Bereavement and Complex Grief: Understanding Loss, Lingering Pain, and Paths Toward Healing

Loss is an unavoidable part of being human. At some point in life, nearly everyone experiences the death of someone they love—yet nothing truly prepares us for how deeply grief can affect the mind, body, emotions, and sense of identity.

For many people, grief gradually shifts over time. The pain remains, but it becomes more manageable, woven into life rather than overtaking it. For others, grief stays intense and consuming long after the loss, interfering with daily functioning, relationships, and the ability to imagine a future. When this happens, grief may move beyond typical bereavement and into what clinicians call complex grief, formally recognized as Prolonged Grief Disorder.

This article is written to help you understand:

• What bereavement is and how grief normally presents

• When grief becomes more complicated

• The diagnostic symptoms of complex grief

• How grief affects thinking, emotions, behavior, and the body

• Who is most affected and why

• Practical, compassionate coping strategies

• How counseling can help and which therapy approaches are especially effective

Grief is not a problem to be solved—it is an experience that deserves understanding, support, and care.

What Is Bereavement?

Bereavement refers to the experience of loss following the death of someone significant. It is not a mental illness. It is a natural response to attachment, love, and connection.

During bereavement, people may experience:

• Waves of sadness or longing

• Emotional numbness

• Difficulty concentrating

• Fatigue

• Changes in sleep or appetite

• Heightened sensitivity

• Moments of disbelief

Grief is not linear. It often comes in surges, with periods of relative calm followed by unexpected intensity. There is no universal timeline, and cultural, relational, and personal factors all shape how grief unfolds.

When Grief Becomes More Complicated

While grief is painful, most people gradually adapt to life after loss. The pain does not disappear, but it softens and becomes more integrated.

For some, however, grief remains persistent, intense, and disruptive, long after the loss occurred. When grief feels frozen in time—dominating thoughts, emotions, and daily life—it may reflect complex grief, clinically referred to as Prolonged Grief Disorder.

Complex grief is not about loving someone “too much” or grieving incorrectly. It reflects how deeply the loss has disrupted emotional regulation, identity, meaning, and safety.

Prolonged Grief Disorder (DSM-5-TR Criteria, Explained)

Prolonged Grief Disorder is formally defined in the DSM-5-TR. To meet criteria, an adult must experience persistent grief symptoms for at least 12 months following the death (6 months for children and adolescents), with significant distress or impairment.

Below are the diagnostic symptoms, explained in plain language, with real-life examples.

Core Symptoms (At Least One Required)

1. Persistent Longing or Yearning for the Deceased

This involves a deep, ongoing ache to be with the person who died.

Example:Feeling a constant pull to call or text them, or an overwhelming desire for their presence that does not ease with time.

2. Preoccupation With Thoughts or Memories of the Deceased

Thoughts about the person or the loss dominate mental space.

Example:Replaying conversations, memories, or the circumstances of the death repeatedly, making it difficult to focus on work or daily tasks.

3. Identity Disruption

A feeling that part of yourself has been lost.

Example:“I don’t know who I am without them,” or feeling unanchored in roles once shared.

4. Difficulty Accepting the Death

The loss does not feel real on an emotional level.

Example:Expecting the person to return or feeling shocked months later when reminded they are gone.

5. Avoidance of Reminders

Deliberately avoiding reminders of the loss.

Example:Avoiding photos, places, music, or conversations connected to the person to escape emotional pain.

6. Intense Emotional Pain

Strong emotional distress related to the loss.

Example:Sudden waves of anguish, anger, guilt, or bitterness that feel overwhelming.

7. Difficulty Reengaging With Life

Feeling unable to move forward.

Example:Loss of interest in social activities, hobbies, or future plans.

8. Emotional Numbness

A sense of emotional shutdown or detachment.

Example:Feeling disconnected from joy, meaning, or relationships.

9. Feeling That Life Is Meaningless Without the Deceased

A collapse of purpose or direction.

Example:Believing life has lost its value because the person is no longer present.

10. Intense Loneliness

A deep sense of isolation that persists even around others.

Example:Feeling that no one can truly understand the depth of the loss.

How Grief Affects the Whole Person

Grief is not just emotional—it affects every system.

Cognitive Effects

• Difficulty concentrating

• Forgetfulness

• Intrusive memories

• Rumination

Emotional Effects

• Sadness

• Anger

• Anxiety

• Guilt

• Emotional numbness

Behavioral Effects

• Withdrawal

• Avoidance

• Reduced self-care

• Sleep disruption

Physical Effects

• Fatigue

• Body aches

• Headaches

• Weakened immune response

How Common Is Complex Grief?

Overall Prevalence

• Approximately 7–10% of bereaved adults develop Prolonged Grief Disorder

Prevalence by Age

• Children & Adolescents: Higher risk after sudden or traumatic loss

• Young Adults: Elevated risk after loss of a partner, parent, or peer

• Middle Adulthood: Risk increases with cumulative losses and caregiving stress

• Older Adults: Higher prevalence due to social isolation and multiple losses

Prevalence by Gender

• Diagnosed more frequently in women, who often report stronger yearning and emotional pain

• Men may experience grief through withdrawal, irritability, or physical symptoms and are less likely to seek help

15 Practical Ways to Support Yourself Through Grief

Grief does not need to be eliminated—it needs care. These strategies are meant to support you emotionally while honoring the reality of your loss.

1. Write Letters to the Person You Lost

Writing letters allows you to express thoughts and emotions that no longer have a place to go. You might write about what you miss, what you wish you could say, or how life has changed since their death. There is no structure required—this is about expression, not closure. Many people find that letter writing releases emotions that feel stuck or unspoken.

2. Journal About Your Grief Without Editing Yourself

Grief often includes contradictory feelings, and journaling provides a private space where all of them are allowed. You can write about anger, sadness, guilt, confusion, or numbness—whatever shows up. Try not to censor your thoughts; grief is not logical. Over time, journaling can help you notice patterns and moments of emotional shift.

3. Identify “High-Risk” Times and Create a Grief Plan

Grief often intensifies at predictable times, such as evenings, weekends, anniversaries, or holidays. Identifying these “danger zone” periods allows you to plan ahead rather than being overwhelmed unexpectedly. Develop three to five activities, hobbies, or grounding options you can turn to when grief peaks. Planning ahead does not eliminate grief, but it can make it more manageable.

4. Schedule Activities That Gently Require Social Interaction

Isolation can deepen grief, even when being alone feels easier. Scheduling low-pressure activities—such as classes, volunteer work, or standing plans—can provide structure and connection. These interactions offer distraction and routine without requiring emotional disclosure. Being around others does not mean you must talk about your grief unless you choose to.

5. Join a Grief Support Group

Support groups connect you with others who understand grief firsthand. Hearing others’ experiences can normalize your reactions and reduce isolation. Many people find comfort in being with others who do not expect grief to be “fixed.” Grief groups often provide a level of understanding that friends and family cannot.

6. Create Rituals That Honor the Person You Lost

Rituals provide a way to maintain connection while acknowledging the reality of loss. This might include lighting a candle, visiting a meaningful place, or honoring anniversaries intentionally. Rituals give grief a container rather than allowing it to spill out unexpectedly. They affirm that love continues, even in absence.

7. Allow Yourself to Speak About the Person Without Apologizing

Many grieving individuals stop mentioning their loved one to avoid discomfort. Saying their name and sharing memories keeps the bond alive in a healthy way. You do not need permission to remember or speak about someone who mattered deeply to you. Continuing bonds are a normal part of grief.

8. Use Creative Expression When Words Are Not Enough

Grief is not always accessible through language. Art, music, movement, or crafting can help externalize emotions that feel overwhelming internally. You do not need artistic skill—only willingness. Creative expression often allows grief to move rather than remain trapped.

9. Maintain Simple, Predictable Daily Routines

Grief disrupts focus and motivation. Simple routines—waking at the same time, eating regularly, or taking a daily walk—provide stability when life feels chaotic. Routines reduce decision fatigue and support emotional regulation. Even small structure can help anchor your day.

10. Set Boundaries With People Who Minimize Your Grief

Well-meaning comments can feel invalidating. It is okay to limit time with people who pressure you to “move on.” Protecting your emotional space is not avoidance—it is care. Grief deserves respect.

11. Talk to the Person You Lost in Your Own Way

Some people find comfort in speaking aloud, writing, or praying. This does not mean denial or being “stuck.” It reflects the reality that relationships do not disappear with death. Ongoing connection can be emotionally regulating and meaningful.

12. Engage in Physical Movement That Feels Supportive

Grief is stored in the body. Gentle movement such as walking, stretching, or yoga can help release tension. The goal is grounding, not performance. Movement often improves sleep and emotional regulation over time.

13. Ask for Practical Help

Grief drains energy for everyday tasks. Asking for help with meals, childcare, or errands can reduce overwhelm. Many people want to help but need direction. Accepting help is a response to loss, not weakness.

14. Allow Moments of Relief Without Guilt

Moments of laughter or peace do not mean you have forgotten. Grief and joy can coexist. Allowing relief supports healing rather than undermining it. You are not betraying your loved one by experiencing life.

15. Work With a Grief-Informed Counselor

Professional support can help when grief feels overwhelming, frozen, or isolating. A counselor trained in grief work provides space where loss does not need to be minimized or rushed. Therapy can help integrate grief into life in a sustainable way. Support matters when grief begins to interfere with daily functioning or meaning.

How Counseling Helps With Bereavement and Complex Grief

Counseling offers a consistent, compassionate space to explore grief without pressure to “move on.” Therapy helps people process emotions, reduce avoidance, and restore connection to life.

Therapeutic Approaches Especially Effective for Grief

• Grief-Focused Therapy

• Cognitive Behavioral Therapy (CBT)

• Trauma-Informed Therapy

• Narrative Therapy

• Existential Therapy

Each approach supports different aspects of grief and is tailored to the individual.

A Closing Reflection

Grief reshapes lives. When loss feels endless or isolating, support can help restore balance and meaning. Bereavement and complex grief are real, deeply human experiences—and help is available.

Our counseling practice offers thoughtful, evidence-based support for individuals navigating loss, honoring both the depth of grief and the possibility of healing.