Complicated grief

Diagnosis

Grieving is a highly individual process for each person, and determining when normal grief becomes complicated grief can be difficult. There's currently no consensus among mental health experts about how much time must pass before complicated grief can be diagnosed.

Complicated grief may be considered when the intensity of grief has not decreased in the months after your loved one's death. Some mental health professionals diagnose complicated grief when grieving continues to be intense, persistent and debilitating beyond 12 months.

There are many similarities between complicated grief and major depression, but there are also distinct differences. In some cases, clinical depression and complicated grief occur together. Getting the correct diagnosis is essential for appropriate treatment, so a comprehensive medical and psychological exam is often done.

Treatment

Your doctor or mental health professional considers your particular symptoms and circumstances in determining what treatment is likely to work best for you.

Psychotherapy

Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD, but it's specifically for complicated grief. This treatment can be effective when done individually or in a group format.

During therapy, you may:

• Learn about complicated grief and how it's treated
• Explore such topics as grief reactions, complicated grief symptoms, adjusting to your loss and redefining your life goals
• Hold imagined conversations with your loved one and retell the circumstances of the death to help you become less distressed by images and thoughts of your loved one
• Explore and process thoughts and emotions
• Improve coping skills
• Reduce feelings of blame and guilt

Other types of psychotherapy can help you address other mental health conditions, such as depression or PTSD, which can occur along with complicated grief.

Medications

There's little solid research on the use of psychiatric medications to treat complicated grief. However, antidepressants may be helpful in people who have clinical depression as well as complicated grief.

Coping and support

Although it's important to get professional treatment for complicated grief, these strategies also may help you cope:

• Stick to your treatment plan. Attend therapy appointments as scheduled and practice skills learned in therapy. If needed, take medications as directed.
• Practice stress management. Learn how to better manage stress. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
• Take care of yourself. Get enough rest, eat a healthy diet and take time to relax. Exercise regularly. Physical activity can help relieve stress, depression and anxiety. Don't turn to alcohol or recreational drugs for relief.
• Reach out to your faith community. If you follow religious practices or traditions, you may gain comfort from rituals or guidance from a spiritual leader.
• Socialize. Stay connected with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
• Plan ahead for special dates or anniversaries. Holidays, anniversaries and special occasions can trigger painful reminders of your loved one. Find new ways to celebrate, positively reminisce or acknowledge your loved one that provide you comfort and hope.
• Learn new skills. If you were highly dependent on your loved one, for example, to handle the cooking or finances, try to master these tasks yourself. Ask family, friends or professionals for guidance, if necessary. Seek out community classes and resources, too.
• Join a support group. You may not be ready to join a support group immediately after your loss, but over time you may find shared experiences comforting and you may form meaningful new relationships.

Preparing for your appointment

You may start by contacting your doctor. After your initial appointment, your doctor may refer you to a mental health professional who can help diagnose your symptoms and provide a treatment plan.

You may want to ask a trusted family member or friend to be present for your appointment, if possible, to help you remember key information.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing and for how long. Your doctor will want to know the extent to which these symptoms are affecting your daily life, including work and personal relationships.
• Your key personal information, especially any additional major stress or change you've experienced since your loved one died, such as serious illness, significant family disruptions or financial problems.
• Medical information, including other physical or mental health conditions with which you've been diagnosed.
• All medications, vitamins, herbs or other supplements you're taking, and the dosages.
• Questions you'd like to ask your doctor.

Some questions to ask your doctor or mental health professional include:

• Do you think my symptoms are more severe than what's typical after a loved one's death?
• Do you think psychotherapy would help me?
• Are medications available that could improve my symptoms?
• What are the possible side effects of those medications?
• What self-care steps are most likely to help me?
• Are there local support groups or online support groups that might help me?
• How long do you expect it will take me to feel better with treatment?
• Will I eventually feel like myself again?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Questions may include:

• How often do you think about your deceased loved one?
• Do you believe you could have prevented your loved one's death?
• Do you ever wish that you had died along with your loved one?
• How well are you functioning in your daily life, such as work, household maintenance and relationships?
• Have you experienced any other major stresses, changes or loss since your loved one died?
• Have you had trouble eating or sleeping since your loved one died?
• How much social support would you say you have, such as from relatives, friends or a church community?
• Have you been diagnosed with any medical conditions?
• Have you ever been treated for mental health conditions? If yes, what type of therapy was most beneficial?
• Have you ever thought about harming yourself or others?
• Do you drink alcohol or use recreational drugs? If so, how often?