What Is Complicated Grief — And How Do You Know If You Have It?
Most people expect grief to soften over time. And for many people, it does. The loss stays real. The pain becomes more manageable. Life slowly starts to feel livable again.
But for some people, that doesn't happen.
The grief stays heavy. It interferes with work, relationships, sleep, and daily life. It doesn't follow the expected pattern — and it doesn't seem to be getting better, even months or years later.
That's what clinicians call complicated grief. And if you've been wondering whether what you're experiencing falls into that category, this post is for you.
You don't have to wait until grief becomes unbearable to reach out for support. But it helps to understand what complicated grief actually is — and what it isn't.
What is complicated grief?
Complicated grief — also called prolonged grief disorder or complicated mourning — is when the natural grieving process becomes stuck. Instead of gradually adjusting to loss, a person remains in intense grief that interferes with daily functioning. It affects an estimated 10 to 20 percent of people who experience significant loss.
Grief itself is a completely normal response to loss. It isn't a disorder. Most people work through grief over time, even when it's painful and uneven.
Complicated grief is different. It's grief that has become derailed. The processing that needs to happen — emotionally, cognitively, and even physiologically — isn't moving forward the way it naturally should.
This doesn't mean something is wrong with you. It means your nervous system and mind are stuck in a response that once made sense, and they need support to get unstuck.
How is complicated grief different from regular grief?
Regular grief is painful and disruptive, but it gradually shifts over time. Complicated grief feels frozen. The intensity doesn't lessen. Milestones and daily moments continue to feel as raw as they did in the early days of the loss.
With typical grief, most people experience what researchers call a "dual process" — moving back and forth between feeling the pain of loss and re-engaging with daily life. Neither side is constant. There's movement.
With complicated grief, that oscillation gets stuck. A person may be consumed by grief with little relief. Or they may be working so hard to avoid it that the grief never actually gets processed at all.
Both patterns — being overwhelmed by grief and avoiding it entirely — can lead to complicated grief.
What does complicated grief feel like?
Complicated grief can feel like the loss just happened, even years later. It often involves persistent yearning, difficulty imagining a future without the person, and grief that feels physically present in the body.
Common signs of complicated grief include:
Intense longing for the person who died that doesn't lessen over time
Difficulty accepting that the loss is permanent, even when you "know" it intellectually
Feeling like part of yourself died or is missing
Bitterness or anger that stays sharp and doesn't fade
Feeling that life is meaningless or purposeless without the person
Avoiding places, people, or activities connected to the loss
Difficulty trusting others or feeling connected since the loss
Feeling like you can't grieve because you'd be "letting go" of the person
Grief that feels physically heavy — chest tightness, fatigue, physical ache
It's also worth naming something that doesn't get said often enough: complicated grief can involve holding onto the grief on purpose. Some people sense, even without fully realizing it, that their pain is the last connection they have to the person they lost. "If I give up my grief, I give up them." That feeling makes complete sense. It's also something that grief therapy can address directly — because healing doesn't mean letting go of the person. It means finding a way to keep them with you differently.
Why do some people get stuck in grief?
Grief gets complicated for many reasons — secondary losses that pile up, old grief that gets activated, attachment patterns, the nature of the loss itself, and whether someone had adequate support. It's rarely just about the original loss.
Here's something that often surprises people: grief researchers and clinicians have found that new losses tend to activate old ones. Your brain has a network for grief, and when it gets triggered, it often pulls in other losses you've never fully processed. A death in 2024 might open up something from 2010. That's not a sign of weakness. It's how memory and emotion are wired.
Secondary losses also play a significant role. When someone dies, the primary loss is obvious — you lost the person. But secondary losses are all the things that change because of the death: the loss of your role as a spouse, the loss of financial security, the loss of a shared future, the loss of who you were in that relationship. These ripple effects are real losses, too. When secondary losses aren't acknowledged or processed, they accumulate — and that's often what tips grief toward becoming complicated.
Attachment style matters as well. If you grew up learning that your emotional needs weren't consistently met, grief can feel particularly destabilizing. When the person you depended on for safety and security is gone, the loss isn't just about love — it's about the loss of your anchor in the world.
The circumstances of the loss also shape how complicated grief becomes. Sudden deaths, traumatic losses, suicide, violence, and losses where there was conflict or ambivalence in the relationship all carry additional layers that can make grief harder to process.
What is prolonged grief disorder — and is it the same as complicated grief?
Prolonged grief disorder is the clinical diagnosis introduced in the DSM-5-TR in 2022. It's largely the same condition that clinicians have called complicated grief or complicated mourning for decades. The name changed; the experience didn't.
To meet the diagnostic criteria, a person must have experienced the death of someone close, be at least 12 months past the loss (6 months for children), and be experiencing significant yearning or preoccupation with the deceased, along with at least three other symptoms — such as difficulty accepting the death, intense emotional pain, feeling like a part of yourself died, or difficulty engaging in life.
The diagnosis exists so that people can access appropriate clinical care. If you're wondering whether your grief has crossed into something that warrants a diagnosis, a licensed therapist can help you figure that out. But you don't need a formal diagnosis to reach out. If your grief is interfering with your life, that's enough reason to get support.
What does the grief process actually look like — and where does complicated grief fit in?
Grief researchers have developed several models to describe how mourning unfolds. One of the most clinically useful frameworks comes from Therese A. Rando, whose work describes mourning as a set of active processes — not a fixed sequence of stages.
In Rando's model, mourning involves six interconnected processes (Rando, 1993):
Recognize the reality of the loss — fully taking in that it has happened.
React to the separation — experiencing and expressing the emotional weight of the loss.
Recollect and re-experience the relationship — remembering the person honestly, including who they were and what they meant to you.
Relinquish old attachments to the person as they existed in physical life — not forgetting them, but adjusting to their physical absence.
Readjust — adapting to a changed inner and outer world.
Reinvest — eventually finding ways to put energy back into life, relationships, and a future.
The key insight in Rando's model is that these aren't stages you pass through once and leave behind. They overlap. They circle back. A person might be working on readjusting while still processing the initial shock of recognition. That's normal.
Complicated grief — or complicated mourning, in Rando's language — happens when someone gets stuck in one or more of these processes. They can't recognize the loss as real. They can't stop holding on. They can't imagine readjusting. The natural movement through mourning has stalled.
William Worden (2009) offers a parallel framework built around four tasks of mourning: accepting the reality of the loss, processing the pain of grief, adjusting to a world without the deceased, and finding an enduring connection to the person while moving forward. Both frameworks point to the same thing — grief is active work. When it gets stuck, support can help it move again.
Is complicated grief different from depression?
Yes — and the distinction matters clinically. Complicated grief and depression can look similar, but they're different experiences that often call for different treatment approaches.
Here's a useful comparison:
Complicated grief tends to involve:
Self-esteem that largely remains intact
Grief that comes in waves, with some moments of relief
Thoughts like "I wish I could be with them" — which is yearning, not suicidal ideation
Emotion that centers specifically on the loss and the person
Limited benefit from antidepressants alone
Depression tends to involve:
Heavier, more constant low mood that isn't tied to thoughts of the person
A pervasive sense of worthlessness or that things will never improve
Guilt that expands beyond the loss — "I am a terrible person"
Self-esteem that feels consistently diminished
It's also possible to have both. Complicated grief can lead to depression, or the two can coexist. A good therapist will assess both and help you understand what's happening — because the treatment looks different for each.
If you're ever having thoughts of harming yourself or not wanting to be alive, please reach out for support right away. The 988 Suicide and Crisis Lifeline is available 24/7.
Try This: Take a moment and notice — when you think about your loss, does the intensity feel the same as it did early on, or has it shifted? Are there moments, even brief ones, when you feel okay? If the answer is "no, it hasn't shifted at all" — even after many months — that's worth talking to someone about. You don't have to be in crisis to deserve support.
When does grief need professional support?
You don't have to be in crisis to benefit from grief therapy. If grief is significantly affecting your relationships, your ability to function, your sense of who you are, or your ability to imagine a future — those are signs that support could help.
More specific indicators that grief counseling might be right for you:
The intensity of your grief hasn't lessened after 6–12 months
You're avoiding grief entirely — staying so busy or numb that you can't access it
You feel consumed by grief and can't get relief
Your work, relationships, sleep, or health are being consistently affected
You feel stuck between two worlds — unable to let go of the past and unable to move into the present
You're using alcohol, food, overwork, or other behaviors to manage the pain
You're carrying guilt, anger, or regret that won't ease
The death was sudden, traumatic, by suicide, or involved conflict in the relationship
At Aspire Counseling, grief support has been part of our work since the practice opened in 2017. Our therapists use structured, evidence-based approaches to grief — not just talking about the loss, but actively helping the brain and nervous system move through it. Our client outcomes reflect that: our clients show an average effect size of 1.52 on the Grief Intensity Scale, which reflects meaningful, measurable reduction in grief symptoms over the course of treatment.
We've also invested in advanced training specific to grief work. In March 2026, several of our clinicians completed a two-day advanced EMDR grief training in Overland Park, Kansas with Krista Helman, MSW, RSW. As part of that training, we learned a structured clinical framework for assessing factors that may complicate grief — helping us identify early on where someone might need extra support and how to tailor our approach accordingly. It's the kind of clinical preparation that makes a real difference in how we show up for clients navigating complicated loss.
FAQ: Complicated Grief
Can grief be complicated if no one died? Yes. Complicated grief can develop after any significant loss — divorce, infertility, a diagnosis, a major life transition, or even the loss of a relationship that others didn't fully recognize. Read more about grief that isn't about death →
How long does grief have to last before it's considered "complicated"? The clinical benchmark is roughly 12 months after the loss for adults (6 months for children), combined with symptoms that are interfering with daily life. But that's a clinical guideline — not a rule. If your grief feels stuck at any point, it's okay to seek support.
What's the difference between prolonged grief disorder and complicated grief? They describe the same experience. "Prolonged grief disorder" is the current clinical diagnosis in the DSM-5-TR (added in 2022). "Complicated grief" and "complicated mourning" are older terms that many clinicians and researchers still use.
Does grief therapy mean I have to "let go" of the person I lost? No. In fact, one of the goals of good grief therapy is helping you maintain a continuing bond with your loved one — just in a form that doesn't require you to stay in pain to feel connected to them.
Can EMDR help with grief? Yes — and in ways that go beyond what many people expect. Read more about how EMDR works for grief →(coming soon in this series)
I've been grieving for years. Is it too late for therapy to help? No. There's no expiration date on grief support. Old, unprocessed grief can be worked through even years later — and doing so often brings relief that people had stopped believing was possible.
Ready to Talk to a Counselor About Your Grief?
If something in this post resonated with you, you don't have to figure out next steps alone.
Our therapists in Lee's Summit and Columbia, Missouri work with grief of all kinds — recent losses, old losses, traumatic losses, and losses that others didn't always recognize as real. We'll meet you where you are.
Learn more about grief counseling at Aspire →
Call our Lee's Summit office at (816) 287-1116 or our Columbia office at (573) 328-2288. We also offer telehealth throughout Missouri.
About the Author
Jessica Oliver, LCSW, is the founder and Clinical Director of Aspire Counseling, with offices in Lee's Summit and Columbia, Missouri. Grief has been part of her personal and professional life for as long as she can remember — her mother worked in hospice and her father in the field of aging, which made conversations about death and loss a normal part of growing up. During her graduate training, she had the opportunity to work alongside a skilled bereavement counselor through The Telehospice Project — an experience that still shapes how she approaches grief with clients today. Jessica has advanced training in EMDR, CPT, and trauma therapy, and is committed to ongoing clinical learning. She sees clients individually, leads Aspire's EMDR consultation group, and supervises the clinical team.
This post is the second in a series on grief and EMDR at Aspire Counseling. It was inspired by advanced clinical training our team completed in March 2026 in Overland Park, Kansas with Krista Helman, MSW, RSW, whose work on EMDR-informed grief therapy continues to shape how we approach this work with our clients.
References
Rando, T. A. (1993). Treatment of complicated mourning. Research Press.
Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). Springer.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
