Grief, Complicated

Simple grief or normal bereavement includes such symptoms as shock, sadness, anger, guilt, anxiety, regrets, intrusive thoughts or images of the deceased or the death, yearning for the deceased, fear, depersonalization, feeling overwhelmed, and loneliness. Its intensity, course, and duration are highly variable. Initially after a death, such symptoms may seem ever-present or may occur intermittently. Painful feelings and memories may intermingle with positive ones. For most people, although progress may be uneven and difficult, symptoms gradually subside. When grief has disrupted normal activities and relationships, adaptive grief is characterized by the return over time of the capacity to engage in meaningful relationships and activities. Most people improve with the support of friends and family and/or with the help of bereavement-related support groups. Progress is generally evident by 6 months after the loss.

Age-related differences are evident in the manifestations, variable associations, and impact of grief. From childhood to adulthood, understanding evolves related to the universality, inevitability, unpredictability, irreversibility, bodily nonfunctionality, and causality of death as well as the impact that a death may have on the future. Additionally, grief-related reactions, death-related preoccupations, and the developmental tasks that might be disrupted by grief vary among age groups.

Complicated grief (CG) occurs in an estimated 10% to 15% (on average) of bereaved individuals. CG indicates that grieving has been complicated by the presence of other factors. That is, grief reactions are prolonged, intensified, and/or thwarted, for example, because of qualities of the griever, the nature of the loss, and/or the relationship to the deceased. CG can be persistent and debilitating. In addition to intensified and/or prolonged grief symptoms, CG is associated with impairments in personal, career, academic, interpersonal, and other aspects of functioning as well as increased traumatic reactions, interference with memory specificity, and altered treatment needs. Not all individuals exposed to the same set of circumstances develop complicated grief or other disordered reactions.

To follow are discussions of proposed or observed types of complicated grief reactions and some of the variables associated with them. A clear understanding of some of the forms of complicated grief has been [Page 290]thwarted by the lack of scales that assess all the symptoms proposed for particular types of complicated grief (e.g., traumatic grief, TG), variations in assessed populations and/or assessment methods, and the need for the use of a broader range of symptoms and a developmental perspective for assessing children.