How to distinguish between normal grief and complicated grief
Let's look at the differences between normal psychological grief and pathological grief.
Grief is a normal process that is usually experienced after a loss, such as the death of a loved one. This experience of emotional management is necessary for the subject to overcome and adapt to the new life without the deceased.
The problem occurs when the evolution of this grief is not adequate and ends up giving rise to a vicious circle of discomfort that generates even more emotional pain; in cases like this, what is known as complicated or pathological grief arises, where we will observe similar symptoms but more intense, more severe and with a longer duration. In other words, the subject's functioning and quality of life will be impaired, and he/she will not be able to carry out the activities he/she used to do.
In this article I will explain the main characteristics, phases and stages of normal and complicated grief in order to make it easier to understand their differences and which variables are presented as predictors of a pathological development of the grief process.
What does normal grief look like?
The grief "to dry" is a normal process that can appear when there is a loss that generates a strong psychological impact, whether it is the death of a loved one, the rupture of a relationship, the loss of work or the loss of a part of the body due to an illness, among other similar experiences.
Thus, a period of adaptation begins a period of adaptation begins in which the subject may show emotional, physical, cognitive, relational and behavioral symptoms. in general: he/she is in a transitional stage between a time in life when he/she assumed he/she could have a person, pet or important object at his/her disposal, and a time when he/she no longer has access to it. He or she must adapt to a life without what he or she developed an emotional attachment to.
Thus, mourning is not always a pathological process; on the contrary, in most cases it is necessary for the individual to overcome the loss and adapt to the new life. The individual will have to go through different stages in order to cope with the loss and be able to continue with his or her life..
The evolution of grief can be different for each person, but it has been observed that in the case of the death of a loved one, there are usually several characteristic phases: First there is the initial phase in which there is shock at the news of the death or loss, in this case there may be emotional uncontrol or the opposite blockage; then comes a phase of intense Pain or loss (at this point the subject is more aware of the loss, a fact that involves an increase in pain, can react by avoiding any stimulus that reminds him of the deceased) and the resolution phase (this phase involves adaptation and acceptance of the loss).
Stages of normal grief
There are different authors who have proposed different stages through which subjects go through in the face of loss. These stages can have different durations depending on the individual and can also present different order, going back to previous stages, in order to move forward.
A well-known author on this subject is Elisabeth Kübler-Ross, who proposed 5 stages in the grief process. These stages can be passed through by family members as well as by the subject who sees his or her own death approaching. They are the following.
- Denial: at first, when faced with negative news, we tend to deny such information in order to defend ourselves.
- Anger: at this point the individual feels angry with life for such an event.
- Negotiation: any way to avoid death is tried, to get more time.
- Depression: at this stage people begin to see death as imminent and inevitable.
- Acceptance: this is the last phase in order to be able to adequately overcome the death or bereavement.
Characteristic symptoms of normal grief
A series of symptoms appear that are normal in the grieving process and that help the subject to cope with the loss, adapting to it and overcoming it. help the subject to cope with the loss, adapting to it and overcoming it..
At first we observe agitation, or, on the contrary, affective blunting. The death begins to be accepted and grief and pain arise, and after a few weeks depressive symptoms, anxiety and irritability may appear. Finally, there is the feeling of fullness, in which the person is able to recall the past without feeling very bad.
On the other hand, it is typical that in the first phases the symptoms are more physical, and later the psychological ones predominate.to later predominate more the psychological ones.
The distinction between normal grief and complicated grief.
Once we know the characteristics and symptoms of normal grief, in the case of complicated grief these are not usually qualitatively different, although the temporality and intensity of these symptoms change. That is to say, in pathological grief we will observe that these symptoms last longer and instead of improving they are maintained or even worsen, increasing their emotional impact.
Thus, the characteristic features of pathological grief are as followsThe following are characteristic of pathological grief: feeling of deep sadness and permanent thoughts about the loss, difficulty concentrating in the different areas of life, extreme attention focused on the memory of the deceased, extreme longing and yearning, difficulties in accepting the death, social isolation and feeling of alienation, resentment about the loss, feeling that life has no meaning, diminished self-confidence and difficulty in enjoying life.
Other behaviors that can be observed in complicated grief are: difficulty in carrying out activities of daily living, feelings of guilt, and, in the most extreme cases, suicidal ideation. in the most extreme cases, suicidal ideation (desire to die, often mediated by the religious belief that one can take one's own life and thus be reunited with the other person).
As we have already seen, an important criterion in the distinction between the two types of grief is related to the time of the process. It is after 12 months when we can consider that a grief is complicated, although this is not the only variable that the therapist will take into account; he/she has to evaluate other characteristics of the subject, since as we have said a normal grief can also present different lengths of time without being pathological. Therefore, clinical criteria will be important in making a diagnosis of persistent complex grief, taking into account the way in which the person experiences the distress.
Another factor that helps to distinguish between the two processes is how the onset occurs. In normal bereavement, symptoms usually appear at the moment or within a few days of the loss; in contrast, in the case of pathological bereavement, symptoms usually appear at the moment or within a few days of the loss, in the case of pathological grief this can be observed weeks or months later, being considered as delayed grief.This can be considered as delayed grief, with a denial of grief.
In the same way, as in any other disorder, we must assess how the alteration affects the individual's functionality, social, work, family life... since this loss of adaptation in the activities of daily life will indicate the presence of a pathology.
Also differences have also been observed in the aspects that have been denied.. In the case of the normal process, the subject may deny some circumstances related to the death or negative characteristics of the deceased, idealizing. On the contrary, in complicated grief this denial is more worrisome, since the person may deny the death and think that it has not happened and the loved one is still alive.
Another different criterion is how the person identifies or relates to the deceased. When the grief is normal, the individual may imitate or present behaviors similar to those of the person who has died, and this fact is intensified when we speak of complicated grief, since the subject may believe that he or she is the deceased or that a part of that person is inside his or her mind in a literal way.
With regard to complicated grief, psychotic symptoms psychotic symptoms such as delusions or complex hallucinations may also be present.On the other hand, when the process is normal, some hallucinations may appear, such as believing to hear or smell the deceased, but without being so complex, and the subject is always aware that what he/she perceives is not real.
As already mentioned, there may also be physical or somatic symptoms. In normal mourning, the person may perceive discomfort in the place of the body that caused the death of the loved one, although this discomfort is diffuse and does not become intense. But in the pathological type, the person does identify this pain as more intense and may come to believe that he or she will also die from the same causes..
We must also take into account the culture of the subject we are evaluating, since depending on this we will be able to assess whether some of the behaviors performed are normal or not. Thus, when the mourning process is not pathological, we can observe behaviors typical of the culture and social context of the subject; on the other hand, when the mourning is complicated, abnormal behaviors not related to the culture are shown, behaviors that are strange and worrying to their environment.
Variables that increase the risk of developing complicated grief.
It has been shown that there are different variables that increase the likelihood that the grieving process is not normal and ends up becoming complicated.
These are: the characteristics of the death, being considered higher risk when it is sudden and traumatic, when more than one person dies or when the victim was young; the type of relationship that was maintained with the deceased (it will affect more if this was closer, there was more contact); when there was a previous pathological grief; if there is a history of psychological involvement or pathology (this increases the possibility of worsening the process); or when the social and family environment does not help to adequately overcome the death or also show pathological symptoms.
What can be done?
The way to face and overcome a pathological grief is to go to psychotherapy.. In a psychology consultation you will find the strategies and techniques to properly manage emotions and stop feeding the behavioral dynamics that keep that alteration in operation.
If you are looking for psychological assistance of this kind, please contact me.
(Updated at Apr 13 / 2024)