Complicated Grief: When Time Doesn’t Heal

Some people think of grief as a profound sadness, while others describe it as hopelessness or despair. For some the pain of grief is devastating; for others, a painful but brief bump in the road. And the standard, one-year travel time commonly assigned to the journey through grief? At best, it’s a very rough estimate – grief adheres to no particular timetable.

With such a wide spectrum of “normal” in the grieving process, how can we know when grief is spinning out of control? Bereavement counselors and therapists who differentiate normal grief from “complicated grief” are leading a movement to establish “Prolonged Grief Disorder” as a new mental-health diagnosis for clients who, six months after the loss of a loved one, are showing no signs of being able to recover or move on with their lives.

Normal response or mental disorder?
Holly Prigerson, who studies bereavement at Dana Farber Cancer Institute, says the key symptom that makes Prolonged Grief Disorder different from depression or anxiety is an intense yearning. Prigerson says that normal grief is “wanting what you can’t have. That hankering and yearning and pining and craving for something that you think is essential to your sense of happiness and well-being.”

In complicated grief, the intense yearning, preoccupation with the deceased, and feelings of emptiness do not lessen with time. In other words, complicated grief is the inability to recover after the death of a loved one. Prigerson’s research suggests that 10 to 20 percent of Americans who suffer a loss experience prolonged grief.

The current Diagnostic and Statistical Manual of Mental Disorders (DSM) defines grief as the normal response to loss rather than a medical diagnosis, and doctors are not paid to treat it. If complicated grief is approved as a new disorder, symptoms and treatment protocols would be established, and doctors could be reimbursed for treating patients with the disorder.

How to recognize complicated grief
According to the National Institutes for Mental Health (NIMH), the following symptoms may indicate complicated grief when they persist, with no sign of abating, for more than six months following the death of a loved one:
•    Strong yearning for the person who died
•    Waves of intense sadness and longing
•    Feeling of disbelief or difficulty accepting the death
•    Avoiding people, places or things that call to mind the loss
•    Pervasive bitterness or anger
•    Feeling intensely alone or lonely
•    Inability to control thoughts, memories, or images of the person who died
•    Seeing life as empty or meaningless without the lost loved one
•    Belief that grieving less would be a betrayal of the deceased

Study to explore complicated grief in older adults
In April, NIMH began recruiting 200 older adults who suffer from unrelenting symptoms of complicated grief to participate in a four-month, non-drug clinical trial. Dr. M. Katherine Shear of Columbia University is the psychiatrist conducting the study. “The death of a loved one can take an especially devastating toll on an older adult,” says Shear. “Older people may experience a cascade of losses as their social circles become smaller. The death of a spouse, adult child, friend, parent, or sibling — along with the social, financial and medical issues that accompany it — can throw an individual into a discouraging downward spiral. People who continue to struggle with bereavement after more than six months may be experiencing complicated grief. We believe we can help.”

Source: Reuters,

Comments (2)

Russell FriedmanSeptember 4th, 2009 at 12:56 pm

The Grief Recovery Institute Educational Foundation
P.O. Box 6061-382 Sherman Oaks, CA 91413
Ph: 818-907-9600 Fax: 818-907-9329
On the web at:

I have tremendous respect for my new friend Holly Prigerson, although I don’t see eye to eye with her on this particular matter. It’s not so much that I would contest the facts of her research, indicating 10-20% of those dealing with a death experience “prolonged grief.” It is the missing context that troubles me.

For example, of that 10-20%, how many of them, apart from the absence of their missing spouse [or other person who died], have an otherwise rich and full life of friends, family, and activities, as opposed to those whose primary interaction had been with the spouse [or other person] who died, and who are now essentially isolated a great deal of their time?

What I’m asking is if absent other productive life areas and people to participate with, are those 10-20% classified as prolonged grievers solely because of their continued “yearning” for the person who died, without regard for their personal life circumstances?

Has there been any research to indicate that the other 80-90% who are less “yearning” for their mates who died, are that way because they deal with loss or grief better than the others, or because they have a great deal of connection and activity in their day-to-day lives?

[I must make it clear that one of the major myths we highlight in our books, The Grief Recovery Handbook & When Children Grieve, is the idea of Keeping Busy, which is not necessarily helpful for grieving people. So above, when I’m talking about “rich and full life of friends, family, and activities,” I’m not talking about just Keeping Busy just for busy’s sake.]

I would direct the same concerns and questions to Dr. Shear, for the same reasons.


Russell Friedman
Executive Director

Pam BrownSeptember 4th, 2009 at 4:08 pm

If the prolonged grief disorder is recognized as a medical condition, what would be the treatment? You state doctors can treat the disorder but I was just wondering if the treatment methods include drugs?

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