The Signs of Complicated Grief: Understanding Symptoms, Causes, and Distinctions from Depression

Dr. Tracey Marks, a psychiatrist, delves into the complexities of grief, outlining typical trajectories and distinguishing normal grief from prolonged or complicated grief. She explains that while immediate high levels of grief followed by a gradual decline is common, some individuals experience a delayed response, remaining in shock initially before the emotional loss sets in, which can lead to feelings of isolation as others move on. The episode emphasizes that the first year is often the hardest due to anniversary reactions, but a healthy progression involves grief becoming less consuming and thoughts shifting towards positive memories.

The core of the discussion focuses on complicated grief, which, while not a formal DSM diagnosis, is recognized in the International Classification of Diseases (ICD) manual. Dr. Marks defines it by specific characteristics lasting over a year in adults or six months in children. Key signs include an intense, almost daily yearning or longing for the deceased, often manifesting in wish-fulfillment dreams or daydreams. Other indicators are persistent intense emotional pain (anger, blame, non-acceptance, inability to feel positive emotions, emotional numbness) and active avoidance of reminders of the loved one.

The podcast identifies four primary causes contributing to complicated grief. These include unresolved guilt from a conflicted relationship with the deceased, experiencing a traumatic death (e.g., witnessing an accident or prolonged suffering), pre-existing separation anxiety that is exacerbated by loss, and a profound sense that the death was an injustice, such as from a crime, preventable accident, or events like COVID-19, which can fuel anger and bitterness.

Finally, Dr. Marks meticulously differentiates grief from clinical depression, acknowledging that prolonged intense grief can sometimes lead to depression. She advises that individuals with a history of depression might recognize a relapse, marked by dysfunction across life areas and physical symptoms like appetite loss. For those without a prior history, she cautions against rushing to conclude depression, suggesting several weeks or months of observation. She clarifies that while antidepressants can treat depression, they do not erase the sadness of loss, and healing from grief remains a long, slow process, often requiring professional counseling or grief support groups.

"Grief is a very personal and normal reaction to losing someone."

"Typically the first year is the hardest because of the anniversary reactions."

"A good place to get is when you think of the person that you lost, you still miss them, but the predominant thoughts that you have are positive memories."

"Prolonged grief, which some people will refer to as complicated grief, is not an official diagnostic term in our psychiatric manual, but it is listed as a disorder in the International Classification of Diseases manual and it's gaining more and more ground as a focus of clinical attention."

"We consider grief to be prolonged and complicated when it has certain characteristics and lasts for more than a year in adults and six months in children."

"One sign that you have complicated grief is that after the year period, you continue to have an intense yearning or longing for the person."

"Another indication that you have a complicated grief picture is you continue to experience intense emotional pain, like anger, blame, refusing to accept the death, an inability to have a positive mood at all, trouble engaging with people, or feeling emotionally numb, like you can't feel anything positive or negative."

"Grief is not the same as depression, but sometimes after a prolonged of intense grief, people will slip into a depression."

"Antidepressants treat an illness and take several weeks to work. They improve mood and other depression symptoms, but they don't erase sadness from a loss."

"Healing from grief is a long, slow process."