Complicated grief

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Causes

By Mayo Clinic staff

It's not known what causes complicated grief. As with many mental health disorders, it may involve an interaction between inherited traits, your environment, your body's natural chemical makeup and your personality.

Researchers used to believe that all people moved through five specific stages of grief, in order. Today it's accepted that different people follow different paths through these experiences of grieving:

  • Accepting the reality of your loss
  • Allowing yourself to experience the pain of your loss
  • Adjusting to a new reality in which the deceased is no longer present
  • Having other relationships

You may accomplish these in a different order or on a different timeline than another person grieving a similar loss. These differences are normal. But if you're unable to move through one or more of these stages after a considerable amount of time, you may have complicated grief.

Risk factors Symptoms
References
  1. Block SD. Grief and bereavement. http://www.uptodate.com/home/index.html. Accessed July 18, 2011.
  2. Abrahm JL. Caring for patients at the end of life. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/das/book/body/149504704-4/862286866/1709/49.html#4-u1.0-B978-0-443-06694-8..50048-8_1340. Accessed July 18, 2011.
  3. Shear MK, et al. Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety. 2011;28:103.
  4. Bereavement. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed July 18, 2011.
  5. Marchand L. End-of-life care. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-2/0/1494/0.html. Accessed July 18, 2011.
  6. Grief, bereavement, and coping with loss. http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/HealthProfessional. Accessed July 18, 2011.
  7. Coping with the loss of a loved one. American Cancer Society. http://www.cancer.org/Treatment/TreatmentsandSideEffects/EmotionalSideEffects/GriefandLoss/coping-with-the-loss-of-a-loved-one-depression-and-complicated-grief. Accessed July 18, 2011.
  8. Powell AD. Grief, bereavement, and adjustment disorders. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-04743-2..50040-8&isbn=978-0-323-04743-2&uniqId=267674922-4#4-u1.0-B978-0-323-04743-2..50040-8--cesec1. Accessed July 19, 2011.
  9. Sung SC, et al. Complicated grief among individuals with major depression: Prevalence, comorbidity, and associated features. Journal of Affective Disorders. In press. Accessed July 18, 2011.
  10. Wittouck C, et al. The prevention and treatment of complicated grief: A meta-analysis. Clinical Psychology Review. 2011;31:69.
DS01023 Sept. 29, 2011

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