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~ Complications of Grief ~

There are many sequelae of loss, change, grief and bereavement; they can affect the grieving in many different spheres of life—physical, psychological, behavioral, social, emotional, economical, philosophical and spiritual. Repressed, unrecognized, unprocessed and untreated the grief response following a significant loss can result in personal anguish, increased anxiety, multiple physical complaints, functional impairment, strained relationships, marital discord, disrupted sleep, impaired childhood, increased substance abuse—tobacco, alcohol, drugs, tranquilizers; clinical depression, and an increased mortality from heart disease and suicide.

Several definitions apply to the complications of grief:

  • Complicated Mourning is a delayed or incomplete adaptation to loss or failure in the process of mourning. 
  • Prolonged Grief (Chronic Mourning, Protracted Mourning) is acute mourning that persissts interminably. Mourning that fails to draw to its natural conclusion and in which intense reactions do not abate over time.
  • Unresolved Grief is a halting of the grief process, which becomes chronic unless treated.
  • Potential Sequalae
    Major Depression, Anxiety, Suicide and Post Traumatic Stress Disorder are all potential sequalae of complicated mourning. Follow the links below to more information on the different possible complications: Getting More Help and/or Referring
    Cases of complicated bereavement or grief should be referred for more extensive grief therapy, with a therapist that is knowledgeable about the grief process. Several "Red Flags" and warning signs exist that should be clear indicators of the need to refer for evaluation by their Primary Care Physician or a Mental Health Practitioner ASAP. 
    • Expression of suicidal intent.
    • A pattern of alcohol abuse and/or dependence.
    • Drug dependency.
    • Psycho-physiologic reactions.
    • Inability to care for self e.g. not getting sleep, not eating.
    • Uncontrollable rage directed at others.
    • Physical harm to self or others.
    • Severe depression.
    • Uncontrollable phobias, such as an inability to be by themselves at any time.
    • Psychotic States.
    • Characteristics of mourning that do not appear to change at all over a period of months.
    • Inhibited or absent grieving.
    We must also recognize that grief is not isolated to the grieving person. Despite pressures to keep the emotions hidden and repressed, loss and the resulting grief response affect the family, friends, social network, workplace environment, and overall community of the bereaved. Thus one person's grief can impact many, many others.

    Rando TA. Complications in Mourning Traumatic Death. In Doka KA (ed). Living with Grief After Sudden Loss: Suicide, Homicide, Accident, Heart Attack, Stroke. Washington D.C.: American Hospice Foundation, 1996.
    Rando TA. Treatment of Complicated Mourning. Champaign, IL: Research Press: 1993.
    Wolfelt AD. How to Start and Lead a Bereavement Support Group. Batesville Management Services, 1994.

    Grief is a journey, often perilous and without clear direction, that must be taken.
    The experience of grieving cannot be ordered or categorized,
    hurried or controlled, pushed aside or ignored indefinitely.
    It is inevitable as breathing, as change, as love. It may be postponed, but it will not be denied.

    Molly Fumia

    See the Emergency 911 Page for links to immediate resources
    if you are feeling helpless, hopeless, overwhelmingly depressed, or suicidal.

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    Last update Sept. 11, 2002