7 Signs of Incomplete or Complicated Grief

Following the loss of a loved one, it can take a while to work through the grief process. Sometimes, the process may feel complete, even when it is not. Oftentimes when this is the case, people can suffer from a disorder known as Incomplete Grief, or more recognizably, Complicated Grief. Complicated Grief is a disorder in which the death of a loved one is process similarly to a significant life stressor or trauma (Mayo Clinic Staff 2017). As a result, someone may experience a whole range of symptoms, similar to those of depression or PTSD, although it does remain a completely distinct disorder. This can occur at any age, but has been studied most extensively in older adults (Shear et al. 2013). If you or a loved one is going through this, remember that you are strong, worthy, and never alone. Here are 7 signs of Complicated Grief.

1. Impulsivity

Grieving, in any form, is an emotionally taxing process. It may require pushing through a lot of sadness, pain, and loneliness, among other emotions. When someone is working through Complicated Grief, they not only feel the intensity of these emotions, but it is often supplemented with others. Examples include distress or survivor’s guilt (Simon 2013). With this combination, it can be especially difficult for people to move through the healing process, and they can become emotionally unhinged.

According to a Psychology Today article written by Dr. Ralph Ryback, M.D., one of the main effects of Complicated Grief is a process called introjection, where someone starts to direct all of the pain they feel towards their loss inward, projecting it onto themselves instead (Ryback 2017). This could cause a lot of emotional pain and instability, making outbursts and impulsivity much more plausible (Mayo Clinic Staff 2017, Ryback 2017).

2. Guilt

Directing a large amount of pain inward often comes with consequences. A common sign of Complicated Grief is excessive guilt associated with the death (Shear 2013). This person could spend hours, or days, ruminating over the event, convincing themselves that it was somehow their fault or responsibility when it is actually not.

The guilt felt in this context can come in many forms. A study done by Dr. M. Katherine Shear, M.D., et al.  reports that people going through Complicated Grief are prone to feeling guilty about potentially letting their deceased loved one down or may be self-critical towards the experience as a whole (Shear 2013). The guilt felt is often irrational, and tends to occupy a large amount of space in the person’s mind.

3. Strong desire to remember the deceased and their death

In the process of normal grief, it is not surprising to want to honor a deceased loved one and keep their memory alive. While this may also be the case during the process of Complicated Grief, the difference is that the focus on remembering a deceased loved one becomes unhealthy, almost like an anxious obsession (Mayo Clinic Staff 2017, Shear 2012). Similar to guilt, this can lead to excessive, if not constant, rumination over events that lead up to, or took place during the event. Shears states in her study that these obsessive thoughts lead someone down a spiral of what-ifs, leading to excessively worrying about the past and future (Shear 2012).

4. Avoidance of any memories of the deceased

On the other hand, another common sign of Complicated Grief is a perpetual avoidance of anything related to their deceased loved one (Mayo Clinic Staff 2017). It is similar to when something is eating away at you on the inside, and to try and cope, you do everything in your power not to think about it, even though it is all you can do.

Avoidance in the context of Complicated Grief works in a similar way: if this happens, according to a study by Dr. Naomi M. Simon, M.D., people will likely avoid talking about the loss, doing activities they may have done with their loved one, or anything that could potentially remind them of their loss (Simon 2013). The avoidance is a coping mechanism, and although it could shield someone from potential pain, it could also interfere with someone fully accepting the loss of their loved one.

5. Isolation and Detachment

Similar to avoidance, isolation tends to be a common sign of Complicated Guilt (Mayo Clinic Staff 2017). Constant thoughts and rumination can be overwhelming, and a common way to cope with a crowded mind is isolation (Mayo Clinic 2017, Simon 2013). Isolation and a detachment from normally enjoyed activities could indicate that someone is being consumed with thoughts about the death of their loved one. 

In addition to physical isolation, someone suffering with Complicated Grief could go through a period of emotional detachment or numbness (Mayo Clinic Staff 2017). This could be in relation to their recent loss, or just in general. 

6. Depression-like behavior

As previously mentioned, you might have noticed that a lot of these signs overlap with those of depression. Although these are two very distinct disorders, many symptoms of Major Depressive Disorder can also indicate Complicated Grief. Both of these disorders are rooted in extreme sadness, and are often accompanied by guilt and isolation (Shear et al. 2013). But based on a 2013 study, one of the major differences between the two is that most of the guilt, isolation, and sadness tends to be general and lack a concrete source, but in the case of Complicated Grief, every symptom is directly related to the experienced loss of a loved one (Shear et al. 2013). In addition, those with Major Depressive Disorder do not typically experience any sort of avoidance or desire towards a certain memory, as seen in Complicated Grief (Shear et al. 2013).

7. PTSD-like behavior

Similar to depression, Post-Traumatic-Stress-Disorder has some commonalities towards Complicated Grief. Seeing as the individual has processed the loss of a loved one like a trauma, it makes sense that they would have similar symptoms to those suffering with PTSD. For example, according to an article by Andreas Maercker and Hansjörg Znoj, a couple of common symptoms between the two are avoidance and emotional numbness (Maercker and Znoj 2010).

Although Shear described PTSD as Complicated Grief’s “closest neighbor”, important distinctions still stand between the two (Shear 2012). In PTSD, the anxiety is often accompanied by a fear of one’s own safety, but in Complicated Grief, people can experience anything from an influx of intrusive, unwanted images of their loved one, to a yearning to have the relationship back (Shear 2012). Shear also emphasizes that the trauma typically experienced with PTSD and the loss experienced in Complicated Grief are different in nature (Shear 2012). Although both are big life changes, traumas and losses are experienced, responded to, and coped with differently, making both disorders different as well (Shear 2012).

We hope that we were able to give you a better understanding of Complicated Grief, and what it may look like. If you know of any other signs, let us know in the comments below. Thanks for reading!

References

Maercker A, Znoj H. “The younger sibling of PTSD: similarities and differences between complicated grief and posttraumatic stress disorder”. European Journal of Psychotraumatology. 2010; Vol 1(1). 

Mayo Clinic Staff. “Complicated grief–Symptoms and causes”. Mayo Clinic. 05 October 2017.

Ryback, Ralph. “The Ways We Grieve”. Psychology Today. 27 February 2017.

Shear, M Katherine. “Grief and mourning gone awry: pathway and course of complicated grief.” Dialogues in Clinical Neuroscience. 2012; Vol 14(2): 119-28.

Shear MK, Ghesquiere A, Glickman K. “Bereavement and Complicated Grief”. Curr Psychiatry Rep. 2013;15(11):406.

Simon, Naomi M. “Treating Complicated Grief”. JAMA. 2013; Vol 310(4): 416-423.