Differences Between Normal and Complicated Grief

Grief is an expected response to a painful loss, the experience and duration of which can vary from one person to the next. In psychology, the variations in response can range from normal grief to complicated grief.

"Normal" or uncomplicated grief suggests that a person is processing their feelings in a way typical to cultural expectations, while complicated grief suggests that they are not. The terms are not meant to imply that either response is "right" or "wrong."

This article explains what grief actually is and the ways in which normal grief differs from complicated grief.

What Is Grief?

Grief is the powerful set of feelings that human beings have after a painful or traumatic loss. The intense feelings of grief are not something a person has much control over.

Feelings of grief are usually associated with the death of a loved one, but there are also other losses that can trigger grief, including:

• Losing a job
• A significant change in lifestyle or financial status
• Stillbirth or miscarriage
• Divorce or the ending of a romantic relationship
• Serious illness in you or someone you love
• Losing your physical mobility or independence
• A robbery, accident, or accident that makes you feel a loss of safety

Grief is not a single emotion. It's an experience that you feel physically, emotionally, mentally, and/or spiritually when you go through a meaningful loss.

Each person is affected by grief differently. Even two people who go through the same loss may grieve in different ways. For example, one person might go through grief for longer or be less able to function on a day-to-day basis.

What Is Normal Grief?

Grief is a necessary part of going through a painful or traumatic loss. While grief is different for everyone, most people have common experiences and emotions in the days, weeks, or months following the major loss. This is referred to as normal grief.

Symptoms of normal grief include:

• Crying or sobbing
• Sleep problems (such as difficulty falling asleep or getting too much/too little sleep)
• A persistent lack of energy
• Feeling lethargic or apathetic about life in general
• Changes in appetite (such as not eating at all or eating excessively)
• Withdrawing from usual social interactions and relationships
• Difficulty concentrating on important tasks
• Questioning spiritual or religious beliefs, career choices, or life goals
• Feelings of anger, guilt, loneliness, emptiness, sadness

There is no set timetable for grief. That said, people with normal grief will gradually establish a "new normal" in the ensuing weeks or months. They may never entirely forget the loss but, in time, will learn how to cope with it.

What Is Complicated Grief?

Normal grief is temporary. With complicated grief, the response to a loss or death does not fade over impacts someone's ability to feel or function normally.

People refer to complicated grief in different ways, including chronic grief, atypical grief, exaggerated grief, pathological grief, and persistent complex bereavement disorder.

In the most current revision of the Diagnostic and Statistical Manual (DSM-5-TR), the most commonly-used reference for diagnosing mental disorders, the American Psychiatric Association included the diagnosis of prolonged grief disorder.

This can be diagnosed if symptoms persist 12 months (six months for children and adolescents) after the loss of a close loved one. It is characterized by the experience of intense longings for or preoccupations with thoughts of the deceased, accompanied by identity disturbances, disbelief about the loss, avoidance of reminders of the death, intense emotional pain, and experiences of numbness, meaninglessness, or loneliness, causing significant distress, impairment, and dysfunction in important areas of one's life.

Whatever the name, the condition infers the abnormal delay or absence of coping in a way that causes undue disability or distress.

The characteristics of complicated grief can include many of the same experiences as normal grief. However, other symptoms may include:

• Persistent anger, irritation, or episodes of rage
• Inability to focus on anything but the loss
• Excessive avoidance of any reminders of the loss
• Intense feelings of sadness, pain, detachment, sorrow, hopelessness, emptiness, or low self-esteem
• Problems accepting the reality of the loss
• Self-destructive behavior, such as substance abuse use or risk-taking behaviors
• Suicidal thoughts or actions
  

How to Know If It's Complicated Grief

There is no set point at which normal grief becomes complicated grief. Even so, many people find that the first year following a major loss is hard to get through. There are holidays, birthdays, anniversaries, and other significant dates and events that serve as reminders of a loss.

If you are experiencing complicated grief, you may feel "trapped" in your grief. You might feel as if your grief has stayed the same or gotten worse over time.

Working with a mental health professional can help you learn about your grief response and find ways to cope. You may also want to consider joining a bereavement support group, particularly one for people who are going through a similar loss as yours.

Grief can make a person feel very alone. Talking about your situation with others who are mourning may help you understand your own feelings.

Other Types Related to Complicated Grief

There are certain types of grief that may predispose to complicated grief. But this is not necessarily the case, and these types of grief may resolve in the same way as normal grief.

Delayed Grief

Delayed grief is when a person's normal grief response is put off until a later time. A person might be doing this intentionally or without even realizing it.

In some cases, a person may feel the need to "put on a brave face" and "be strong." Or, they might feel a responsibility to help other loved ones cope. The pressure to take on this role may start during the funeral arrangements or in the weeks and months that follow.

There may be other reasons for delayed grief. For example, a person may be under too much stress, need more time to process the loss, or feel that they can't grieve until something "triggers" those feelings.

Disenfranchised Grief

Disenfranchised grief, also known as silent grief, occurs when a grieving person feels they cannot openly acknowledge certain significant losses because of real or imagined societal pressures. The source of this pressure could be family and friends, cultural or religious beliefs, or society in general.

For example, the stigma around HIV, miscarriage, and same-sex marriage can affect whether people feel they can grieve openly.

Traumatic Grief

Traumatic grief can occur when a death takes place violently, unexpectedly, or causes the loss of someone who "dies before their time." Examples include the death of an infant or child, a friend or family member who has been murdered, or a loved one who has died violently in an accident.

Sudden or traumatic grief can lead to very intense reactions. In some cases, people may develop and require treatment for post-traumatic stress disorder (PTSD).

Summary

Grief is part of how humans respond to significant losses. Each person experiences grief differently. However, there are many things that most people commonly experience as they process their 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 feelings and responses that can be extremely intense and persistent. A person with complicated grief may need more support to help them understand what they are feeling and how to move through the grieving process.

A Word From Verywell

If you are experiencing delayed, disenfranchised, or traumatic grief, it does not mean that you will develop complicated grief. Many people are still able to process their grief even if the process is not typical.

If you're having a hard time with your grief experience, it's important to work with a mental health professional. They can help you figure out if you have complicated grief and help you cope with what you are going through.