The Distinction Between Complicated Grief and Depression

There is increasing support for the recognition of complicated grief (CG), or pathological reactions to grief, as its own mental health syndrome. Most individuals who experience grief struggle with similar emotions during the grieving process. However, some people exhibit more severe and persistent symptoms that result in impaired sleep, increased stress, and poor quality of life and often require psychological intervention. The proposed changes to the DSM include listing CG as a unique syndrome, but controversy exists over precisely which subgroup it should fall under. People who have major depressive disorder (MDD) or posttraumatic stress (PTSD) may show symptoms that are somewhat like those of complicated grief. But it is necessary to understand the cognitive processes that underlie CG in order to determine if CG is truly a form of MDD or not. To better identify the way in which the symptoms of CG are processed compared to the symptoms of MDD and PTSD, Ann-Marie J. Golden of the Emotion Research Group and Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, looked at the executive functioning, personal narratives, self-cognitions, and other symptoms in 272 grieving individuals.

Golden conducted three separate studies that examined individuals whose symptoms of grief ranged from normal to both moderate and severe CG. After analyzing all of the data, Golden found that the individuals who had CG did not exhibit negative attributions about themselves, whether related to the bereavement or otherwise. Golden believes that these findings indicate that cognitive processing in individuals with CG is unique and should not be classified in the same way as PTSD, MDD, or other mood disorders. Golden said, “The current data are consistent with the distinctiveness of CG as a discrete syndrome, in line with proposals for the inclusion of a bereavement-related adjustment disorder in the DSM–V; the data are also consistent with other evidence indicating that CG has distinct phenomenology, merits a different treatment approach, and has differential predictive validity.” She added that symptom similarity notwithstanding, people who are suffering with CG are better able to show their emotions than those with PTSD and MDD. These findings are beneficial to clinicians who treat individuals with CG and may help them realize the importance of fully exploring their clients’ attributions and appraisals. But clinicians are cautioned to proceed slowly so as not to exacerbate the extreme emotional state of their clients.

Golden, A.-M. J., Dalgleish, T. (2012, February 13). Facets of Pejorative Self-Processing in Complicated Grief. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027338

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  • Gus

    February 17th, 2012 at 4:37 PM

    When we all realize that death and dying are a natural part of life then maybe we would not be so sad when it happens. I know that it means losing someone in life that you love but just because they die does not mean that that love and what they meant to you has to die too. You just love them in a different way and from a different place. And most people who lose someone go through this processing of grief and depression. Completely normal.

  • pietro

    June 9th, 2018 at 6:48 AM

    Very good reflection


    February 17th, 2012 at 8:20 PM

    Sounds like it is different from PTSD from what the study has found..And if it is indeed different then it ought to be classified as something unique..Looking at the external traits is not enough,what the person feels and expresses is very important too..

  • carmen m

    February 18th, 2012 at 9:52 AM

    No matter whether it is complicated grief or it is depression, both are things that someone is going to need some help getting over.

    I have lost family before, and it is like society will give you a certain amount of time to grieve and be sad but then when that preconceived amount of time that they think that you need is up then they expect you to get on with it.

    But grief and that process is not a one size fits all. What happens quickly for some will never fully go away for others.

    So I think that as a whole society needs to do a little better job at trying to understand these complicated feelings and be a little more accepting of the differing ways in which we all handle things.

  • Lynette stevens

    February 20th, 2012 at 7:58 AM

    Have been watching my own mom deal with the loss of her mother and I have to tell you that you can never be prepared for this kind of loss and the ways that it is going to affect you.
    This has been going on for over three months and whereas I think that she should now be ready to move on, it is for lack of a better term, complicated.
    She still can’t think straight and to tell you the truth I am getting pretty worried about her.
    It is like nothing can get her out of this funk, and I don’t really know what to do to help her out of it either.

  • Dan Bolton

    February 22nd, 2012 at 3:17 PM

    Great thoughts to mull over Noah. I have been reading up on attachment again lately, and I wonder whether these folks who experience CG may have an ‘anxious-preoccupied attachment’ pattern. I agree also that one size does not fit all, as Carmen said, but maybe the complicated world of attachment may have something to do with varying reactions.

  • Eddy

    September 27th, 2012 at 6:43 PM

    Parent loss takes time, and the waves wash over you, frequently in the first year, and progressively less as time goes on. Long illnesses may make it easier, but that’s from the perspective of experiencing a short illness. I have likened the feeling of a piling at the end of a jetting, and it has fallen in, and now I am the next piling….

    Spousal loss is made more profound when the couple has done most everything together, and not built lives outside the relationship. My Mom is still grieving and exhibiting significant symptoms. I suspect PTSD as well from earlier life experiences and well… its not much fun to cope with. Talking helps, so therapy seems in order.

    Maybe the rituals surrounding death help with coping regardless of faith or lack thereof… we were quite unorthodox and may be the rituals help bring closure. I know so little.

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