What you need to know about complicated grief and how therapy can help

What Is Complicated Grief?

Complicated grief is when intense feelings of loss persist far beyond what’s typical, keeping you stuck in a cycle of pain that doesn’t seem to ease. Unlike normal grief, which gradually becomes more manageable over time, complicated grief feels like a constant weight that makes everyday activities feel impossible.

The clinical community recently recognized this as “prolonged grief disorder,” officially added to the DSM-5-TR in March 2022. While related to complicated grief, it represents the specific clinical criteria now used for diagnosis and treatment. But the name matters less than this reality: when grief interferes with your daily functioning for months on end, it’s not something you have to endure alone.

“Complicated grief causes significant impairment in relationships and daily functioning, and involves a significant amount of distress as you are navigating this loss,” explains Alex Cromer, a licensed professional counselor at Thriveworks. “Often, this grief is acute, and its healing process is rarely linear.”

With complicated grief, you may feel unable to adapt to life without your loved one. This can happen for many reasons—the circumstances of the loss, your coping mechanisms, your support system, or simply how your brain processes trauma and attachment.

Complicated grief shows up in three main forms:

• Chronic grief: Persistent, unrelenting grief that doesn’t improve over time
• Delayed grief: Grief that gets suppressed initially, then hits unexpectedly later
• Absent grief: Emotional numbness or detachment that prevents you from processing the loss

Understanding which type you might be experiencing helps tailor the right support and treatment approach.

What Are the Symptoms of Complicated Grief?

Identifying the symptoms of complicated grief is crucial for early intervention and support. Some of the key indicators include:

• Intense and persistent pain over the loss of a loved one that does not diminish with time
• Constant, intrusive thoughts and memories of the deceased
• Deep feelings of sadness and guilt over the loved one’s death
• Difficulty going about daily life and going through normal routines
• Avoidance of reminders of the loved one’s passing
• Feeling emotionally detached from those around you
• Isolating yourself from family and friends, leading to social withdrawal
• Feeling like you should’ve died in their place or you don’t want to live without them

Emotional and Psychological Symptoms

Complicated grief can also manifest through emotional and psychological indicators such as:

• Heightened irritability or anxiety
• Difficulty concentrating
• Changes in memory
• Vivid dreams involving the deceased loved one

Physical Symptoms

There are also physical manifestations, including:

• Shortness of breath
• Chest or throat tightness
• Disruptions in sleep patterns (either excessive sleep or insomnia)
• Fluctuations in appetite (either overeating or loss of appetite)
• Extreme fatigue or restlessness

All of these symptoms create deep physical, mental, and emotional sorrow that keeps you from moving through your grief. It keeps you stuck in your mourning and makes it extremely difficult to heal on your own.

Recognizing these symptoms can be the first step in seeking the necessary help and support to guide you in your grief journey and arrive at a place of healing and acceptance.

How Is Complicated Grief Different From Normal Grief?

It’s crucial to differentiate between normal grief and complicated grief, as the latter can have severe consequences on an individual’s mental and emotional well-being. Here is a simplified breakdown of the differences:

Common Causes and Triggers of Complicated Grief

Complicated grief can happen to anyone, but certain factors make it more likely:

• Sudden, unexpected deaths (accidents, suicide, heart attacks)
• Loss of a child or someone you felt responsible for protecting
• Lack of coping skills or previous experience with major loss
• Limited support from friends, family, or community
• Unresolved conflicts or things left unsaid
• Existing mental health conditions like depression or anxiety

“Complicated grief can have many causes, but one of the most frequent is a significant lack of protective factors,” Cromer explains. “Things like lack of social support, unstable housing, poor finances, trauma experiences, chronic stress—these can cause grief to escalate or block the healing process. Complicated grief becomes ‘complicated’ when it’s made worse by external factors that aren’t easily resolved.”

Here’s what’s important to remember: There’s no single cause, and anyone can experience complicated grief. If your symptoms have persisted beyond six months and are interfering with your life, seeking help isn’t admitting failure—it’s taking care of yourself.

Coping Strategies for Complicated Grief

Coping with complicated grief is a challenging process, but there are strategies that can help individuals navigate this difficult journey:

Remembrance Practices

Finding ways to honor and remember the lost loved one through rituals, memorials, or creative expressions can provide a sense of closure and connection.

Seeking Support

Allowing others to be there for you during this challenging time is vital. Don’t hesitate to lean on friends, family, professionals, or support groups for emotional support. Even just telling your loved ones that you’re struggling can be enough for them to rally around you and help you get the help you need to heal.

Socialization

Isolation can exacerbate complicated grief. Make an effort to engage with friends and family to combat feelings of loneliness and detachment as much as you’re able. Making plans once a week, making an effort to chat with coworkers, or spending time at home with close friends or family members can be simple ways to help break a pattern of social withdrawal.

Joining Support Groups

Support groups specifically tailored to complicated grief can provide a safe space to share experiences and receive guidance from others who have walked a similar path. People come to group at all stages of complicated grief—both those in the thick of it and those who have done the work to heal—and they can offer a level of understanding that others who haven’t experienced this condition can’t, which can in turn heal feelings of loneliness and isolation.

Self-Care Techniques and Practices

In addition to coping strategies, self-care plays a pivotal role in managing complicated grief. Here are some self-care practices to consider:

1. Listen to your body’s grief signals.

Grief shows up physically in ways you might not expect. When your chest feels tight, try slow breathing for 30 seconds. If you’re exhausted but can’t sleep, rest with your eyes closed instead of forcing it. Keep easy snacks nearby—grief can make you forget to eat, then feel dizzy or weak. Even 2-3 minutes of gentle stretching can help when your body feels heavy or achy from carrying emotional weight.

2. Give yourself permission to function differently.

You don’t have to be “productive” right now. Maybe today you can only manage a shower and feeding yourself—that’s enough. If work feels impossible, focus on just showing up rather than performing well. Tell people “I’m not myself right now” instead of pretending you’re fine. Grief isn’t a problem to solve quickly; it’s a process that requires lowering the bar for what counts as a successful day.

3. Use routine as an anchor.

Your old routines might feel meaningless now, but they can provide stability when everything else feels chaotic. Try doing one small familiar thing each day—making your bed, listening to a specific playlist, or walking the same route. Don’t worry about enjoying it; the familiarity itself can be comforting. These routines create structure when grief makes everything feel unpredictable.

4. Practice micro self-care.

Grand self-care gestures might feel impossible, but tiny acts of kindness toward yourself add up. Put on clothes that feel soft. Drink something warm. Step outside for 60 seconds. Text someone who makes you feel understood. When basic tasks feel monumental, ask yourself: “What’s the smallest thing I can do right now to be kind to myself?” Then do just that.

Can Therapy Help with Complicated Grief?

Yes, and it’s often essential. Grief counselors and therapists who specialize in loss understand that complicated grief isn’t just “regular grief that’s taking longer.” It requires specific approaches that address the unique ways your grief has gotten stuck.

Complicated grief therapy combines cognitive behavioral therapy with other proven techniques specifically designed to help you:

• Process the reality of your loss
• Manage overwhelming emotions
• Rebuild your sense of identity
• Create a meaningful life that honors your loved one while allowing you to live

You’ll want to look for therapists who specifically mention grief counseling or bereavement therapy. Many have training in approaches like complicated grief treatment (CGT), which has strong research backing its effectiveness.

Inside a Therapy Session for Complicated Grief

Wondering what grief therapy actually looks like? “Primarily, a therapy session for complicated grief focuses on identifying emotional and behavioral patterns and bringing awareness to what’s blocking your daily functioning,” Cromer explains.

Here’s what you might work on:

• Cognitive behavioral therapy (CBT) to recognize thought patterns that keep you stuck and learn new ways of thinking about your loss and your future
• Dialectical behavior therapy (DBT) skills for managing intense emotions, tolerating distress when grief feels overwhelming, and rebuilding relationships
• Understanding grief itself through psychoeducation about how grief works, what’s normal, and what isn’t
• Problem-solving strategies to break healing into manageable steps and find solutions for your specific challenges
• Guided reflection to help you understand yourself, your relationship with your loved one, and what healing might look like for you

“The first session or two will involve you and the therapist creating a tailored, individualized treatment plan targeting healing from your grief, preventing future relapses, and supporting your overall wellness goals,” Cromer adds.

The early focus is always on building a safe therapeutic relationship where you feel understood and supported—because healing happens in connection with others.

When and How to Seek Support for Complicated Grief

Often, seeking professional help is essential to effectively address complicated grief. The best way to start looking for a therapist or psychiatrist is to get a reference from a primary care provider or look at a list of providers covered by your insurance, which can be found by calling your insurance company and, many times, on your insurance company’s website.

You may need to speak to a few clinicians before finding one who is the right fit for you, but having a provider you feel comfortable with and understood by is vital to the therapy process.

If you aren’t sure whether or not to seek treatment, here are some signs that you should speak to a mental health professional:

• Persistent feelings of hopelessness, sadness, guilt, etc.
• Intense loneliness
• Withdrawing from friends and loved ones
• Excessive fatigue, hypersomnia
• Insomnia
• Inability to enjoy activities that you used to enjoy
• Difficulty taking care of responsibilities (cleaning, bills, hygiene, etc.)
• Over- or under-eating
• Symptoms that aren’t lessening over time

“Put simply,” Cromer says, “It’s time to seek help when you feel like you are ‘stuck’ in this cycle of grief.”

If you are experiencing these symptoms, or even if you’re not sure whether your symptoms are “severe” enough to seek help, consider talking to a professional. No matter what you’re dealing with, they can advise you on the right course of action, work with you to create a personalized treatment plan, and guide you through the process of healing at your pace.

The Bottom Line

Complicated grief is real, it’s treatable, and it’s not your fault. If you’re stuck in intense, persistent grief that’s preventing you from living your life, you deserve support and care.

Whether through therapy, support groups, or the ongoing love of friends and family, healing is possible. You don’t have to “get over” your loved one—therapy helps you learn to carry them with you in a way that doesn’t break you.

Your grief matters. Your pain is valid. And with the right support, you can find your way to a life that honors both your loss and your need to live.