Continuing on from last week, we look at complicated grief. This isn’t the normal grief cycles and then a period of gradual healing. This is grief on a different level.

According to the DSM-V, where complicated grief was added in 2022, this sort of grief is an ongoing and increasingly damaging space. Among the symptoms listed are,

• Identity disruption (such as feeling as though part of oneself has died).
• Marked sense of disbelief about the death.
• Avoidance of reminders that the person is dead.
• Intense emotional pain (such as anger, bitterness, sorrow) related to the death.
• Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).
• Emotional numbness (absence or marked reduction of emotional experience).
• Feeling that life is meaningless.
• Intense loneliness (feeling alone or detached from others).

As you can see, this sort of grieving is damaging to the self, to personal relationships, and potentially more. That is why it was finally given its own space in the DSM-V.

While the definitions center around death, I can tell you from personal experience, you can encounter this type of grief after the loss of a relationship, the loss of a job, and so on. Grief, as I mentioned last week, isn’t always about someone dying.

In treatment for this type of grief, multiple approaches are leveraged. The most commonly used are pieces of CBT therapy. Mindfulness, targeting behaviors to change, and reframing are just three examples. In addition, exposure therapy can come into play when it is used to help a patient open up about the loss and their grief enough to speak about the initial event.

In a few cases, medications may be helpful for a short time, to provide a buffer against the more intense emotions, but these are always recognized as an aid, not a cure. From what I have found in my research, this is not usually the route chosen unless therapy alone is not helping things to improve after a reasonable amount of time.

Again, from experience, therapy can help with complicated grief. I lost a fiance, and in hindsight, it was a blessing that I did. He and my roommate decided to be together. I found out a few weeks before we had been planning to send out wedding invitations.

Given that this man had been in my life for over a decade, and was a key figure in my romantic life, the loss was traumatic and devastating. For months I cried myself to sleep, only to wake myself up by crying. I had most of the symptoms of complicated grief, and no one to tell me that was what I was experiencing.

I did have experience in working with therapists, though, and I was fortunate enough to find one who was skilled on my first try. Working with him, I was able to process the loss enough to get back around to a much more normal grief cycle. It still took years to get over it enough to not want to drive by my ex’s old house (which was already inhabited by other people), or to not want to reach out to him every time something big happened in my life.

Complicated grief is so overwhelming that it’ll feel as if the lights have gone out, or, as I recall describing to someone, all the colors in the world went dull.

Yet, regardless of the source event, it’s not something for which anyone should be ashamed of going through. We are humans. We have hearts and minds that are wonderful, powerful things, and capable of overturning immense odds. They can also be wounded so deeply that we lose sight of ourselves in the face of all the pain.

I can’t say it’s “normal” because if it were, it wouldn’t be in the DSM, right? But if you are experiencing this sort of grief, know that about 7-10% of adults will encounter it. It’s a minority population, but it’s not so uncommon as to be deemed unworthy of a listing in the DSM.

Please, if you’re in that darkness, find help. You can find your way back to living the sort of life you once enjoyed. Sometimes we just need a little help getting there when we’ve fallen so far.

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