- Hey everybody today we're gonna talk about
complicated grief and how it differs
from regular grief, but before we jump into that,
are you new to my channel?
Welcome.
I am a licensed therapist making mental health videos
on Mondays and on Thursdays
so make sure you have your notifications turned on
so that you don't miss out.
But now let's hop in to today's topic.
And it's important, as always I wanna define things
so it's important to first know that grief itself
is the natural reaction to loss.
It's the body and mind's way of healing wounds
caused by loss of something precious.
We tend to think of it mostly as intense sorry,
but it can present itself as a lot of different emotions
or thoughts or even physical symptoms.
The important thing to know about grief
is that while it can feel awful,
it is a healthy and adaptive process of healing.
It's just your brain's way of making sense of the loss
and it helps us to learn what we value
and leads us to reach out for comfort and relationship.
So in a way, grief is really
just a helpful tool for processing the loss.
Now complicated grief, on the other hand,
can feel very similar to grief,
but it is in fact very different from it.
While grief is an adaptive process
of making sense of a loss,
complicated grief is actually a disruption
of the grieving process.
It keeps you from processing a loss.
It's like a complete roadblock.
Grief involves positive feelings and memories
and complicated grief generally makes it tough
to be able to access the memory or loss
in a way that enables you to have
a positive or honoring feeling.
Also grief is a reaction to losing something you value.
Complicated grief is a reaction to
like the negative thoughts or feelings that we have
about some element of the loss,
almost like the loss stirred something up inside of us
and it feels icky and the thoughts
that we have about it are all negative.
That's where complicated grief comes out of.
And overall, if that doesn't make sense
just know that complicated grief is really borne
out of a negative belief or experience
that we've attached to the loss.
It could be a negative belief that we have about ourselves
or possibly the relationship that we had
with the person who's passed away
or is no longer in our lives.
Instead of processing the loss,
complicated grief keeps us stuck in the process,
unable to do the healing work of grieving.
A better way of explaining this
is if we talk about the loss like it's a physical wound.
Grieving is the healthy process of that wound healing.
It's the cleaning out of the wound
through experiencing and processing
the different losses associated with that wound.
It feels painful at first, you know.
If you like have a cut on your leg,
you put rubbing alcohol or hydrogen peroxide on it
and you're like, oo, it really hurts
and then if we're processing it,
it can get kind of confusing
and it can be hard at times,
but this whole grief process is necessary
if we want the wound to heal fully.
Does that kinda make sense?
In complicated grief, on the other hand,
is when that wound becomes infected
or you kind of keep tearing out the sutures.
I love the band The Postal Service
and I just couldn't help myself, had to add that in.
But anyways, during complicated grief
you are still feeling pain and confusion,
but it's caused, not by the wound itself,
but by the infection that has gotten into the wound.
For example, let's say you have suffered
the loss of a person or relationship
that is really important to you.
The grieving process would be the emotions and the thoughts
and the physical responses, they can often be uncomfortable,
that come as your mind works to make sense of that loss.
Complicated grief is the interruption of that process.
So instead of being able to honor the person
or thing that was lost, some narrative,
like I was talking about, all those
negative thoughts or beliefs we maybe have about ourselves
is going to distract and stop that.
And so instead of the grief narratives
which are rooted in the loss and might sound like,
why did this happen to me
or I miss the way that they cared for me
or I don't wanna do this without them.
Instead a complicated grief narrative
might be something like people who cry are babies
or this is all my fault, I deserved this, I'm so weak.
Or even narratives caused by other losses in our life,
like everyone is always leaving me
or is this is always happening.
Does that make sense?
It's like instead of having a healthy thought
and belief and story, we tell ourselves about the grief,
complicated grief prevents it
and almost makes it personal,
where we did something to cause it.
And so of course we're not gonna
be able to process it and move forward.
Now as far as the emotions side,
they may feel very similar, especially in the beginning.
When you lose someone or you're grieving,
you feel sad, angry, hopeless,
maybe even depressed, but these emotions
are not rooted in working through the loss
and over time, it'll become clear
that you're just stuck in a cycle.
You're responding to that maladaptive narrative you had,
which maladaptive narrative's just a therapisty way
of saying that unhealthy story you keep telling yourself
about the loss, like all those beliefs
that we're having, right?
So we can respond to that
rather than ever being able to respond to
the actual loss we're facing,
which is really why we can't process it.
Does this all makes sense?
I hope so.
So if we think this is happening to us,
what could have caused it?
Why would we have complicated grief versus regular grief?
Now there are a lot of things that can cause it.
It could be, number one, and the most common
is unresolved past grief or trauma,
especially from childhood.
When you're a kid, sometimes you experience injuries
that you don't yet have the language
or cognition to even process.
These things can be triggered or resurface
when something happens in your life.
And the second cause is loss you feel responsible for,
like you did something to cause this.
Like I said some of those maladaptive
or negative thoughts that we can have
can be like, people always leave me,
this is all my fault, I did something.
So that can obviously lead to complicated grief as well.
And number three it could be from invalidated loss.
And invalidated loss occurs
when you feel your grief is disproportionate
to the situation, meaning you really think
you're overreacting and you're judging your grief
instead of allowing yourself to feel it
and validating the experience.
And this could be because of the circumstances
surrounding the loss or the ways others react to your loss
or the culture in your family about grief.
It can happen when you compare losses
or when certain emotions in the grief process
feel off-limits to you in your mind.
For example, you feel guilty about anger
or have a belief system that makes you feel weak
for really feeling sad and missing someone.
And complicated grief can also occur
when you find yourself in a situation
involving delayed grief, so this is the fourth cause,
fourth potential cause of complicated grief.
And delayed grief is when circumstances
make it difficult to process the loss as it happens.
Maybe you're busy planning a funeral
or you have to care for someone else's experience
of the same loss, so you aren't able
to fully process your own.
And I remember, honestly, when my dad passed away
my mom was sort of in this weird trance
during the whole process, because she had to
make sure that all the finances were in order,
and she had to plan the funeral,
and she was also consoling me
and being there for other members of the family,
and there was just so much to do
that I think it almost just distracted her
from her own loss.
Another source might be ambiguous or hidden loss.
Some losses are invisible,
like losing a child to miscarriage.
When loss isn't seen or acknowledged by others,
you can end up experiencing complications.
Or the sixth cause is compounded losses.
When multiple losses occur around the same time,
it can make it challenging to process each one.
And number seven, sudden lingering or violent loss.
Essentially these kinds of injuries
are often being experienced
as what we would call a traumatic loss.
Recurring losses or losses that are a disruption
of some sort of a central belief or thought you have
about yourself can create trauma
and essentially, in the end, create complicated grief,
meaning that if the loss seems to go against
what you feel you truly are,
it could be as simple as always believing
that you are strong and independent.
But if our grief makes us feel weak
and lost without someone,
it goes against what we believe about ourselves.
Do you know what I mean?
And that can lead to complicated grief.
Okay, enough about that and the causes,
let's move into how we can know
if we're struggling with complicated grief.
So identifying complicated grief can be tricky,
because at times it can look very similar to regular grief,
not to mention that we don't just wanna start thinking
we have a mental illness when we're just doing something
as normal and healthy as a grieving.
Now since complicated grief is in the DSM,
remember it's not the end-all be-all,
but it just gives us a way to better define
and diagnose and treat certain mental illnesses,
but in the DSM it's called persistent
complex bereavement disorder, or PCBD,
and it's included in the DSM as a condition
that needs further study precisely because
it is so complicated.
And if you remember, I did a video a long time ago
about non-suicidal self-injury
and that was in that same portion of the DSM,
under conditions that need further research.
And so what that means is is that we might find it
in the next update of the DSM.
Now in order for someone to struggle with PCBD,
we must have experienced the death of a loved one
at least six months previous
and at least one of the following symptoms
has to be happening longer than expected,
okay, so that has to be going on.
And then we have to have at least one of these things, okay.
And obviously when we're assessing this,
we have to take into consideration
a person's social or cultural environment
because different people of religions
and backgrounds and cultures
have different grieving processes
and what's considered quote unquote normal.
Okay, but they have to have at least one of these.
Number one, intense
and persistent yearning for the deceased.
Number two, frequent preoccupation with the deceased.
Three, intense feelings of emptiness or loneliness.
Four, recurrent thoughts that life is meaningless
or unfair without the deceased.
And five, a frequent urge to join the deceased in death.
And in conjunction with those,
we also have to have at least two of the following,
and these must have been occurring
and been recorded for at least one month, okay.
And the first one is feeling shocked, stunned,
or numb since the loved one's death.
Number two, feelings of disbelief
or inability to accept the loss.
Number three, rumination about the circumstances
or consequences of the death.
Number four, anger or bitterness about the death.
Number five, experiencing pain
that the deceased suffered
or hearing and seeing the deceased.
Number six, trouble trusting or caring about others.
Number seven, intense reactions
to memories or reminders of the deceased.
And number eight and finally,
avoidance of the reminders of the deceased
or the opposite where we'll seek out such reminders
so we can feel closer to them.
Now in order to diagnose, symptoms
would need to create substantial distress for the sufferer
or impact significantly on areas of functioning
and cannot be attributed to other causes.
Just like all other diagnosis,
in order for them to be a real issue
they have to impair our ability to function.
I've talked about that a lot
in all of my other DSM diagnosis videos.
But also know that grieving can still
involve complicated emotions that you may not like,
but they are about the loss
and not about you, and not about the grief itself.
What I mean is, don't think it's complicated grief
just because it's extremely painful
and there are mixed emotions.
Trust me, I feel like everything I've had to grieve,
every person I've lost in my life
has created mixed emotions
and it's been really uncomfortable.
And these complications that we're talking about
when it comes to complicated grief
are the things that are keeping you
from healing and grieving, so the question to consider is
is what you're experiencing helping you mourn the loss?
Or is it keeping you from even thinking about the loss?
And if you think you might be
dealing with complicated grief,
please reach out to a therapist
or other mental health professional in your area.
They can really help you figure out
what's interrupting the grief process for you
and help you move past it so you're able
to process the grief you're feeling.
And one type of therapy that's known to help with this
is CBT, or cognitive behavioral therapy.
In CBT, your therapist will work with you
to identify the narratives.
Remember those faulty beliefs or guilt?
Anyways, they'll help you identify the ones
that are interrupting your grieving process.
Then they will help you identify
what these faulty beliefs are rooted in
and either help you work through them
or separating them out from the loss
so that it can be processed separately,
because let's say it was a trauma
that's causing your complicated grief,
we'd wanna process through that trauma first
and then get into the grieving process.
But overall, the important thing to know
is that complicated grief is very, very common
and it can and will get better.
So please reach out because if its left untreated,
complicated grief can lead to other mental health issues
that would need their own treatment,
such as depression or anxiety.
And finally, I wanna just get into something
that you can use today to help you begin this process.
And one way to do that is to start
working through past losses.
I offer this up as an option
because it can be easier to start with something
you aren't currently struggling with.
Just like when we go to process through trauma,
we may start off with a smaller
less emotionally charged portion of that first.
So take a few minutes and think through
some of the losses you've experienced in your life.
Do you feel like you've done all the work
of working through those losses?
If not, maybe carve out some time this week
to journal through those losses
and see what emotions or narratives,
you know, those nasty stories we tell ourselves
about it, see what comes up for you.
And remember to be compassionate about this process
and ensure you're talking kindly to yourself
as you work through it.
Loss is really hard, so try to pay attention
to the thoughts you have when you
start thinking about your loss.
Are these thoughts about the loss
or are they things that might be about yourself
and what's keeping you from actually facing the loss?
Then take some time to think about the loss itself.
What do you miss about that person?
What do you think feel about that loss?
As you process, just try to notice any thoughts
that arise when you think about the loss.
Those can be clues to what may be preventing you
from grieving fully.
Even identifying these will help you
make more space in the process for your loss
and resolve the complications.
I hope you found this video helpful.
If you want to know more
you can check out the links below
and let us know in the comments
if you've ever experienced complicated grief.
And if so, how did you know that's what it was?
Or how did you work through it?
Leave those in the comments below
because you never know who you're gonna help
and I will see you next time, bye.
(gentle music)