Complicated Grief

Historically, researchers have argued that complicated grief is an expression of a major depressive disorder or an anxiety-based disorder that has been triggered by a specific loss. More recently, researchers have concluded that grief symptoms only partially overlap with symptoms of depression and other DSM-IV-TR categories, such as anxiety and post traumatic stress disorder, and that although there may be some expected shared variance, complicated grief reactions do display sufficiently unique variance to warrant separate consideration (Kristjanson, Lobb, Aoun & Monterosso, 2006).

Bereavement is a painful experience. Even though it is painful, most people adjust to the trauma of a loved one dying and continue to live full and satisfying lives. However, some people do not make such an adjustment and instead, develop complicated grief. Unresolved grief or complicated grief refers to the disruption and disturbance of the normal grieving process. 

In many cases this may be due to the grief being suppressed or cut short whereby the person avoids mourning by denying themself opportunities to experience the progression of the mourning process. In this context the goal of the bereaved is to deny the loss and hold on to the dead loved one (Shear, Monk, Houck, Melhem, Frank, Reynolds & Sillowash, 2007).

Complicating grief by suppressing it, cutting it short or avoiding it may occur as a result of a significant distortion in the mourning process due to:

  1. A failure to undo the attachment that binds the mourner to the loved one;
  2. An inability to develop new relationships
  3. A failure to modify or adopt to new roles (Mitchell, 1999).

Figure 1. Forms of Unresolved/complicated Grief

Types of Complicated Grief

Absent Grief ischaracterised by the bereaved acting as though nothing has happened.The bereaved show no feelings of grief or mourning and become detached from reality as if the death never occurred.Emotional numbness is common with this form of grief. Maladaptive behaviour is also common but often the bereaved is unable to associate such maladaptive behaviours with the loss experienced.

Delayed grief may result from pressing responsibilities (e.g. funeral arrangements) that the mourner needs to attend to, resulting in postponed grief that may last for years. An experience of grief may eventually be triggered by another loss or an event related to the original loss.

Inhibited grief involves inhibition of the normal behaviours that are associated with grief. Those who do not allow themselves to experience the pain of grief directly may develop some kind of somatic complaints or illness. It is common in this form of grief for the mourner to choose mourning some aspect of the deceased and not the other. For example: the positive aspects and not the negative ones. Like absent grief, this form of grief also encompasses maladaptive behaviour that the bereaved will usually be unaware of or not attribute it to their grief response.

Conflicted grief involves an exaggeration of one or more behaviours commonly displayed in normal grief while other aspects of the grief is suppressed. This form of grief is often characterized by extreme anger and guilt. Exaggerated anxiety manifested in panic attacks is also common.  Substance abuse problems may also arise or existing problems may be exacerbated. The conflicted grief pattern can become quite prolonged and is normally associated with dependent or ambivalent attachment to the deceased.

Chronic grief involves the mourner exhibiting intense grief reactions that are common in the early stages of grief but continue long after the loss has occurred. There is little or no progress and mourning fails to come to any conclusion. The bereaved seems to keep the deceased alive with their mourning. This form of grief is maintained by feelings of insecurity and insecure attachment to the deceased. The bereaved feels that they have sustained a loss of an irreplaceable relationship. With regard to this type of grief, the therapist needs to identify those aspects of grief that are not resolved and intervention would then need to focus on the resolution of this (Williamson & Shneidman, 1995; Freeman, 2005; Worden 2005).

Unanticipated grief like the name suggests, is grief that results from unexpected sudden death. This form of grief is said to be disruptive to the bereaved and will often involve a complicated recovery. This form of grief entails great difficulty in accepting the loss that is accompanied by overwhelming feelings. The adaptive capabilities of the bereaved can be seriously damaged in the context of an unexpected and sudden death, resulting in their inability to function normally in any area of their life. Although the grieving person can intellectually recognize the death, they will often have great difficulty in accepting the loss due to it being so sudden and so unexpected. In this situation grief symptoms will tend to continue on much longer than normal grief reactions.

Abbreviated grief is typically a short lived but normal form of grief. This is often mistaken for unresolved grief. The grief process is shortened or abbreviated commonly because the attachment figure or lost person is immediately replaced (e.g. remarrying immediately after the spouse dies) or there has been little or no attachment to the deceased. At times abbreviated grief occurs due to anticipatory grief whereby an individual embarks on the grieving process prior to the actual loss occurring. This results in a much shorter grief after the actual death.The problem with abbreviated grief is that the bereaved may show very little sense of discomfort as negative feelings can be blocked away by denying themselves the opportunity to experience normal grieving process at the time of loss. This type of grief can manifest in the future.

In every form of complicated grief, the bereaved tries to deny or avoid aspects of the loss and the full realisation of what the loss means to them. The tendency to hold on to and avoid giving up the loved one is also a common factor in complicated grief. 

Source: www.mentalhealthacademy.com.au