What is Complicated Grief?
Complicated grief, also known as prolonged grief disorder or persistent complex bereavement disorder, is a prolonged and intense form of grief that extends beyond the ‘normal’ grieving process. Characterised by persistent and debilitating symptoms, survivors of suicide bereavement are at a higher risk of developing the disorder, manifesting as major depression, post-traumatic stress disorders, and suicidal behaviours/ideation.
Unlike typical grief, which tends to ease over time and allows people to gradually resume their daily activities and find enjoyment in life again, complicated grief is marked by the following features:
1. Intense and persistent emotional pain that does not improve over time.
2. Preoccupation with thoughts, memories and longing for their lost loved one, so much so that they cannot focus on other aspects of life.
3. Emotional numbness or avoidance, resulting in avoiding situations or places that might remind them of their lost loved one, and detachment from others.
4. Difficulty moving forward, and unable to imagine a future without their lost loved one, or set new goals/make plans.
5. The loss can disrupt a person's sense of self and identity, leading to feelings of emptiness and purposelessness.
6. Social isolation, people struggling with complicated grief might isolate themselves socially, withdrawing from social activities, friends, and family, which can exacerbate their emotional distress.
7. Severe emotional reactions of sorrow, anger, guilt, or despair can occur at any time, but especially when triggered by reminders of their lost loved one, or on special occasions.
What sets complicated grief apart is that these symptoms are not a typical part of the grieving process, and it can significantly impact a survivor's mental and emotional well-being.
Feelings of guilt are common for those who have experienced a loss through suicide. They may feel guilty of things they did or didn’t do while the person was alive.
‘What if’s and ‘what could have been’s may begin playing in their head, with thoughts similar to “I should have seen the signs”, “why didn’t I do anything to stop this?”, and “I wasn’t there when they needed me the most”.
Abandonment and Betrayal
Those left in the aftermath of a loss may feel betrayed or abandoned by those who passed away. Thoughts of “how could they leave me like this?”, and “did they not think about their family?” are common. This can often feed back into feelings of guilt due to feeling anger towards their loved one who passed away.
Shame and Stigma
Feeling unable to speak about the circumstances of a loved one’s passing may be driven by feelings of shame and stigma, as suicide continues to carry judgement and misunderstanding.
The topic may make others uncomfortable through deep cultural roots of suicide being seen as a crime, a sin, or as a weakness, meaning that someone may not reach out for support. Others may be unsure what to say and avoid the topic, creating a feeling of isolation.
Suicide can be traumatic for those involved, even if they didn’t directly witness it. Thoughts of how someone took their own life may play in someone’s imagination just as vividly as if they were there. Loss survivors may also need to handle police, coroners, and potential press inquiries or articles. The trauma of processing the grief itself is also a factor to consider.
Bereavement Strategies: how can you help?
The shock of grief might leave someone unable to complete day-to-day tasks as they process it. Offering to cook, clean, or look after their pets or children can go a long way for someone who’s struggling.
Offers to help with funeral arrangements and finances may also be welcomed. Be proactive about offering help rather than saying you’re there if they need anything, as often people may feel hesitant to reach out regardless.
Don’t be afraid to talk about loss, but refrain from asking intrusive questions surrounding the circumstance of death. Take the approach of an active listener and supporter, allowing the loss survivor to guide the conversation.
After the immediate shock of loss wears off and the funeral has passed, it may seem as though life continues as usual. But for many loss survivors, this is the time when reality starts to set in and navigating life without their loved one becomes the next challenge. Reach out and ask how they’re doing, and be prepared to listen but also accept if they don’t want to talk about it. On emotional days such as anniversaries and birthdays, a gentle reminder of your support could come through the form of a card or a phone call.
If you or someone you know is experiencing complicated grief, seeking professional help from a mental health therapist or counsellor is highly recommended – help and support is available. Various therapeutic approaches, such as grief counselling, cognitive behavioural therapy (CBT), and support groups, can all help individuals manage and navigate their grief and embrace life.
There are many support options available in the UK for suicide loss survivors. For a full directory of local support available to you, please see:
Free counselling is also available through the NHS Improving Access to Psychological Therapies (IAPT) service, which you can self-refer to: