How to distinguish between normal grief and complicated grief

Grief is a normal process that people go through after a loss, such as the death of a loved one. This experience of managing emotions is necessary so that the subject can overcome and adapt to the new life without the deceased.

The problem occurs when the evolution of this duel 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 but more intense symptoms, of greater severity and with a longer duration. In other words, the functioning and quality of life of the subject will be seen to be worn out, and they will not be able to carry out the activities that they used to do before.

In this article I will explain the main characteristics, phases and stages of normal grief and complicated grief to make it easier to understand their differences and what variables are presented as predictors of a pathological development of the mourning process.

• Related article: "The 6 differences between sadness and depression"

What is normal grief like?

Grief "plain" is a normal process that can appear when there is a loss that generates a strong psychological impact, be it the death of a loved one loved one, the breakup of a relationship, the loss of a job or the loss of a body part due to illness, among other experiences Similar.

So that an adaptation period begins where the subject can show emotional, physical, cognitive, relational, and behavioral symptoms in general: you are in a transition stage between a moment in life in which you took for granted that he could dispose of an important person, pet or object, and another in which he no longer has access to it. He must adapt to a life without that to which he developed an emotional bond.

Thus, grief 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 subject You will have to go through different stages to be able to cope with the loss and be able to continue with your 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, several phases usually appear Characteristics: First is the initial phase in which there is a shock at the news of the death or loss, in this case there may be emotional lack of control or everything opposite lock; then comes a phase of intense pain or loss (at this point the subject is more aware of the loss, a fact that supposes an increase in pain, can react by avoiding any stimulus that reminds him of the deceased) and the resolution phase (this phase involves the adaptation and acceptance of the lost).

• You may be interested: "What is anxiety: how to recognize it and what to do"

stages of normal grief

There are different authors who have proposed different stages through which the subjects pass before the loss. These stages can have different durations depending on the individual and can also have a different order, going back to previous stages, to later be able to move forward.

A well-known author on this subject is Elisabeth Kübler-Ross, who proposed 5 stages in the grieving process. Family members as well as the subject himself, who sees his death approaching, can go through these stages. They are the following.

• Denial: at first, when faced with negative news, we tend to deny such information to defend ourselves.
• Anger: at this point the individual feels angry with life for such an event.
• Negotiation: any way is tried to avoid death, to get more time.
• Depression: in this stage people begin to see death as something imminent and inevitable.
• Acceptance: it is the last phase to be able to adequately overcome death or grief.

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.

At first we observe agitation, or just the opposite, emotional blunting. Death begins to be accepted and grief and pain arise, and after a few weeks depressive symptoms, anxiety and irritability may appear. Finally, there will be the feeling of fullness, in which the person is able to remember the past without feeling very bad.

On the other hand, it is typical that in the first phases the symptoms are more physical, to later predominate the psychological ones.

• Related article: "The 8 types of emotions (classification and description)"

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. In other words, in pathological grief we will observe that these symptoms last longer and instead of improving, they remain the same or even worsen, increasing their emotional impact.

In this way, The characteristic features of pathological grief are as follows: feeling of deep sadness and permanent thoughts about the loss, difficulty concentrating in the different areas of his life, extreme attention focused on the memory of the deceased, extreme desire and longing, difficulties in accepting death, social isolation and feeling of alienation, resentment of loss, feeling that life is meaningless, decreased self-confidence, and difficulty enjoying yourself of the life.

Other behaviors that we can observe in complicated grief are: difficulty in carrying out activities of daily life, feelings of guilt, and in the most extreme cases, suicidal ideation (desire to die, often mediated by the religious belief of being able to 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 mourning is related to the time of the process. It is from 12 months when we can consider that a duel is complicated, although it is not the only variable that the therapist will take into account; it has to assess other characteristics of the subject, since, as we have said, a normal duel can also have different durations without being pathological. Therefore, clinical criteria will be important to make a diagnosis of persistent complex grief, taking into account the way in which the person experiences the discomfort.

Another factor that helps distinguish between the two processes is how they are started. In normal grief, symptoms usually appear at the time or a few days after the loss; However, in the case of pathological grief, this can be observed weeks or months later, considering delayed grief, giving himself a denial of the duel.

In the same way, as in any other disorder, we must assess how the alteration affects the functionality of the individual, in his life. social, work, family… since this loss of adaptation in the activities of their daily life will be what indicates the presence of a pathology.

Too differences have been observed in the denied aspects. In the case of the normal process, the subject may deny some circumstances related to death or negative characteristics of the deceased, idealizing. On the contrary, in complicated grief, this denial is more worrying, since it can lead to denying the death and thinking 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 mourning is normal, the individual can imitate or present behaviors similar to those of the subject who has died, seeing this fact intensified. when we talk about complicated grief, since the subject may believe that he is the deceased or that a part of that person is inside his mind in a way literal.

Regarding the complicated duel, also psychotic symptoms such as delusions or complex hallucinations may occur; On the other hand, when the process is normal, some hallucination may appear, such as believing to hear or smell the deceased, but without being so complex, and the subject at all times is aware that what he perceives is not it is real.

As I already mentioned, there may also be physical or somatic symptoms. In normal grief, the person may perceive discomfort in the place of the body that caused the death of their 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 they perform are normal or not. Thus, when the grieving process is not pathological, we can observe behaviors typical of the subject's culture and social context; On the other hand, when the duel becomes complicated, abnormal behaviors not linked to the culture are shown, behaviors that are strange and worry those around them.

• You may be interested: "Grief: coping with the loss of a loved one"

Variables that increase the risk of developing complicated grief

It has been seen that there are different variables that increase the probability that the grieving process is not normal and ends up getting complicated.

These are: the characteristics of death, considering it to be of greater risk when it is sudden and traumatic, when more than one individual dies or when the victim was young; the type of relationship that was maintained with the deceased (it will affect more if it was closer, there was more contact); when a pathological duel has already occurred previously; if there is a history of psychological involvement or pathology (this increases the possibility that the process will worsen); or when the social and family environment does not help to adequately overcome death or they also show pathological symptoms.

• You may be interested: "What is trauma and how does it influence our lives?"

What can be done?

The way to face and overcome pathological grief is to go to psychotherapy. In a psychology consultation you will find the strategies and techniques to properly manage the emotions and stop feeding the behavioral dynamics that keep that disturbance.

If you are looking for psychological assistance of this type, please contact me.