The majority of individuals experience normal grief after the death of a loved one. But, about 10-20% of bereaved individuals experience a persistent, debilitating phenomenon referred to as complicated grief (CG). It has also been mentioned to as prolonged or pathologic grief; DSM V relabeled it as Persistent Complex Bereavement Disorder.

CG is principally considered an attachment disorder. Insecure attachment styles (excessive dependency, compulsive caregiving, defensive separation) are correlated with CG. Additionally, supportive marital relationships are correlated with CG after the loss of a spouse suggesting that the loss of a spouse who provides emotional stability and security may lead to an exacerbated grief reaction. Other risk factors include weak parental bonding in childhood, childhood abuse and neglect, female gender, low perceived social support, and low preparation for the loss.

CG is associated with mental and physical health problems including depression, hypertension, work and social impairment and reduced quality of life. It also increases an individual’s risk of suicide and suicidal behavior.
CG shares characteristics with major depressive disorder (suicidal ideation, preoccupation with worthlessness) and post-traumatic stress disorder (re-experiencing intrusive thoughts of the deceased, avoidance of reminders of the deceased and emotional numbness).

Commonly agreed upon diagnostic criteria for CG:
• yearning, pining, or longing for the deceased
• trouble accepting the death
• feeling uneasy about moving on with one’s life
• inability to trust others since the death
• excessive bitterness or anger about the death
• persistent feeling of being shocked, stunned, or emotionally numb since the death
• frequent intense feelings of loneliness
• feeling that life is empty or meaningless without the deceased
• frequent preoccupying thoughts about the person that died

Symptoms must cause marked dysfunction in social, occupational or other important domains. The duration of symptoms required to meet criteria for CG varies between six to twelve months after the death.

See reference for more information about screening and treatment.

Adapted from Claxton R, Reynolds III CF. Complicated grief. Palliative Care Network of Wisconsin. Fast facts and concepts #254. Internet. Accessed on December 27, 2018.