What Is Complicated Grief? How Long Is It Normal to Grieve?

January 10, 2024 ◊ By Elisa Everts ◊

What Is Complicated Grief? How Long Is It Normal to Grieve?

What is complicated grief? How long is it normal to grieve?

How long should grief last? When should a bereaved person be “over it”? There is no easy answer to that question since each grief is as unique as the person grieving and the relationship that is lost.

Normatively, people tend to grieve heavily for six to twelve months and then the aftershocks gradually become less jolting and further apart over time until it is eventually not so gut-wrenching and a more peaceful sadness that is mixed with joyful memories. However, grief is different for everyone, and it is hard to tell how long a person will be grieving hard for a loss.

One thing that is certain, you cannot know another person’s grieving experience and it is never ok to tell someone, “It’s time to move on now.” If a person is not done grieving, she is not done grieving, and there is undoubtedly a reason for that, whether you can see or understand it or not. It’s hard to watch a loved one go through this, but you can’t hurry them. Each person’s grief has its own timetable and others need to treat that timetable with reverence and respect.

If you can’t understand why someone is grieving so deeply or so long, thank God and your lucky stars and be as kind as you possibly can because one, that is what love calls us to do, and two, unfortunately, inevitably, your turn will come. Like the rising of the tides, in time, if you are blessed enough to know love, you will know deep grief. And you will need the tender patience of others.

When a person grieves hard beyond the usual twelve-month window, it can be because she is suffering from complicated grief. What, you may be wondering, could be complicated about grief? Someone dies and rips your heart to shreds; seems pretty straightforward. And yet there is little that is perfectly straightforward about grief.

When my dear friend Diane died in 2001, I cried profusely for seven years. Seven. Years. For the first year I woke up crying, cried off and on throughout the day and cried myself to sleep every night. I had nightmares that she was alive again just so I could watch her die again. She wasn’t even my spouse or my child. Is that normal?

Well, no. It’s not what we would call normal, healthy grief. This was an example of what experts call, complicated grief. The DSM refers to it now as Prolonged Grief Disorder. As the American Psychological Association describes it, it is characterized by intense and persistent grief that causes problems and interferes with daily life.

In the early stages of grief complicated grief and “normal” grief might look exactly the same on the surface. However, normal grief will start to fade over time, whereas complicated grief persists and may even worsen with time. The Mayo Clinic describes this as like “being in an ongoing, heightened state of mourning that keeps you from healing.”

It is estimated that it only occurs in 10-15% of bereavements, but you may know someone who has been or, God forbid, will be affected by it. While you can’t rush them through their process, it may be helpful to recognize the symptoms and effects of complicated grief and to be familiar with some of the risk factors.

Being aware of the phenomenon of complicated grief may help you find the patience and understanding you need to support a loved one while they are experiencing it. In some cases, it may be appropriate to encourage the person to seek professional help.

First of all, what causes complicated grief? It tends to occur when a death happens very suddenly or in a violent or traumatic way. Think of tragic accidents, suicide, murder, illnesses that are especially traumatic. People who suffer from depression or bipolar disorder are more susceptible than others. Caregivers and older people also seem to be disproportionately affected.

Signs and symptoms of complicated grief may include:

· Intense sorrow, pain and rumination over the loss of your loved one

· Focus on little else but your loved one's death

· Extreme focus on reminders of the loved one or excessive avoidance of reminders

· Intense and persistent longing or pining for the deceased

· Problems accepting the death

· Numbness or detachment

· Bitterness about your loss

· Feeling that life holds no meaning or purpose

· Lack of trust in others

· Inability to enjoy life or think back on positive experiences with your loved one

Complicated grief also may be indicated if you continue to:

· Have trouble carrying out normal routines

· Isolate from others and withdraw from social activities

· Experience depression, deep sadness, guilt or self-blame

· Believe that you did something wrong or could have prevented the death

· Feel life isn't worth living without your loved one

· Wish you had died along with your loved one

While these are indicators that grief is wreaking havoc on your life, it does not mean that you are defective in your grief. It is important to recognize what you going through is intense and grave without pathologizing your grief which, I know, is definitively what that DSM-5 has done by labeling this Prolonged Grief Disorder.

I would say this labeling is important because we may need loving, professional attention when grief is beyond our control. We need the DSM so that insurance will pay for the professional guidance we may need. Insurance companies require a diagnosis. But you are not defective even if your grief is "disorderly." (It's ok to chuckle in a newsletter about grief!)

If you are on the outside looking in, it is helpful to understand what your grieving loved one is enduring and to be tender and patient. If, God forbid, you are yourself drowning in your grief, keep reaching out. Reach out to me, if you like. There are those of us who are comfortable sitting with you in the darkness, and we are comfortable holding an inobtrusive little light for you, too.

In my next newsletter I will talk more about what you can do as a griever and as a supporter. The very most important thing is to feel all the feelings—do not muzzle grief. That is the road to mental and emotional illness. Let it all out. More on that in my next missive.

I send love and healing prayers for you all,

Elisa square portrait

About the author

Dr. Elisa Everts is the founder of Evertree Hope Management and is a dynamic public speaker, author and trainer. Dr Everts is passionate about helping cancer patients and bereaved people in their quest to survive and live a full life during and after cancer and grief. She has the personal experience of surviving Stage IV cancer and the loss of many loved ones. She understands the challenges inherent in these experiences and the importance of cultivating hope through the stories we tell others, and even more importantly, to ourselves.

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Elisa Everts, phd

Speaker | Author | Educator

Finding Hope in Cancer & Grief

Elisa Everts, phd

Speaker | Author | Educator

Finding Hope in Cancer & Grief

I speak to medical professionals and patients, helping them provide hope when there seems to be none. If you or your organization need someone to help process the difficult topics of cancer and grief, let's set up a complimentary call, 703-656-6691, ee@elisaeverts.com.

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