When to seek assistance

Persistent and complex grief reactions
Sometimes the death of someone leads to grief reactions that do not gradually reduce with time. Instead they remain complex, highly distressing and unresolved on almost any level. 

Whilst any type of grief reaction can be experienced intensely, persistent and complex grief reactions are experienced constantly and with minimal change over time (e.g., 18 months +). Furthermore, they have a major disrupting effect on the person’s ability to function in major life domains (e.g., work, family, friends etc).

Typical signs of this grief reaction

Some of the typical signs of persistent and complex bereavement reactions include:

  • Marked difficulty with accepting the death on any level
  • Excessive avoidance of any reminders of the death/loss, such as places, people, or activities, in order to cope with painful emotions
  • Constant thinking (called rumination) about aspects of the death/loss, such as how the person died, or thoughts of self-blame, unworthiness and dread for the future
  • A sense that one’s total identity has been shattered permanently as a result of the loss
  • Significant difficulty with regulating distress – to the extent that the person is almost constantly in high distress, with no capacity (or no desire) to balance the pain with respite by doing other things (e.g., being with other people or distracting themselves)
  • Constant bitterness and anger about the loss
  • Total loss of meaning in life
  • Persistent inability to establish any degree of purpose or plan for the future

Vulnerability factors to having these grief reactions

Certain factors can leave a person more vulnerable to developing persistent and complex bereavement reactions. Some of these factors can include:

  • The way the person died (e.g., violent deaths)
  • Unexpected deaths (e.g., the death of a child)
  • A relationship where there was a particularly strong attachment to the deceased (e.g., spouse loss)
  • Difficulties with accepting the permanence or ‘reality’ of the death
  • The presence of other life stressors around the time of the death that may have delayed/obstructed the grieving process
  • Relationships where there were problems, unresolved issues, or conflicts in the relationship
  • Situations where aggressive medical interventions were involved (e.g., child chemotherapy)
  • Bereavement overload (i.e., multiple losses in quick succession)
  • Caregiver burden (i.e., a long period of time was spent caring for a dying person)
  • Feelings of self-blame/guilt or responsibility for something associated with the death
  • Situations in which the person who died had struggled to accept/live with their diagnosis/illness and to cope with the dying process/death
  • Situations where there was no opportunity to anticipate/prepare for the death/say goodbye to the person before they died (e.g., sudden deaths)
  • Questions around the perceived preventability of the loss (e.g., where a person believes the negligence of another may have contributed to the death)
  • Negative evaluations/responses from others towards the way a person is grieving (or not grieving)

In summary, as the number of signs and vulnerability factors associated with persistent and complex grief reactions increases, so too does the likelihood that specialist grief therapy may be beneficial.