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When Grief Doesn’t Go Away: Understanding Complicated Grief Disorder
- Moe | Scarlet Plus
- Jul 28
- 4 min read
At Caritas Behavioral Health Services in Columbia, MD, we understand that grief is a deeply personal experience. While most people gradually find ways to cope and adjust following loss, some face persistent, intense grief that disrupts daily life.
Known as Complicated Grief Disorder (CGD), or Persistent Complex Bereavement Disorder, this condition impacts mental health, relationships, and overall functioning.
This comprehensive guide explores:
What differentiates typical grief from CGD
The signs and cognitive patterns of persistent grief
Psychological and physiological impacts
Evidence-based treatment strategies and resources
How Caritas integrates compassionate, trauma-informed care
Practical self-help approaches between sessions
When and how to seek professional help
On this page:
1. Grief vs. Complicated Grief: What’s the Difference?
Grief is natural and multifaceted, characterized by sadness, longing, and fluctuating emotions. In typical bereavement, these feelings gradually ease over time, allowing individuals to adapt and reconnect with life.
Complicated Grief Disorder, however, involves persistent and intense grief that lasts beyond six months to a year, significantly impairing functioning and wellness. Key distinctions include:
Persistent yearning or preoccupation with the deceased
Intense emotional pain, guilt, or emotional numbness
Avoidance of reminders of the loss or environments tied to the deceased
Difficulty engaging in daily life or pursuing meaningful activities
CGD affects roughly 7% of bereaved adults, but risk increases following traumatic losses, ambiguous loss, or disrupted support systems (Shear et al., 2016).
2. Recognizing the Emotional and Cognitive Profile of Complicated Grief Disorder
A. Core Emotional Symptoms
Preoccupation with the deceased, as though they’re still present
Deep emptiness, sorrow, or anger that disrupts daily life
Emotional numbness or detachment from people or activities
B. Cognitive and Behavioral Patterns
Persistent thoughts like: “I can't live without them,” or “Life has no meaning now”
Avoidance: steering clear of memories or locations tied to the deceased
Difficulty trusting support or fear that moving on dishonors the deceased
C. Risk Factors
Relationship type: losing a spouse, child, or caregiver often leads to more intense grief
Traumatic circumstances: sudden, violent, or preventable deaths
Prior mental health conditions: preexisting anxiety, PTSD, or depression
Social isolation or minimal support systems
3. Psychological and Physical Impacts of Unresolved Grief
A. Mental Health and Cognitive Effects
Deepening depression, persistent anxiety, or suicidal ideation
Difficulty concentrating, impaired memory, or decision paralysis
Intrusive memories and rumination about the loss
B. Physical Health Consequences
Sleep disruptions, lingering fatigue, or appetite changes
Increased inflammatory markers and weakened immune response
Elevated risk of chronic illnesses including heart disease and autoimmune conditions
4. Evidence-Based Treatment Strategies for CGD
A. Complicated Grief Therapy (CGT)
A structured therapy that combines emotional processing, restorative rituals, and gradual re-engagement in meaningful activities. CGT often involves imaginal exposure to the loss and explores new bonds beyond the deceased.
B. Cognitive Behavioral Therapy (CBT)
CBT helps identify maladaptive thoughts about loss, and reframes beliefs with gentler, realistic perspectives, promoting adaptive coping.
C. Acceptance and Commitment Therapy (ACT)
ACT teaches acceptance of grief-related emotions, practicing mindfulness, and pursuing life goals aligned with personal values, despite the pain.
D. Medication Adjuncts
While there’s no medication to cure grief, antidepressants (e.g. SSRIs) can support co-occurring depression or anxiety symptoms when appropriate.
E. Supportive Peer and Group Programs
Group therapy offers shared understanding and practical coping strategies, lessening isolation and normalizing grief experiences.
5. How Caritas Supports Healing Through Grief
A. Trauma-Informed Assessment
Caritas clinicians begin with a comprehensive intake, screening for CGD symptoms, underlying mental health issues, and cumulative stressors.
B. Tailored Therapeutic Pathways
Treatment may include CGT, CBT, ACT, or integrative modalities, based on individual needs and evidence-based best practices.
C. Psychoeducation and Rituals
Clients learn about the grief process, understand biological and emotional waves, and identify soothing routines and practices.
D. Collaborative Treatment
Our structured approach integrates family or community engagement where appropriate, encouraging supportive rituals and emotional reconnection.
E. Flexible Modalities
Clients can choose telehealth or in-person sessions. Group workshops and grief support circles are available during transitional periods.
6. Self-Care Tools Between Sessions
You can reinforce therapy with these empirically supported practices:
Memory pacing: schedule short exposures to reminders followed by calming practices
Meaningful routines: reengage in passions like art, music, or movement
Mindful presence: observe grief without judgment, focusing on breath or grounding cues
Gratitude journaling: record moments of connection, compassion, or small joys
Values exploration: pursue activities that affirm life’s meaning—volunteer work, nature walks, creativity
Rest and self-compassion rituals: honor emotional exhaustion with healing rest, not distance from grief
7. When to Seek Additional Help
Consider professional support if you experience:
Persistent grief lasting beyond six months with minimal emotional relief
Functional impairment, mental, relational, or occupational
Ongoing trauma, intrusive memories, or suicidal ideation
Co-occurring depressive, anxious, or PTSD symptoms
Loss of safety, support, or capacity to cope
While grief is universal, prolonged disruption need not be permanent. Therapeutic intervention offers structured pathways forward.
Conclusion
Loss can reshape your inner world, but it doesn’t define its end. Healing from traumatic grief is possible when approached with care, structure, and emotional insight.
Caritas Behavioral Health Services offers evidence-based strategies, compassionate clinical support, and a trauma-informed environment dedicated to helping you rebuild meaning and connection.
References
Shear, M. K. et al. “Complicated Grief and Related Bereavement Issues for DSM-5.” Depression and Anxiety, 2011.
American Psychiatry Association. Persistent Complex Bereavement Disorder. DSM-5, 2013.
Trevino, K. C., & Shear, M. K. “Evidence-Based Recommendations for Complicated Grief Treatment.” Journal of Clinical Psychology, 2020.
Najavits, L. M. “Healing the Hurt That Never Goes Away” – online resource.
American Psychological Association. “The Effects of Grief on Physical and Mental Health.”Apa
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