by Ciara O
In the world of Psychiatry, Complicated Grief Disorder (also known as CGD) is a condition in which those who have been bereaved, experience overwhelming functional impairment due to prolonged grief symptoms that usually persist for up to one month after six months of the death.
Further research around complicated grief disorder is under review pending further study, according to the DSM-5, who has since named the disorder Persistent complex bereavement disorder.
The diagnostic criteria for those showing signs of CGD are as follows:
- Continuous emotional dysregulation surrounding the death
- Isolation and suicidal ideation
- Maladaptive behaviours and thoughts about the deceased or the death
- An inability to resume responsibilities and normal activities beyond six months after the bereavement
It’s clear that more research needs to be done surrounding complicated grief disorder and the multiple pathways leading up to it.
What is Complicated Grief Disorder?
The loss of a loved one is perhaps one of the hardest things all of us will have to endure at some point. Grief rips open our hearts, wreaking havoc on the nervous system, the brain, and everything else in between.
When we think we are coping, grief rears its ugly head, plunging us back into the darkest depths imaginable.
What remains largely misunderstood about grief is that it is continuously oscillating. Like a snake shedding its skin.
People often group their days into being ‘acceptable’ through to small handfuls of ‘bearable’ moments.
Oftentimes grief is a raw and painful experience so much so that it often feels as though there is no ending of the pain in sight.
In the early days of grief, simple tasks that once were minimal, become a monumental avalanche needing to be climbed. Teeth brushing, showering, and making breakfast are huge milestones, particularly for those in early grief.
The morning my mother died, it took me hours to get dressed, showered, and into the car before going to the hospital to say my final goodbyes. Everything seemed so big, so exhausting, so perplexing, as though I was attempting (albeit very badly!) to walk up an icy mountain with constant curve-balls coming at me from all directions.
Everything I did during that period was done in bits and pieces, dribs and drabs of unfinished tasks – makeup that wasn’t applied correctly, clothes that didn’t match, keys that were left in unlocked doors (and that was just the first hour of her passing!).
Trauma experts describe this as dissociation. A condition where individuals often detach from their surroundings and experience a separation from normally related mental processes.
Trauma experts explain that when someone becomes dissociated – it’s possible for them to ‘exist in pieces’.
In what is considered a ‘normal’ grief response, the griever, after around eighteen months’ of the death, is usually able to accommodate the loss into their lives.
This doesn’t mean that they don’t experience rip-roaring pain every now and then, but they have somehow moulded their lives around the loss and can function as they once did before the death.
Research suggests that between 10 – 20% of grievers experience persistent, unrelenting grief reactions, leading them to require mental health treatment such as counselling and/or medication.
Complicated grief is a chronic condition featuring many unpleasant symptoms including:
- Trouble accepting the death
- PTSD (including flashbacks and reliving unpleasant memories surrounding the death)
- Preoccupation about the death and the deceased
- Severe inability to enjoy life and the things that once gave a person pleasure
- Constantly feeling irritated or agitated
- Depression, anxiety and constant feelings of misery
- Feeling unheard and misunderstood by others
- Difficulty carrying out normal tasks and sticking to a normal routine
What causes Complicated Grief
Essentially, CGD stems from unresolved feelings about the deceased and the circumstances surrounding the death.
The at-risk groups with a strong likelihood of developing some form of complicated grief disorder are:
- Those whose loved ones’ death was sudden or violent
- Those who have experienced the death of a child
- Individuals who have lost a loved through suicide or murder
- Caregivers and family members who witnessed loved ones’ physical and mental decline due to terminal or long-term illness
Other factors that put people at risk include:
- Those with a history of depression and post-traumatic stress disorder
- Traumatic experiences in childhood such as neglect or abuse
- Those with financial burden and or/hardships
- Loss of support systems such as friends, partners and family members (known as a secondary loss)
It’s impossible to determine why one person experiences complicated grief, while others don’t.
However, studies show that how people form attachments and the way in which they process information plays a significant role in the many different styles of grief.
‘Normal’ Grief vs ‘Complicated’ Grief
Essentially, grief becomes complicated when a person gets stuck in a moment, preoccupied with painful memories and thoughts related to death and the deceased.
Although, it’s important to note, that in the first few months’ after a bereavement, normal and complicated grief reactions are very similar. It’s hard to tell them apart as grief is most intense immediately after a death has occurred.
However, as the intensity of normal grief starts to fade with time, people experiencing complicated grief will notice that their grief gradually worsens as time goes by.
CGD often holds people emotionally captive, resulting in them being in a constant state of mourning.
Addiction also plays a significant role when it comes to more complicated forms of grief disorder, as people are significantly vulnerable to developing substance addiction issues in an attempt to escape severe and persistent mourning.
Treatment for complicated grief disorder varies from person to person and is largely dependent on other factors such as:
- Other preexisting mental health disorders (such as depression and anxiety)
- The circumstances around the death and style of grief experienced by the mourner
- Whether someone suffers from addiction disorders such as alcoholism, drug, and prescription drug addictions
- An individual’s willingness and capability in seeking support and treatment
When it comes to medication, there is little research on how helpful it is in treating CGD.
Although, for people with clinical depression as well as CGD, antidepressants are known to be helpful.
Psychotherapy treatment, particularly complicated grief therapy, is an extremely effective therapy as it is specifically targeted at those experiencing complicated grief.
During therapy, individuals learn to:
- Explore emotions and thoughts about the death and the deceased
- Learn the principles of complicated grief and any useful treatments
- Decrease any lingering feelings of guilt and shame
- Increase the ability to cope
- Talk freely about the circumstances surrounding the death in a safe environment, allowing a person to come to terms with the death and how it happened. This enables a person to become less distressed about any thoughts and images about their loved one
Cognitive Behavioural Therapy is another effective treatment for people suffering from CGD, as it can help individuals to process their thoughts and emotions, explore them and adopt healthier ways of coping.
Other emotionally supportive factors include:
- Continuous self-care (such as regular exercise and meditation)
- Reaching out to the local community by attending church/charity events
- Learning a new skill
- Attending therapy and reaching out to other bereaved families
- Starting (or joining) a helpful support group
- Practising stress management