Therapy in Alexandria, VA

Important Differences Between Normal and Complicated Mourning

Grief can take many forms. True, when people speak of “grief and loss” it’s often in reference to an individual “passing away” (a term frequently used as a substitute euphemism for “died”). However, grief and loss comes in many forms: loss a mental or physical ability due to a medical illness or injury, loss of status of all kinds, loss of financial health or standing and loss of childhood due to abuse or neglect or due to parental irresponsibility. These are only a few of the many kinds of losses that result in grief and mourning.

Given that grief and loss comes in many forms and in numerous ways, I would like to address one important facet of this topic. What is “normal grief” (also known as uncomplicated mourning) and “abnormal grief” (also known as complicated mourning)?

Characteristics of normal/acute grief are: (Lindeman 1944)

1) Bodily distress of some type

2) Preoccupation with the image of the deceased person

3) Guilt related to the deceased individual or to the circumstances around his/her death

4) Angry or hostile behavior or reactions and

5) Difficulty functioning or the inability to function as one had prior to the person’s death

There will be sadness present along with other common distress markers such as sleep disturbances, appetite changes, reduced/abandoned socialization, forgetting, dreams of the deceased, disbelief, confusion, preoccupation (obsessional thinking/remembering), visual and auditory hallucinations of the deceased (believing one sees or hears the deceased loved one), loneliness, anxiety, numbness and fatigue. Depression may develop during the mourning process but it is not a “clinical depression” which involves a loss of self-esteem and worth, a negative evaluation of themselves, the world and the future. Freud said it well when he described grieving as the world looking poor and empty to the mourner while in depression the person feels poor and empty.  

During a complicated grief reaction (mourning) the survivor experiences difficulty navigating the natural grief and mourning process. Sometimes the individual will self-diagnose, as in the instance of chronic grief, realizing their grief is resolving itself and subsequently seek professional help. Or the survivor will seek help for a medical condition or an underlying psychiatric problem seemingly unrelated to the problematic mourning.  Here are some indicators that complicated grief may be at play:

1. There is an intense or “fresh” sadness that occurs at the mention of the loss although many years may have passed since the death or loss.
2. A relatively minor event triggers and intense/acute grief reaction
3. The survivor may be unwilling to move or put away things belonging to or associated with the loss/deceased. Or the individual may rid themselves of or throw away everything belonging to the deceased right after the loss.
4. The survivor may develop physical symptoms like that of the deceased before their death, on the anniversary of the death or around holiday seasons or when the survivor reached the age of the deceased at the time of their death.
5. Radical changes in lifestyle right after the death or avoiding people, places of things associated with the deceased.
6. A compulsion to imitate the dead person that is a way to identify with the deceased (unconsciously) and/or adopt their personality characteristics, again outside of personal awareness.
7. Self-destructive impulses.
8. Inexplicable sadness occurring at a certain time each year.
9. The survivor may develop a fear or phobia about an illness that can be traced back to the cause of death of the deceased.

If you have recently suffered a significant loss of any kind or have suffered a serious loss that had occurred years ago and can identify with any of the above listed indicators, you may want to seek professional help.