Grief is an unpleasant emotion triggered by a major loss or change. Normal grief often occurs after the death of a loved one, contraction of an incurable disease, or after being diagnosed with a debilitating disease.
In any of these cases, the feelings of grief are normal. However, in some cases, the grief lasts for an extended period of time and is associated with other abnormal factors. When this happens, the person is suffering from prolonged or complicated grief and may need medical help.
Normal vs. Complicated
Normal grief and complicated or prolonged grief are both triggered by an emotional or physical trauma. According to MedlinePlus, the course of normal grief is tracked by five stages:
Denial. Grief-stricken individuals often do not accept the cause of their grief and are disbelieving or numb. This is usually the first stage of grief.
Anger. In this stage of grief, the subject blames others for their grief and may act violently. Most patients return to this stage often during the process of grief.
Bargaining. During this stage, patients will make deals with “higher powers” and say things like, “If you bring back my loved one, then I will never hurt anyone ever again,” or “If I recover from this cancer, then I will never smoke again.”
Depression. Grief will cause sadness and decrease one’s desire to go out or socialize. Usually, this stage is prolonged in patients suffering from complicated grief.
Acceptance. In this stage, the subject will come to terms with whatever initially caused the grief and hopefully move on from the traumatic event. When patients reach this stage of grief, there is a smaller chance that they will develop prolonged grief disorder.
Not everyone experiences each of these stages, and some people may experience one or more stages at the same time. You do not have to experience these symptoms in a specific order to be classified as experiencing a normal grieving process.
The acute symptoms of normal grief generally last for about 60 days, while the milder symptoms can last for years. Normal grief causes no lasting impairment on the subject’s functional capabilities. However, in cases of prolonged or complicated grief, patients will have the more severe symptoms of grief – such as emotional numbness and depression – for at least six months, while also suffering from some form of functional impairment.
Functional impairment refers to a situation where the grief has caused the patient to be unable to perform basic tasks. The patient may be suffering from a decrease in work performance, self-imposed seclusion or other domestic problems. Over time, chronic symptoms of grief are potentially life threatening.
Medical research has not identified what causes complicated grief or who may be more susceptible. However, there are some established situations where a person is more likely to develop prolonged grief. These include:
An unexpected or especially violent death
Lack of a support system – either family or close friends
Suicide of a loved one
Childhood separation from parents or loved ones
Dependent relationship with the deceased loved one
History of childhood abuse or neglect
Being unprepared for the loss
Experiencing multiple losses within a short period of time
These factors may indicate a situation where prolonged grief can occur. However, some people will not experience prolonged grief even when they are exposed to one or more of these situations. The best way to diagnose complicated grief is to carefully monitor your loved one and make sure that the symptoms of grief subside over time.
As mentioned previously, the initial symptoms of complicated grief are similar to those of normal grief. For the first few months, normal grief and complicated grief are often indistinguishable. The difference occurs because the symptoms of normal grief begin to disappear over time while the signs of complicated often linger or worsen.
Other signs of chronic grief include:
Obsessive focus on the loss or on reminders of the lost loved one
Intense yearning for the deceased
Numbness or detachment from the outside world or from inner emotions
Preoccupation with personal grief
Bitterness or anger
Inability to find pleasure in life
Inability to carry out normal routines
Lack of trust in others
No motivation to attend social events
Feeling that life has no meaning or purpose
Prolonged grief is a mental illness that affects the patient physically, mentally and socially. As the disease progresses, the individual is at risk for developing a variety of complications that range from mild to severe.
As grief continues to linger, patients are more likely to slide into a deep, profound depression. They have no motivation to perform any task and would rather not interact with the people around them. In the worst cases of depression, the bereaved individual will turn to thoughts of suicide. Without treatment, truly depressed individuals are at a high risk for attempting to kill themselves.
Prolonged grief places a great amount of stress and tension on the affected person. High levels of stress can cause physical illness, the Mayo Clinic warns. Patients suffering from prolonged grief are more likely to suffer from high blood pressure and heart disease. Cancer rates are also elevated in people who suffered from complicated grief.
Unbearable grief often drives people to substance abuse. At first, they turn to mild substances such as alcohol or nicotine but as the grief lingers, patients graduate to more powerful substances like heroin or cocaine. Initially, the individual may turn to substance abuse to alleviate the symptoms of grief; however, over time, they will become addicted to the substance. Addiction to an illicit substance is a whole other disease that brings its own set of complications and usually exacerbates the effects of a grief disorder.
The most telling complication of prolonged grief disorder (PGD) is the inability to deal with daily living. Even the most mundane chores seem daunting to someone suffering from PGD. They will need care and monitoring from a dedicated caregiver. If the grief is not treated, patients will slowly deteriorate physically and psychologically.
The disease also adversely affects the friends and relatives of a person suffering from PGD. They often feel hurt and helpless when they are unable to help their loved one. Some people react with anger or frustration. In most cases, complicated grief places a massive burden on all of the patient’s relationships. Prompt, comprehensive treatment helps prevent any long-term damage to the patient’s interpersonal connections.
There is no set treatment modality that works in every case of prolonged grief disorder. Most medical professionals will design a treatment plan that best suits the patient’s specific symptoms and life situation.
The best treatment plans use a mix of psychotherapy and medications. In psychotherapy, therapists guide the patient into the basis and foundation of their grief. Patients are encouraged to explore their reaction to grief, their symptoms and their personal goals. An article in Clinical Psychology and Psychotherapy recommends that therapists attempt to redirect the patient’s goals from inward-directed goals (making themselves feel better) to outward-directed goals (goals related to outside events). Therapy should provide the patient with coping mechanisms that reduce feelings of blame and grief.
The pharmacological options for complicated grief have yet to be established. Antidepressants are the most often used medications as they help patients deal with the symptoms of grief-associated depression. In most cases, pharmacological treatment is secondary to psychotherapy.
While in the midst their grief, most people are unable to even consider treatment. The longer the grief lasts, the less likely they are to seek treatment for their depression. If left alone, people with prolonged grief are likely to suffer severe complications.
Luckily, most grief-stricken individuals are surrounded by friends and relatives who are willingly to support and help them. Most relatives will recognize the symptoms of prolonged grief disorder and suggest the subject seek medical help. This is usually enough, but in some cases, the patient is resistant to treatment. They may believe that their grief is normal, that they deserve to suffer or that the grief is the best way to hold on to what initially caused the grief.
Overcoming this resistance is usually too difficult for most families. Therefore, instead of approaching the patient on their own, families will employ a professional interventionist and stage an intervention. During the intervention, the team is able to vocalize the numerous adverse effects the prolonged grief has caused. Ideally, the patient will then consider the presented information and agree to undergo treatment.
If you have any questions about interventions, or would like help staging an intervention for your grief-stricken loved one, contact us today. We are here to help.