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When Grief is Just Too Much

Prolonged Grief, grieving, grief, prolonged grief,

By: Cindy Spiegel

It’s rare that we can get through most of life without experiencing at least one significant loss. As we age, those losses can start to pile up: deaths of parents and friends, moving out of a family home, loss of mobility or health due to injury or illness, loss of independence, loss of a career. 

Even if we’re fairly well equipped to handle grief in a healthy way, sometimes it can feel overwhelming and threaten our ability to function in our daily routines. When intense grief, particularly over the loss of a loved one, continues for months without much relief, it may be time to reach out for support. 

What is “Normal” vs. Prolonged Grief?

When we lose someone important to us, it’s important to take time to acknowledge and process the emotions we feel. As hard as it is to grieve, holding those feelings inside or trying to ignore or escape them will only prolong the pain and potentially cause other issues (health complications, addictions, and more). So even though everyone will experience grief differently, “normal” grief usually lowers in intensity over time, at which point you adjust to your new reality and start to cultivate other relationships to feel joy again. 

While grief will typically fade over time, prolonged grief stays at intense levels or worsens, making it difficult to carry out daily routines. As of just last year, in early 2022, prolonged grief disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Its addition was not without controversy, but it makes possible the further study and treatment of those who cannot seem to move past their grief. 

Symptoms of prolonged grief disorder (also called complicated grief or persistent complex bereavement disorder) can include one or more of the following

  • Intense mourning and pining for the deceased
  • Excessive focus on reminders of the deceased–or avoiding reminders altogether 
  • Inability to adapt to the new situation 
  • Intense emotional pain (sadness, guilt, anger, bitterness) 
  • Feeling that life is meaningless
  • Pulling away from others

If you have this level of intense grief for over a year, it’s time to seek out help. If grief ever leads you to consider suicide, seek help immediately by calling or texting 988, the Suicide & Crisis Lifeline. 

Prolonged Grief Vs. Depression

It’s important to note that prolonged grief is different from depression. The American Psychological Association describes three main differences: 

  1. With depression, emotions are numbed. With prolonged grief, the person feels intense longing for and preoccupation with their memories of the deceased loved one. 
  2. Interestingly, in prolonged grief, the brain’s reward system is activated by memories of the loved one. Depression does not trigger any activity in the reward system. “‘In many respects, prolonged grief is more like an addiction,’ [Dr. Holly Prigerson] says. ‘There is a reward that people feel that’s related to wanting to maintain a connection with someone they love and who made them feel safe and secure.’”
  3. Prolonged grief disorder symptoms are not relieved by antidepressants. 

Who is Most At Risk for Prolonged Grief Disorder? 

According to the American Psychiatric Association, 7%-10% of bereaved adults will experience prolonged grief disorder. Older adults and those with pre-existing mental health disorders like depression or bipolar disorder are more at risk, as are caregivers of the person who died. When the death or loss is sudden or traumatic, it also creates greater likelihood of prolonged grief. 

People who develop prolonged grief disorder may also develop post-traumatic stress disorder, anxiety, and/or depression. In addition, 80% of people with prolonged grief have long-term poor sleep, according to the Association.  

How is Prolonged Grief Disorder Treated?

Several sources point to something called short-term complicated grief treatment, or CGT, as the most evidence-based approach to treating prolonged grief disorder. 

CGT takes place over 16 sessions and combines a mix of therapeutic techniques, including cognitive-behavioral therapy, dialectical behavior therapy, motivational interviewing, and attachment perspective theory. It also involves grief education, explaining what grief looks like and what is helpful in dealing with it.  

CGT is constructed around 7 core themes, listed verbatim here from the Psychiatry Advisor article linked to above:

  • Understanding/accepting grief
  • Managing emotional pain and monitoring symptoms
  • Thinking about the future
  • Strengthening ongoing relationships
  • Telling the story of the death (sometimes called “restorative retelling)
  • Learning to live with reminders
  • Connecting to memories

If you or a loved one are dealing with grief that has felt overwhelming for a long time, it doesn’t hurt to reach out for a consultation with one of our team members at Raleigh Oaks Behavioral Health in Garner, North Carolina. We’ll work with you to determine what level of treatment would benefit you most and help you participate fully in life again. 

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