Complicated Grief: What to Look For

No, really. An actual condition called complicated grief exists (sometimes it’s called pathologic grief, but that term has fallen out of favor for obvious reasons). Nurses deal with grief a lot, both our own and that of our patients and families. We are not, however, taught much about it.

I never heard of complicated grief until I went to work for Hospice. You would think that someone who worked for years in critical care where people died and got bad news constantly would have heard of it, but no. I had heard the typical "time takes time" and "time heals all wounds" types of platitudes, but those did nothing to help with either my nursing burnout or the grief I felt when my father died.

In fact, not knowing about complicated grief made my grief worse and worse, because I felt as if I should be over things. I constantly thought that it had been long enough. Why wasn’t I feeling better? Why, in some cases, was I feeling worse? I even had a physician ask me, "It’s been 3 months since your father died. What is the problem?"

I didn’t have an answer, because I felt the same way. I didn’t know that people who experience a major less complicated by other factors (hence complicated grief) don’t experience decreasing symptoms of loss, depression, or anhedonia. Their symptoms may increase.

What sort of factors complicate a loss? Perhaps the biggest one is multiple losses without inadequate recovery time. A parent might, might, recover somewhat from the loss of a child, but if that loss is followed quickly by a divorce and a job loss, that grief will not look like the reaction to a similar loss in a different person without clustered losses.

In my case, my dad died, and he was my main person. The same day my grandfather had a stroke, and my entire remaining family dynamic changed. When I went back to work after leave for that, I got fired without warning. Then my live-in boyfriend came home from work one day, woke me up, and moved out. There just wasn’t time to come back to baseline after any of those.

Imagine how much worse that phenomenon can be. What about the families where multiple people die in one crash? Parents who lose multiple children? Unfortunately, as in my case, medical emergencies for anyone in the family can lead to job loss, and even without that, finances become a major source of anxiety. Also as in my case, they lead to spouses or significant others packing up and moving on when the stress becomes too much for them.

Once you open your mind to the collateral losses that surround a loss, complicated grief may become obvious and can then be addressed. I suggested not addressing it as my doctor did, but rather by perhaps gently pointing out to the grieving person that things may not be as simple as they wish. It can be empowering to learn that you’re not just a slow griever, but rather a normal one.


About Megen Duffy

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Megen Duffy, RN, BA, BSN, CEN, is a practicing nurse, blogger, and contributing editor for the American Journal of Nursing. Megen has practiced in a variety of settings from emergency rooms to prisons.