From the Guidelines
Grief reactions can be categorized as either uncomplicated or complicated, with important distinctions between them, and the key difference lies in the duration and intensity of the grief, with uncomplicated grief typically resolving within 6-12 months, whereas complicated grief persists for at least 12 months and significantly impairs functioning. Uncomplicated grief is a normal response to loss that typically resolves over time without professional intervention, involving intense emotions like sadness, yearning, and disbelief that gradually diminish as the person adapts to their loss [ 1 ]. During uncomplicated grief, individuals maintain functional capacity despite their distress and gradually reintegrate into daily life while preserving positive memories of the deceased. In contrast, complicated grief (also called prolonged grief disorder) involves persistent, intense grief that doesn't improve with time and significantly impairs functioning, with key features including persistent yearning, preoccupation with the deceased, difficulty accepting the death, emotional numbness, and avoidance of reminders of the loss for at least 12 months after bereavement (6 months in children) [ 1 ].
Some of the key characteristics of complicated grief include:
- Persistent yearning for the deceased
- Preoccupation with the deceased
- Difficulty accepting the death
- Emotional numbness
- Avoidance of reminders of the loss These features are distinct from uncomplicated grief, which typically does not involve such intense and prolonged symptoms. The distinction between uncomplicated and complicated grief is crucial because it informs the need for professional intervention, with complicated grief requiring specialized psychotherapy such as complicated grief therapy (CGT) or prolonged grief disorder therapy, sometimes supplemented with medications like SSRIs (sertraline 50-200mg daily or paroxetine 20-50mg daily) if depression is present [ 1 ].
In terms of supporting individuals experiencing grief, it is essential to recognize different presentations of grief and provide appropriate psychosocial support [ 1 ]. This may involve exploring patient concerns, referring patients for psychosocial support, and educating family members about the grieving process [ 1 ]. The most critical aspect of managing grief is to identify individuals with complicated grief and provide them with timely and effective interventions to improve their quality of life and reduce morbidity and mortality.
From the Research
Definition of Complicated and Uncomplicated Grief
- Complicated grief, also known as prolonged grief disorder, is a debilitating condition characterized by persistent and disabling grief symptoms 2, 3, 4, 5, 6.
- Uncomplicated grief, on the other hand, refers to a normal and adaptive response to loss, where individuals experience intense emotional pain but are able to gradually adjust to the loss over time 5, 6.
Key Differences
- The primary difference between complicated and uncomplicated grief is the duration and intensity of grief symptoms, with complicated grief lasting for an extended period (typically more than 6 months) and interfering with daily life 2, 3, 4.
- Complicated grief is also characterized by intense emotional pain, avoidance of reminders of the deceased, and difficulty accepting the loss, whereas uncomplicated grief is marked by a more gradual and natural process of adjustment to the loss 5, 6.
- Individuals with complicated grief may require more formal interventions, such as cognitive-behavioral therapy or complicated grief therapy, to address their symptoms and improve their functioning 3, 4, 5.
Factors Associated with Complicated Grief
- Research has identified several factors associated with the development of complicated grief, including lower education attainment, loss of a partner or child, early treatment discontinuation, and more severe grief symptoms at pre-treatment 4.
- Additionally, individuals with complicated grief may experience stronger negative cognitions and avoidance behaviors, which can maintain their grief symptoms and interfere with their ability to adapt to the loss 4, 6.