Complicated Grief

Normal grief, although differing in time and process in individuals, has common stages. Grief affects a person in all areas of his life and includes physical, emotional, behavioral, social, and spiritual symptoms. The grief process in most people follows a predictable course. The Kubler-Ross model, commonly known as the five stages of grief, was introduced by Elizabeth Kubler-Ross in her book, On Death and Dying (1969). Stages include: Denial, Anger, Bargaining, Depression, and Acceptance.  These stages have been applied to other types of grief, including the process following a child's sexual abuse disclosure.

Symptoms may begin to subside about six months after the loss; however, this is highly individual. Some individuals, however, do not cope with grief in healthy ways and repress their emotions. They are more likely to have later and more severe or chronic symptoms.

Complicated grief is unresolved grief. Individuals with complicated grief may not demonstrate normal grief reactions, and the grief process may be delayed, conflicted, or chronic. The grief process lasts longer and is more severe than in normal grief and may go on for months or years and resemble a state of chronic mourning. People with complicated grief are more likely to develop severe depression or commit suicide. 

Complicated grief often occurs when the "story" of the loss cannot be told. For instance, in cases where a family member has committed suicide, information may be withheld from all but the family and close friends. This is a more private grief with less opportunity for "telling" the story again and again, something that is normal for grieving individuals. Other factors that may lead to complicated grief include ambivalence about the loss or about the relationship to the lost person or thing. Mixed feelings of anger and guilt make it more difficult for a person to grieve because they are punishing themselves. With complicated grief, the person is unable to integrate the reality of the loss and may struggle with acceptance for years. 

The story of sexual abuse in a family is less likely to be told than that of a child's being abused by a stranger or community member. The elements of shame and secrecy play a part in this. Mothers may keep the information to themselves with all but a few and may maintain a public face that all is well. Humiliation and embarrassment may keep mothers from wanting others to know about the abuse, particularly if it is incest. This isolates the mothers and complicates the normal grief process. Anger, guilt, and self-blame can prevent mothers from normal grieving and maintain them in a chronic grief process.  

Symptoms of complicated grief:
  • Preoccupation with loss
  • Intense longing for things to be as they were before the loss
  • Difficulty accepting the loss
  • Numbness or detachment
  • Bitterness
  • Inability to enjoy life
  • Depression
  • Inability to move forward in life
  • Difficulty in everyday life function
  • Withdrawal from social activities
  • Sense of meaninglessness
  • Lack of trust
  • Irritability

Some factors contribute to complicated grief. If the grieving person does not have a supportive network of friends and family, she is more likely to continue unresolved regarding the loss. The suddenness or unexpectedness of the loss contributes because the shock factor is a barrier to integration of the loss. If a person is unable to get answers to questions regarding the loss, she may be unable to gain closure and accept the loss. If the manner of loss is more traumatic, grief may be more acute, facts and feelings avoided, and grief complicated. With sexual abuse, the age of the child and the severity and invasiveness of the  abuse may make it more difficult for mothers to accommodate the information and come to acceptance. 



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