Understanding Complicated Grief and the Layers of Loss

Updated November 19, 2018
Young woman looking numb with grief

The loss of a loved one is tragic and traumatic. When dealing with grief, it is normal to eventually experience healing and acceptance. But if the grief is more intense, is lasting a long time, is interfering with your ability to function normally and the feeling of loss is nearly debilitating, you or your loved one may be suffering from unresolved or complicated grief.

Definition of Unresolved or Complicated Grief

Unresolved grief is another name for complicated grief. These terms are used interchangeably. It's also known medically as persistent complex bereavement disorder and can occur in approximately 10% of bereaved people. This occurs when someone has prolonged periods of intense mourning which only continues to get worse over time. There is no healing from the loss or relief from the suffering. The term may also describe a person who simply doesn't mourn but instead is in denial over the loss.

It should be noted that this type of grief is frequently paired with other disorders such as "adjustment disorders, major depression, substance abuse, and post-traumatic stress disorder."

Complicated Grief and Normal Grief

With unresolved or complicated grief, the person that is grieving may have intense symptoms emerge such as suicidal ideation or suicide attempts. But initially, it may be difficult to tell the difference between the normal grieving process and unresolved grief. However, it is typically differentiated by its:

  • Severity
  • Duration - it can continue for years
  • Interference with normal, daily functioning
  • Intensity, and the fact that the grief does not decrease over time (the proposed guideline for when to diagnose PCBD is one year after the loss for adults)

Causes and Risk Factors for Complicated Grief

It has been found that complicated grief occurs more often in women and in older age. But it is not known what actually causes complicated grief. However, there are certain risk factors that are believed to contribute to the development of complicated grief which include:

  • Violent death
  • Sudden death
  • Unexpected death
  • Death of a child
  • No social support for the bereaved
  • Childhood trauma
  • Attachment and anxiety issues in childhood
  • Codependent on the deceased
  • Past history of depression, post-traumatic stress disorder or separation anxiety

Behaviors of Unresolved Grief

People with unresolved grief display different types of behaviors. The type of behavior a person displays is dependent upon different factors, including age.


Adults with unresolved grief may have extreme reactions to their loss. They may:

  • Not want to speak about the loss or acknowledge the loss in any way.
  • Are in continued disbelief and are unable to accept the death.
  • Obsess over the person to the point where they are unable to think about other things.
  • Spend all their time immersed in a hobby or work thus avoiding dealing with the grief.
  • Become more anxious about their health.
  • Isolate themselves and withdraw from social activities.
  • Experience deep sadness, depression or guilt.
  • Engage in destructive behaviors, such as drugs and alcohol, or take up smoking.
  • Feel a loss of identity or that life isn't worth living without their loved one.
  • Think that they could have prevented the death.
  • Think that they did something wrong which caused the death to happen.
  • Wish they died along with their loved one.


Unresolved Grief

Teenagers with unresolved grief may display some of the same symptoms as adults or may exhibit symptoms that are inappropriate or even frightening. They may:

  • Show signs of chronic depression.
  • Have difficulty sleeping or are restless.
  • Exhibit low self-esteem.
  • Show an indifference to school or have failing grades.
  • Have no interest in their relationships with family and friends.
  • Be more likely to engage in risky behaviors such as drug and alcohol abuse, fighting, stealing and sexual experimentation.
  • Deny pain while at the same time acting overly strong or mature.


Children typically display different symptoms than adults and teens due to their maturity level. Children with unresolved grief may:

  • Become hostile.
  • Withdraw from friends and family or be very quiet in school.
  • Stop caring about appearance (not brush their hair, or wear ripped clothing).
  • Have problems with sleeping.
  • Feel anxious.
  • Have extreme yearnings for what they lost.
  • Have separation anxiety.

Treatment for Complicated Grief

After the loss of a loved one, getting treatment for unresolved grief may help reduce stress levels, may help you navigate through the stages of grief and may help you adjust to a new life without your loved one. Treatment for unresolved grief:

  • Enables you to understand complicated grief reactions and symptoms.
  • Uses cognitive behavioral techniques that will explore thoughts and emotions, as well as, addresses the trauma and symptoms of stress.
  • Explores pleasant, happy memories about the loved ones which helps reduce avoiding the topic.
  • May implement role-playing of conversations with the deceased.
  • Will help improve coping skills.
  • Will help reduce feelings of guilt and blame.
  • Will eventually help redefine life goals.

When to Seek Professional Help

Unfortunately, there is no known way to prevent complicated grief from happening. But it is important to get help from a professional as soon as possible before grieving complicates and overwhelms your life further. It is especially important to help children who have unresolved grief. Counseling for children is highly recommended as well. This will help them process and understand their feelings during this difficult life event. The Mayo Clinic suggests that early intervention, regardless of age, is the best way to improve grieving outcomes.

Understanding Complicated Grief and the Layers of Loss