Complicated Grief: Symptoms, Causes, and How to Get Help

What Is Complicated Grief

Complicated grief, also called prolonged grief disorder, is a clinical condition in which a bereaved person remains in an acute state of mourning that does not improve over time. While all grief is painful, normal grief gradually eases as the person adapts to the loss and begins to reengage with life. Complicated grief does not follow this trajectory. Instead, the intense pain, longing, and preoccupation with the deceased remain at the same level of severity for 12 months or longer.

Prolonged grief disorder was formally recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2022, giving clinicians a framework for identifying and treating the condition. Research suggests that approximately 7% to 10% of bereaved people develop complicated grief, making it a relatively common but often unrecognized condition.

The distinction between complicated grief and normal grief is not about how much pain a person feels in the early weeks and months after a loss. Intense grief in the immediate aftermath of a death is expected and healthy. Complicated grief is defined by its persistence and its impact on functioning. When grief remains as intense at the one year mark as it was in the first month, and when it prevents the person from functioning in daily life, it has crossed into the territory of a clinical condition that warrants professional help.

How Complicated Grief Differs from Normal Grief

Normal grief, while deeply painful, follows a general pattern of gradual adaptation. In the weeks and months after a loss, grief comes in waves. There are moments of intense pain and sadness, but there are also moments of respite. Over time, the waves become less frequent and less overwhelming. The bereaved person begins to find moments of enjoyment, reconnects with relationships and activities, and slowly integrates the loss into their life story.

Complicated grief does not follow this pattern. The waves of grief do not diminish. The person remains consumed by thoughts of the deceased and may feel as though they are stuck in the earliest, most painful phase of their loss. They may be unable to accept the reality of the death, even after many months. They may feel that their own life has no purpose or meaning without the person who died.

Another key difference is functional impairment. While normal grief can temporarily affect a person's ability to work, socialize, and manage daily tasks, most people gradually return to a baseline level of functioning within several months. People with complicated grief may remain significantly impaired for a year or more, unable to work, maintain relationships, or take care of basic responsibilities. This sustained impairment is one of the hallmarks that distinguishes complicated grief from normal bereavement.

Symptoms of Complicated Grief

The symptoms of complicated grief include an intense and persistent longing or yearning for the deceased person that does not ease over time. This longing can be so powerful that it dominates the person's thoughts throughout the day, making it difficult to focus on anything else. The person may have difficulty accepting the death, even after many months, and may feel shocked or in disbelief as though the loss just happened.

Emotional numbness and detachment are common symptoms. The person may feel disconnected from other people and unable to experience positive emotions. They may feel that life is meaningless or that a part of them died with the deceased. Some people with complicated grief avoid reminders of the loss, such as places, activities, or people associated with the deceased, because the reminders trigger overwhelming pain. Others become excessively preoccupied with reminders, spending hours looking at photos, visiting the gravesite, or holding on to the deceased person's belongings.

Additional symptoms include difficulty engaging in activities that were previously enjoyed, social withdrawal, bitterness or anger about the death, difficulty trusting others, and a sense that the future holds nothing meaningful. Some people with complicated grief also experience physical symptoms such as fatigue, sleep disturbance, appetite changes, and a weakened immune system. If these symptoms persist beyond 12 months and significantly impair daily functioning, a clinical evaluation is warranted.

Who Is at Risk

Certain factors increase the risk of developing complicated grief. The circumstances of the death play a significant role. Deaths that are sudden, unexpected, or violent, such as those caused by accidents, homicide, or suicide, are more likely to lead to complicated grief than deaths that occur after a long illness where the family had time to prepare. The loss of a child is one of the strongest risk factors, as it represents a profound disruption of the natural order of life.

The nature of the relationship with the deceased also matters. People who had an extremely close or dependent relationship with the person who died are at higher risk, as are those who had a conflicted or unresolved relationship. The loss of a spouse or life partner is particularly associated with complicated grief, especially among older adults who may have been with their partner for decades.

Pre-existing mental health conditions, including depression, anxiety, and previous experiences with trauma, increase vulnerability to complicated grief. A lack of social support after the loss is another significant risk factor. People who grieve in isolation, without friends, family, or community to lean on, are more likely to develop the persistent and debilitating form of grief that characterizes this condition.

How Complicated Grief Is Diagnosed

Complicated grief, or prolonged grief disorder, is diagnosed based on the criteria established in the DSM-5. To receive a diagnosis, a person must have experienced the death of someone close to them at least 12 months ago and must be exhibiting a persistent grief response that includes intense longing for the deceased, preoccupation with the deceased, or preoccupation with the circumstances of the death on most days.

In addition to the core symptoms, the person must experience at least three of the following: identity disruption, a marked sense of disbelief about the death, avoidance of reminders that the person is dead, intense emotional pain related to the death, difficulty reintegrating into life, emotional numbness, a feeling that life is meaningless, and intense loneliness as a result of the death. These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A mental health professional, such as a psychologist or psychiatrist, can conduct a thorough evaluation to determine whether your symptoms meet the criteria for prolonged grief disorder. The evaluation will also assess for other conditions that can coexist with or mimic complicated grief, such as major depression, post-traumatic stress disorder, or an adjustment disorder. An accurate diagnosis is important because the treatment for complicated grief differs from the treatment for these other conditions.

Treatment Options

The most effective treatment for complicated grief is complicated grief therapy, or CGT, a specialized form of psychotherapy developed by Dr. M. Katherine Shear at Columbia University. CGT is a structured, time limited therapy that typically consists of 16 to 20 sessions. It combines techniques from cognitive behavioral therapy with grief specific interventions designed to help the person process the loss, address avoidance behaviors, and gradually reengage with meaningful activities and relationships.

Clinical trials have shown that CGT is significantly more effective for complicated grief than standard interpersonal psychotherapy, general grief counseling, or antidepressant medication alone. In some cases, antidepressant medication, particularly selective serotonin reuptake inhibitors, may be prescribed alongside therapy to address co-occurring depression or anxiety symptoms. Medication alone is not considered a sufficient treatment for complicated grief.

Support groups can also play a valuable role in recovery, particularly groups specifically designed for people experiencing prolonged grief. Connecting with others who understand the depth and persistence of the pain can reduce isolation and provide a sense of validation. However, support groups are generally most effective as a complement to individual therapy rather than a replacement for it, especially in the early stages of treatment.

How to Help Someone with Complicated Grief

If someone you care about appears to be struggling with complicated grief, the most important thing you can do is remain present and patient. People with complicated grief often feel misunderstood or judged by those who expect them to be further along in their healing. Avoid saying things like it is time to move on or they would want you to be happy. Instead, acknowledge the pain, listen without trying to fix it, and let them know you are there for them.

Gently encourage the person to seek professional help, particularly with a therapist who has experience treating complicated grief. You can offer to help them find a therapist, accompany them to an appointment, or simply check in regularly to see how they are doing. Be specific in your offers of support rather than saying let me know if you need anything, which puts the burden on the grieving person to ask for help.

Be aware that people with complicated grief may withdraw from social situations and decline invitations. Continue to reach out even when they say no. Your consistent presence matters, even if they are not ready to engage. Do not take their withdrawal personally. It is a symptom of the condition, not a reflection of how they feel about you.

When to Seek Help

If your grief has remained intensely painful and debilitating for more than 12 months and is significantly interfering with your ability to function in daily life, it is time to seek professional help. You do not need to wait for a formal diagnosis to reach out. If you feel stuck in your grief, if you are unable to find any moments of peace or engagement with life, or if you are having thoughts of harming yourself, contact a mental health professional as soon as possible.

Your primary care physician can be a good starting point if you are unsure where to turn. They can provide a referral to a therapist who specializes in grief and loss. You can also search for therapists through your insurance provider's directory or through professional organizations such as the Association for Death Education and Counseling. Look specifically for practitioners who have experience with complicated or prolonged grief.

If you are in crisis or having thoughts of suicide, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day, 7 days a week. You can also text HOME to 741741 to reach the Crisis Text Line. Seeking help is not a sign of weakness. It is a recognition that you deserve support and that effective treatment exists for what you are going through.

Frequently Asked Questions

Related Reading

• Grief Stages Explained: What to Actually Expect
• Grief Counseling Guide: How to Find the Right Support