Most of us have lost someone in our lives. Grief is a completely normal, healthy human emotion. Everyone experiences grief – and everyone grieves differently. But some of us find it harder to move on – despite the passage of time. So when does grief go on too long – and what can you do about it? Psychologists talk about the difference between ‘normal’ and ‘complicated’ grief. But what is complicated grief?

2-8 December is National Grief Awareness Week, so it’s a good time to think about how we deal with grief, and the mental health implications it can have. Here’s what complicated grief is, how to spot the signs – and how to know when it might be time to seek help.

What is normal grief?

Grief is inevitable and universal. We’ve all experienced it, or will do at some point in our lives. Grief is also a completely normal, natural reaction to loss and death, or to painful or traumatic events. Not just normal but necessary and healthy. Grief is part of the human condition.

However, while everyone’s experience of grief is different, and we all grieve in our own way, when we talk about ‘normal’ grief, we mean the typical reactions that most people go through in the days or weeks following a loss. ‘Normal’ grief typically includes some or all of the following:

  • Emotional reactions such as tears, crying, or sobbing. Not everyone reacts like this – but it’s common enough that you might worry what’s wrong with you if you don’t cry.
  • Negative feelings such as anger, sadness, depression, guilt, loneliness, anxiety, worry, stress or emptiness. But even in grief, most people still experience some positive emotions from time to time too, such as joy or happiness.
  • Changes to sleep or energy. Your sleep pattern may be disrupted, such as having difficulty falling asleep or sleeping too much or too little. You might also feel a lack of energy, tired all the time, lethargic or apathetic.
  • Physical symptoms such as headaches or other aches and pains.
  • Changes in appetite, such as not feeling like eating, or ‘comfort eating’.
  • Social withdrawal from your usual interactions and relationships with people.
  • Difficulty concentrating or focusing on a task, whether at work, home or a hobby.
  • Questioning things like your religious beliefs, job, career, relationship or life goals. Grief can be a time of reassessment for some people.

These symptoms of grief may typically be experienced in the days, weeks or months following a loss. But how long should you expect grief to last?

How long should grief last?

When it comes to grief, no one can dictate what you should feel, how you should grieve or how long it should last. It doesn’t help to compare yourself to others, or for anyone else to tell you “you should be over it by now”. Everyone’s different, and grief affects people differently. You’ll mourn your loss in your own unique way.

However, most people tend to experience the ‘normal grief’ reactions most profoundly in the days and weeks immediately following a loss. Over the following weeks or months, there’s usually a gradual return to ‘a new normal’, as you adapt and adjust. You won’t forget – but you’ll learn to cope.

The five stages of grief

While grief doesn’t run to a timetable, there are a number of stages that most people go through. These were defined by Swiss psychiatrist Elisabeth Kübler-Ross in 1969 as:

  1. Denial. May include avoidance, confusion, elation, shock or fear.
  2. Anger. Frustration, irritation or anxiety.
  3. Bargaining. Struggling to find meaning, reaching out to others, telling your story.
  4. Depression. Overwhelm, helplessness, hostility, flight.
  5. Acceptance. Exploring options, putting a new plan in place, moving on.

Although common, these stages don’t follow a strict order, and you may not experience all of them – or, indeed, any of them. You might just experience one or two. But the final stage, acceptance, is where some of us can get stuck. Maybe you’ve found moving on very difficult – and this is what might be called ‘complicated grief’.

What is complicated grief?

Complicated grief goes by many names. It may also be called abnormal grief, chronic grief, pathological grief, exaggerated grief, complex grief disorder – or even persistent complex bereavement disorder. But, whatever you call it, it refers to a situation where your grief doesn’t fade over time, and it interferes with your day-to-day life.

Most people’s experience of grief eventually dissipates with the passage of time. They can resume their normal routines and activities, and get on with life. But if you experience complicated grief, these feelings don’t go away – and can prevent you from leading your normal life.

Complicated grief symptoms

Long-term grief that you just can’t get past, and which interferes with your day-day-life characterises complicated grief. But there are also additional symptoms. As well as the ‘normal’ grief reactions, you may also experience one or more of the following:

  • Intense negative feelings such as sadness, pain, detachment, sorrow, hopelessness, emptiness, low self-esteem or bitterness.
  • Anger, irritation or rage
  • Numbness or detachment
  • Intense and persistent longing or pining for the person you’ve lost, or inability to focus on anything but them.
  • Intense focus on reminders of the death or loss – or an excessive avoidance of such reminders.
  • Inability to think back on positive experiences with your loved one.
  • Problems accepting the reality of the death of a loved one.
  • Self-destructive behaviour, such as alcohol or drug abuse.
  • Inability to enjoy life, or feeling that life holds no meaning or purpose.
  • Suicidal thoughts or actions (Important: if you, or someone you know, has suicidal thoughts, get help from a crisis or suicide prevention helpline.)

Complicated grief therapy – when to seek help

Although no one can tell you how to grieve, if you feel you can’t get past your grief, help is available. It might be time to seek help if you feel you can’t move on, or if it’s affecting your daily life or mental health. You may, for example, experience anxiety or depression as a result of your unresolved grief.

If you have intense grief and problems functioning in your day-to-day life that don’t improve a year after the death of your loved one, it might be time to seek help. You can speak to your GP, therapist or seek out a support group. Bereavement groups and individual therapy can be enormously beneficial in helping you work through your grief. Find out how you can get started with My Online Therapy.

A therapist won’t try to ‘cure’ you of your loss. Rather, they’ll provide you with coping strategies to help you live with it more effectively and deal with your grief in a way that works for you. A therapist can also help you overcome any depression or anxiety you might be experiencing as a result of your grief.

Grief is an incredibly personal and individual experience. So, while the Kübler-Ross five-stage model can be a useful guide, Kübler-Ross herself said it’s neither linear nor experienced by everyone. There’s no right or wrong way to work through your grief. The benefit of working with a therapist is that they can work through the grieving process with you, in a way that’s tailored to your experience. With the right help and support, you can move on. You won’t ever forget your loved one, or what happened – but you will be able to live your life to the full.