Differences between Normal and Complicated Grief

While grief is a perfectly natural and normal response to painful events, some people find it difficult to move on and resume their normal lives despite the passage of time. This article explains the differences between normal and complicated grief following the death of a loved one, the usual symptoms or characteristics of each, and how to deal with complicated grief.​

Grief is the powerful, multifaceted and often uncontrollable response that human beings experience following a personally painful or traumatic event. While typically associated with the death of a loved one, a stillbirth or a miscarriage, many other events can also trigger grief to varying degrees, such as:

• Losing a job
• A significant change in lifestyle or financial status
• Ending a friendship, romantic relationship or a marriage
• Serious illness or disease, whether personal or affecting someone you love
• Losing your physical mobility or independence
• A robbery or burglary that violates your feeling of security/safety
• An automobile accident or other significant "near-death" event

It is important to understand that grief is not a single emotion; it's an experience or state-of-being that manifests itself physically, emotionally, mentally and/or spiritually following a painful or traumatic event. Moreover, like our fingerprints, each of us is unique and how we experience grief, and how long we grieve, can vary considerably from one person to another, even following similar loss situations, such as the death of a parent, spouse/partner, child, pet, etc.

That said, even though everyone experiences grief, there is a difference between normal, uncomplicated or simple grief and abnormal, complicated or exaggerated grief.

Grief is the perfectly natural, necessary and normal way in which people respond to a personally painful or traumatic event. While everyone experiences grief in their own way, most survivors normally exhibit some/all of the following characteristics temporarily when responding to a loss in the days, weeks or months after the death of a loved one:

• Tears, crying or sobbing
• Sleep pattern changes, such as difficulty falling asleep or too little/too much sleep
• An overall lack of energy
• Feeling lethargic or apathetic about the day's necessary tasks or life in general
• Changes in appetite, such as not feeling like eating or consuming too much, particularly junk food
• Withdrawing from normal/usual social interactions and relationships
• Difficulty concentrating or focusing on a task, whether at work, personally, a hobby, etc.
• Questioning spiritual or religious beliefs, job/career choices or life goals
• Feelings of anger, guilt, loneliness, depression, emptiness, sadness, etc. but still occasionally experiencing moments of joy/happiness

As noted above, everyone grieves a loss due to death in his or her unique way, and there is no timetable for grief. However, most grievers experience some/all of these reactions most profoundly in the immediate days/weeks following a loss but gradually return to a "new normal" in the weeks/months afterward. You won't entirely forget your loved one as if he or she never existed, but in time, you will learn how to cope with his or her absence and the scar on your heart and soul.

As noted above, "normal" grief in response to the death of a loved one generally affects mourners temporarily, and the majority of survivors gradually feel the characteristics of grief dissipate with the passage of time and can begin resuming their natural routines and activities. Some people, however, might experience complicated grief in which the usual responses to the death of a loved one do not fade over time and can impair or prevent them from leading their normal lives.

Complicated grief might be referred to by other terms, such as:

• abnormal grief
• chronic grief
• complicated grief disorder
• exaggerated grief
• pathological grief
• persistent complex bereavement disorder

Regardless of the terminology, the characteristics of complicated grief can include (in addition to any of the symptoms shown above):

• Anger, irritation or episodes of rage
• An inability to focus on anything but the death of a loved one
• Focusing intensely on reminders of the deceased or an excessive avoidance of such reminders
• Intense feelings of sadness, pain, detachment, sorrow, hopelessness, emptiness, low self-esteem, bitterness or longing for the deceased's presence
• Problems accepting the reality of the death
• Self-destructive behavior, such as alcohol or drug abuse
• Suicidal thoughts or actions (If you're experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-8255 to speak with a professional counselor!)

As mentioned earlier, everyone's grief response is unique and there is no specific amount of time that defines when normal grief becomes complicated grief. Some impose a threshold of around six months after the death occurred, but it is perfectly normal for grievers to find the first year following a significant loss difficult as survivors experience holidays, birthdays, anniversaries and other significant annual dates/events for the first time without their loved ones.

If you exhibit some of the characteristics of complicated grief above, still feel "trapped" in your grief and/or that your grief response remains the same or has intensified despite the passage of several months or more, then you might consider seeking help from a mental-health professional.

You should also consider joining a bereavement support group in your area, particularly if one exists for people who have experienced a similar type of loss (a spouse, partner, child, etc.) Grief typically causes feelings of isolation but discussing your situation with others mourning a death might help you gain a different perspective on your specific response.

Finally, depending upon the circumstances surrounding the death and/or the unique personalities/relationships of the people involved, certain challenges can occur that might — or might not — either contribute to complicated grief or make you wonder if you're experiencing complicated grief.

Delayed grief involves the postponement of a normal grief response until a later time, whether intentional or unconsciously. In some cases, an individual might need to "be strong" outwardly in order to help another loved one cope following a death, whether during the funeral arrangement process, service or interment, or in the weeks/months that follow. In other instances, someone might not begin grieving right after a death occurs because he or she already has too much stress, needs more time to process the reality of the loss, can't grieve until encountering a "grief trigger," etc.

Disenfranchised grief can occur when a grieving person feels he or she cannot openly acknowledge a loss to death because of real or imagined pressures exerted by his or her family/friends, cultural or religious beliefs, or society in general. Causes might include, for example, a death related to HIV/AIDS, miscarriage or stillbirth, or the death of a same-sex partner or spouse. In these cases, the individual might delay his or her grief response or feel it necessary to mourn alone/privately.

Traumatic grief can occur when a death takes place violently, unexpectedly or causes the loss of someone who dies "before his or her time," such as an infant, child, murder or accident victim, someone stricken with a terminal illness/disease, etc. Sudden or traumatic grief can lead to exaggerated reactions and even post-traumatic stress disorder.

Again, it is important to emphasize that anyone experiencing delayed, disenfranchised or traumatic grief will not necessarily also deal with complicated grief. In many cases, grievers will still process their grief response normally despite these circumstances and without following the particular "stages" of grief. But if in doubt, then you should consider seeking help from a mental-health professional.

Edited and updated by Chris Raymond.