiting the circumstances of the person’s death repeatedly in thought or in conversation
• Persistent refusal or inability to accept that the person has really died
• Feelings of shock and emotional numbness that don’t abate
• Feelings of anger and bitterness directed toward the world in general
• Loss of trust in or empathy for other people, and strong feelings of envy toward those who haven’t lost a loved one
• Hearing the departed person’s voice or seeing them in visions, or actually experiencing the physical pain associated with their death
• Reminders or memories of the lost loved one create intense sadness or despondency
• Notable changes in behavior caused by excessive avoidance of anything that can trigger memories of the departed person, or the opposite (notable changes in behavior caused by an obsessive need to seek out such triggers)

The complicated grief sufferer will experience at least a few of these symptoms for indefinite periods following their loss, and it is the presence of such symptoms that will lead to a diagnosis of complicated grief disorder.

Complicated bereavement is a condition associated with mourning. But it can develop in some instances even if a person has not died, or is not known to have died.

The loved ones of people with terminal illnesses, or who have dementia and must move into long-term care facilities, may also experience complicated grief, as may the loved ones of those who disappear for months or years without explanation. People exposed to warfare or natural disaster may grieve deeply for the victims, even if they were not personally acquainted with any of them.

While anyone who experiences a significant loss, or anticipates one, could develop complicated bereavement, there are certain risk factors that increase the odds by a statistically significant degree.

Those risk factors include:

• Having a pessimistic or negative personality. Men and women who have a negative outlook on life in general are more likely to succumb to complicated grief, and they may be less likely to ask for help for their symptoms unless strongly encouraged to do so.
• Type of death. Studies have shown a relationship between complicated grief disorder and the loss of a loved in a natural or man-made disaster, or to violence. Parents who lose children are also more likely to experience complicated grief.
• History of mood or anxiety disorders. Research reveals that most complicated bereavement sufferers have experienced major depression or post-traumatic stress disorder (PTSD) at some point in their lives (and often simultaneously with their complicated grief). People with bipolar disorder who suffer a sudden loss also face increased chances for complicated grief.
• Guilt over survival. If an individual was somehow exposed to the events that led to the death, but survived, they may develop survivor’s guilt, which can increase the chances of complicated grief developing as well.
• Previous losses. When people lose more than one person they love and the losses occur within a relatively concentrated period, they will be more likely to display the symptoms of complicated grief.
• Isolation and the lack of an effective support network. Men and women who are socially isolated have no one to confide in or turn to when they’re grieving, and no one to encourage them to seek professional help when they show signs of continuing distress. In general, the fewer close relationships a person has, the more severe the impact when someone they love passes away.
• Insecure attachment style. People who experience insecurity or anxiety in their relationships (the definition of insecure attachment) are more likely to suffer from complicated grief if someone they care for and depend on dies.
• Neurological anomalies. People who suffer from complicated grief disorder have heightened activity in a part of the brain known as the nucleus accumbens, a neurological reward center that encourages the pursuit of pleasurable experiences. Men and women with complicated grief seem to gain extra satisfaction from reliving enjoyable memories that involve their departed loved ones, as excessive stimulation of the nucleus accumbens creates a craving for such remembrances that indirectly strengthens the hold of their grief.

The risk factors for complicated grief disorder don’t directly cause its development. But they are significant factors in its onset in many cases.

Complicated grief disorder has not gained official recognition as a distinct mental health condition in part because of its overlap with depression and PTSD. These are the two forms of mental illness that most often co-occur with complicated grief, and the symptoms they produce seem at first consideration to closely resemble those produced by complicated grief disorder.

But after years of research, mental health professionals are virtually unanimous in their acceptance of complicated grief disorder is a separate condition with its own symptoms and course of development.

Major depression is a disorder that affects every area of a person’s life, while complicated grief produces feelings of sorrow and emptiness connected with a very specific set of circumstances. People with complicated grief disorder do frequently have a history of depression, but the two disorders do not always occur concurrently and in fact may be experienced several years apart.

PTSD can produce flashbacks and powerful memories of the past, and that is also the case with complicated grief. But PTSD-related memories are traumatic and always unwelcome, while the memories of complicated grief sufferers are often of happier times, and indulging in them can function as a temporary escape from the pain of the loss. Complicated grief disorder can co-occur alongside PTSD, and the two conditions can reinforce each other, but they always retain their distinct identities.

Complicated grief disorder is a unique condition, and those who suffer from it need targeted therapy that addresses their bereavement and focuses on helping them move forward.

When bereavement lasts longer than expected and never relents in intensity, it is a sign of trouble that should not be ignored.

Fortunately, complicated grief is a condition that responds well to treatment. But sufferers may require extensive intervention before they can move past the pain, and that is why people diagnosed with complicated grief disorder often choose to begin their recovery in residential treatment programs, where concentrated healing services are available.

During inpatient treatment, complicated grief sufferers will participate in individual, group, and family therapy sessions on a daily basis. They may be prescribed with medication if it is deemed appropriate, and they will also be exposed to holistic healing practices and other forms of life skills/personal development training that can help grief sufferers overcome unhealthy states of mind. If co-occurring conditions like depression or PTSD are present, they will need to be treated as well, since recovery will remain elusive without an integrated treatment regimen that confronts those disorders just as aggressively as it addresses the symptoms of complicated grief.

Regardless of its official status, complicated grief disorder is a painful and debilitating condition, and anyone experiencing it should seek help immediately rather than continuing to suffer unnecessarily.