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Massachusetts Medical Society's Physician Focus

August 2013

Complicated Grief


  • Complicated grief is severe and persistent grief that occurs for 12 months or more following the death of a loved one.

  • The condition can impair daily functioning and increase the risk of physical or mental illness, substance abuse, and suicide.

  • It can happen to anyone at any age, reaches about seven percent of those who have experienced a loss, and tends to be more common among women than men.

  • The most worrisome symptom of complicated grief is hopelessness, or a feeling that life is not worth living anymore.

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Grief is a universal phenomenon, reaching all of us at one time or another following the loss of a loved one. While most of us successfully adapt to our loss after a period of mourning, some people find it much harder to accept the loss and develop what is called complicated grief.

“Many people do get confused about what we mean by complicated grief,” says Naomi Simon, M.D., a board-certified psychiatrist, “because all of us are exposed to loss, and loss is one of the most stressful things we experience in our lifetimes.”

Dr. Simon, Director of the Complicated Grief Program and Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital in Boston, joins colleague and program host John Fromson, M.D., Associate Director of the Center, on the August edition of Physician Focus to discuss complicated grief, how it affects individuals, and how it is treated.

“Complicated grief can be thought of in the way we think about medical complications,” Dr. Simon says, “where there’s a complication that interferes with grief progressing along the usual pathway. There’s no single way to grieve; everyone grieves in their own way, and in some way we grieve forever because we can never bring our loved one back. And that’s one of the things that’s really different about loss and grief than other types of stressful experiences like a trauma, where the trauma is over, the loss is permanent.”

Most people after a loss will undergo an intense period of acute grief, measured in days, weeks, or months. Usually, that evolves over time, and people adjust. With complicated grief, however, the grief becomes severe, persists for some 12 months or more (though the time varies from person to person), and has a direct impact on daily functioning, even perhaps becoming a debilitating condition.

The condition is marked by such characteristics as intense longing for the deceased, a preoccupation with or trouble accepting the death, a difficulty returning to shared activities, and a lost sense of purpose. Its most worrisome symptom, Dr. Simon emphasizes, is hopelessness, or a feeling that life is not worth living. That can lead to thoughts of suicide.

“Complicated grief can sometimes focus on the circumstances of the death,” Dr. Simon adds. “People may spend a lot of time focusing on the ‘what if’ - ‘if only I had called the doctor a day earlier or if only I had encouraged my loved one harder not to smoke’ - and thus take some of the blame for the death. This can happen to caregivers or parents who have lost a child, thinking that they had some responsibility for the loss.”

While complicated grief is not widespread – it affects about seven out of every one hundred of those who experience the loss of an important person in their life – research indicates it can occur at any age and to any person, though it appears more common among women than men.

Some risk factors make those numbers rise. Individuals suffering from depression, anxiety or mood disorders prior to the death, for example, may be more susceptible, and some research indicates that among those individuals the rate may be as high as one out of every four. The nature of the loss can also raise the risk: the loss of a child or very close family member can trigger extended, deep grief.

Dr. Simon urges those who think they may be affected by complicated grief to seek help, either through their primary care provider, counselors, or grief support groups in the community.

The key to recovery, Dr. Simon says, is to find a place in the world without your loved one and recognize that “grief is not the only way to honor and be connected to a loved one.”

There is good news, however. “Complicated grief is a treatable condition,” she says, “and it’s our job to help people to move past those complications so they can move forward with their lives.”

Watch the above video for more conversation, including discussion about the differences among complicated grief, depression, and post-traumatic stress disorder; the roles of “avoidance” and “isolation” in extending complicated grief; the influence of religious and cultural traditions in dealing with grief; and how the diagnosis of complicated grief came to be.

MMS/Richard Gulla

Massachusetts General Hospital Complicated Grief Program

MGH Center for Anxiety and Traumatic Stress Disorders

The Complicated Grief Program at Columbia University

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"Complicated Grief" PSA

From left, John Fromson, M.D., Naomi Simon, M.D.
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