Facts about Complicated Grief

By Dr. Saul Ebema- Resident writer. 

Mike is a 30 year old man whose father died of heart attack. Mike had been through many challenges in life, including divorce and imprisonment. His father was always by his side supporting him throughout his struggles. His father was his best friend. “He always had my back” Mike said.

Six months before his father’s death, he had lost his job and was depending on his father for financial support. The father’s sudden death was so hard for Mike that he often contemplated suicide. He experienced major depression and was often isolated from family and friends.

Mike was suffering from complicated grief. Complicated grief is a “syndrome that occurs in about 10% of bereaved people, results from the failure to transition from acute to integrated grief. As a result, grief is prolonged, perhaps indefinitely.”[1]  People that suffer from complicated grief have difficulty accepting the death and “often find themselves in a repetitive loop of intense yearning and longing that becomes the major focus of their lives, accompanied by inevitable sadness, frustration, and anxiety.”[2]

Risk Factors for Complicated Grief

People are more likely to experience complicated grief when:

  • The death was unexpected, sudden, traumatic, violent, or random.
  • The death was from a prolonged illness.
  • The loss was of a child.
  • The bereaved believed the death could have been prevented.
  • The relationship with the deceased person was overly dependent.
  • The mourner suffered more than one loss within a short period of time.
  • The mourner lacks social support to deal with the death.

Rando states the following “ten symptoms of complicated grief”[3]:

  • An inability to accept the loss and adjust to life after a period of six months or more
  • Denial, disbelief, bitterness, or anger about the loss
  • Intense yearning for the deceased person
  • Preoccupation with thoughts of the deceased person
  • Avoidance of reminders of the loss such as shared activities
  • Inability to function normally
  • Physical symptoms similar to those of the illness or injury that caused the death of the loved one
  • Alcohol and/or drug abuse
  • Sleeping problems
  • Suicidal ideation

This list is not all-inclusive. Mourners can be expected to manifest many varying symptoms of complicated grief and counselors will place varying amounts of importance on the presence or absence of specific symptoms depending upon the norms they develop over time as they work with the mourners.

Table 1. The inventory for complicated grief

The Inventory of Complicated Grief is a self-report instrument that allows for the dimensional assessment of the severity of complicated grief symptoms. Scores of 30 or higher (over a range of 0 to 76) indicate a high likelihood that the syndrome is present. Each of the 19 items is rated 0 (not at all) to 4 (severe).
1. Preoccupation with the person who died
2. Memories of the person who died are upsetting
3. The death is unacceptable
4. Longing for the person who died
5. Drawn to places and things associated with the person who died
6. Anger about the death
7. Disbelief
8. Feeling stunned or dazed
9. Difficulty trusting others
10. Difficulty caring about others
11. Avoidance of reminders of the person who died
12. Pain in the same area of the body
13. Feeling that life is empty
14. Hearing the voice of the person who died
15. Seeing the person who died
16. Feeling it is unfair to live when the other person has died
17. Bitter about the death
18. Envious of others


  1. George L Engel. “Is grief a disease? A challenge for medical research.” (accessed February 25, 2015).
  2. Katherine Shear and Harry Shair, “Attachment, loss, and complicated grief.” Journal for Developmental Psychobiology 47 (1999): 253- 267
  3.  Therese Rando. Treatment of complicated mourning (Champaign, IL: Research Press. 1993), 77.
  4. Holly G Prigerson et al., “Inventory of complicated grief: A scale to measure maladaptive symptoms of loss (accessed February 20, 2015).

Hospice Chaplaincy is a nonprofit organization committed to promoting excellence in spiritual care at the end of life. We are committed to the belief that people from all backgrounds, cultures and faith traditions should experience the end of life in a way that matches their own spiritual/religious values and goals. The task of dying is complicated and often confronts us with lots of spiritual, emotional and physical suffering. Hospice Chaplaincy is dedicated to providing support and professional development resources for hospice chaplains, patient advocacy, and education services to the public, to create a cultural shift to inform and transform our thinking around the psychosocial and psychospiritual issues at the end of life .

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