What is Complicated Grief? [CC English & Español] | Kati Morton

- Hey everybody today
we're gonna talk about

complicated grief and how it differs

from regular grief, but
before we jump into that,

are you new to my channel?

Welcome.

I am a licensed therapist
making mental health videos

on Mondays and on Thursdays

so make sure you have your
notifications turned on

so that you don't miss out.

But now let's hop in to today's topic.

And it's important, as
always I wanna define things

so it's important to first
know that grief itself

is the natural reaction to loss.

It's the body and mind's
way of healing wounds

caused by loss of something precious.

We tend to think of it
mostly as intense sorry,

but it can present itself as
a lot of different emotions

or thoughts or even physical symptoms.

The important thing to know about grief

is that while it can feel awful,

it is a healthy and
adaptive process of healing.

It's just your brain's way
of making sense of the loss

and it helps us to learn what we value

and leads us to reach out
for comfort and relationship.

So in a way, grief is really

just a helpful tool for
processing the loss.

Now complicated grief, on the other hand,

can feel very similar to grief,

but it is in fact very different from it.

While grief is an adaptive process

of making sense of a loss,

complicated grief is actually a disruption

of the grieving process.

It keeps you from processing a loss.

It's like a complete roadblock.

Grief involves positive
feelings and memories

and complicated grief
generally makes it tough

to be able to access the memory or loss

in a way that enables you to have

a positive or honoring feeling.

Also grief is a reaction to
losing something you value.

Complicated grief is a reaction to

like the negative thoughts
or feelings that we have

about some element of the loss,

almost like the loss stirred
something up inside of us

and it feels icky and the thoughts

that we have about it are all negative.

That's where complicated
grief comes out of.

And overall, if that doesn't make sense

just know that complicated
grief is really borne

out of a negative belief or experience

that we've attached to the loss.

It could be a negative belief
that we have about ourselves

or possibly the relationship that we had

with the person who's passed away

or is no longer in our lives.

Instead of processing the loss,

complicated grief keeps
us stuck in the process,

unable to do the healing work of grieving.

A better way of explaining this

is if we talk about the loss
like it's a physical wound.

Grieving is the healthy
process of that wound healing.

It's the cleaning out of the wound

through experiencing and processing

the different losses
associated with that wound.

It feels painful at first, you know.

If you like have a cut on your leg,

you put rubbing alcohol
or hydrogen peroxide on it

and you're like, oo, it really hurts

and then if we're processing it,

it can get kind of confusing

and it can be hard at times,

but this whole grief process is necessary

if we want the wound to heal fully.

Does that kinda make sense?

In complicated grief, on the other hand,

is when that wound becomes infected

or you kind of keep
tearing out the sutures.

I love the band The Postal Service

and I just couldn't help
myself, had to add that in.

But anyways, during complicated grief

you are still feeling pain and confusion,

but it's caused, not by the wound itself,

but by the infection that
has gotten into the wound.

For example, let's say you have suffered

the loss of a person or relationship

that is really important to you.

The grieving process would be
the emotions and the thoughts

and the physical responses,
they can often be uncomfortable,

that come as your mind works
to make sense of that loss.

Complicated grief is the
interruption of that process.

So instead of being
able to honor the person

or thing that was lost, some narrative,

like I was talking about, all those

negative thoughts or beliefs
we maybe have about ourselves

is going to distract and stop that.

And so instead of the grief narratives

which are rooted in the
loss and might sound like,

why did this happen to me

or I miss the way that they cared for me

or I don't wanna do this without them.

Instead a complicated grief narrative

might be something like
people who cry are babies

or this is all my fault, I
deserved this, I'm so weak.

Or even narratives caused
by other losses in our life,

like everyone is always leaving me

or is this is always happening.

Does that make sense?

It's like instead of
having a healthy thought

and belief and story, we tell
ourselves about the grief,

complicated grief prevents it

and almost makes it personal,

where we did something to cause it.

And so of course we're not gonna

be able to process it and move forward.

Now as far as the emotions side,

they may feel very similar,
especially in the beginning.

When you lose someone or you're grieving,

you feel sad, angry, hopeless,

maybe even depressed, but these emotions

are not rooted in working through the loss

and over time, it'll become clear

that you're just stuck in a cycle.

You're responding to that
maladaptive narrative you had,

which maladaptive narrative's
just a therapisty way

of saying that unhealthy story
you keep telling yourself

about the loss, like all those beliefs

that we're having, right?

So we can respond to that

rather than ever being able to respond to

the actual loss we're facing,

which is really why we can't process it.

Does this all makes sense?

I hope so.

So if we think this is happening to us,

what could have caused it?

Why would we have complicated
grief versus regular grief?

Now there are a lot of
things that can cause it.

It could be, number
one, and the most common

is unresolved past grief or trauma,

especially from childhood.

When you're a kid, sometimes
you experience injuries

that you don't yet have the language

or cognition to even process.

These things can be triggered or resurface

when something happens in your life.

And the second cause is loss
you feel responsible for,

like you did something to cause this.

Like I said some of those maladaptive

or negative thoughts that we can have

can be like, people always leave me,

this is all my fault, I did something.

So that can obviously lead
to complicated grief as well.

And number three it could
be from invalidated loss.

And invalidated loss occurs

when you feel your grief
is disproportionate

to the situation, meaning you really think

you're overreacting and
you're judging your grief

instead of allowing yourself to feel it

and validating the experience.

And this could be because
of the circumstances

surrounding the loss or the
ways others react to your loss

or the culture in your family about grief.

It can happen when you compare losses

or when certain emotions
in the grief process

feel off-limits to you in your mind.

For example, you feel guilty about anger

or have a belief system
that makes you feel weak

for really feeling sad
and missing someone.

And complicated grief can also occur

when you find yourself in a situation

involving delayed grief, so
this is the fourth cause,

fourth potential cause
of complicated grief.

And delayed grief is when circumstances

make it difficult to process
the loss as it happens.

Maybe you're busy planning a funeral

or you have to care for
someone else's experience

of the same loss, so you aren't able

to fully process your own.

And I remember, honestly,
when my dad passed away

my mom was sort of in this weird trance

during the whole process,
because she had to

make sure that all the
finances were in order,

and she had to plan the funeral,

and she was also consoling me

and being there for other
members of the family,

and there was just so much to do

that I think it almost just distracted her

from her own loss.

Another source might be
ambiguous or hidden loss.

Some losses are invisible,

like losing a child to miscarriage.

When loss isn't seen or
acknowledged by others,

you can end up experiencing complications.

Or the sixth cause is compounded losses.

When multiple losses occur
around the same time,

it can make it challenging
to process each one.

And number seven, sudden
lingering or violent loss.

Essentially these kinds of injuries

are often being experienced

as what we would call a traumatic loss.

Recurring losses or losses
that are a disruption

of some sort of a central
belief or thought you have

about yourself can create trauma

and essentially, in the end,
create complicated grief,

meaning that if the
loss seems to go against

what you feel you truly are,

it could be as simple as always believing

that you are strong and independent.

But if our grief makes us feel weak

and lost without someone,

it goes against what we
believe about ourselves.

Do you know what I mean?

And that can lead to complicated grief.

Okay, enough about that and the causes,

let's move into how we can know

if we're struggling
with complicated grief.

So identifying complicated
grief can be tricky,

because at times it can look
very similar to regular grief,

not to mention that we don't
just wanna start thinking

we have a mental illness when
we're just doing something

as normal and healthy as a grieving.

Now since complicated grief is in the DSM,

remember it's not the end-all be-all,

but it just gives us
a way to better define

and diagnose and treat
certain mental illnesses,

but in the DSM it's called persistent

complex bereavement disorder, or PCBD,

and it's included in
the DSM as a condition

that needs further study precisely because

it is so complicated.

And if you remember, I did
a video a long time ago

about non-suicidal self-injury

and that was in that
same portion of the DSM,

under conditions that
need further research.

And so what that means is
is that we might find it

in the next update of the DSM.

Now in order for someone
to struggle with PCBD,

we must have experienced
the death of a loved one

at least six months previous

and at least one of the following symptoms

has to be happening longer than expected,

okay, so that has to be going on.

And then we have to have at
least one of these things, okay.

And obviously when we're assessing this,

we have to take into consideration

a person's social or cultural environment

because different people of religions

and backgrounds and cultures

have different grieving processes

and what's considered
quote unquote normal.

Okay, but they have to
have at least one of these.

Number one, intense

and persistent yearning for the deceased.

Number two, frequent
preoccupation with the deceased.

Three, intense feelings of
emptiness or loneliness.

Four, recurrent thoughts
that life is meaningless

or unfair without the deceased.

And five, a frequent urge to
join the deceased in death.

And in conjunction with those,

we also have to have at
least two of the following,

and these must have been occurring

and been recorded for at
least one month, okay.

And the first one is
feeling shocked, stunned,

or numb since the loved one's death.

Number two, feelings of disbelief

or inability to accept the loss.

Number three, rumination
about the circumstances

or consequences of the death.

Number four, anger or
bitterness about the death.

Number five, experiencing pain

that the deceased suffered

or hearing and seeing the deceased.

Number six, trouble trusting
or caring about others.

Number seven, intense reactions

to memories or reminders of the deceased.

And number eight and finally,

avoidance of the reminders of the deceased

or the opposite where we'll
seek out such reminders

so we can feel closer to them.

Now in order to diagnose, symptoms

would need to create substantial
distress for the sufferer

or impact significantly
on areas of functioning

and cannot be attributed to other causes.

Just like all other diagnosis,

in order for them to be a real issue

they have to impair our
ability to function.

I've talked about that a lot

in all of my other DSM diagnosis videos.

But also know that grieving can still

involve complicated emotions
that you may not like,

but they are about the loss

and not about you, and not
about the grief itself.

What I mean is, don't think
it's complicated grief

just because it's extremely painful

and there are mixed emotions.

Trust me, I feel like
everything I've had to grieve,

every person I've lost in my life

has created mixed emotions

and it's been really uncomfortable.

And these complications
that we're talking about

when it comes to complicated grief

are the things that are keeping you

from healing and grieving, so
the question to consider is

is what you're experiencing
helping you mourn the loss?

Or is it keeping you from
even thinking about the loss?

And if you think you might be

dealing with complicated grief,

please reach out to a therapist

or other mental health
professional in your area.

They can really help you figure out

what's interrupting the
grief process for you

and help you move past it so you're able

to process the grief you're feeling.

And one type of therapy
that's known to help with this

is CBT, or cognitive behavioral therapy.

In CBT, your therapist will work with you

to identify the narratives.

Remember those faulty beliefs or guilt?

Anyways, they'll help
you identify the ones

that are interrupting
your grieving process.

Then they will help you identify

what these faulty beliefs are rooted in

and either help you work through them

or separating them out from the loss

so that it can be processed separately,

because let's say it was a trauma

that's causing your complicated grief,

we'd wanna process
through that trauma first

and then get into the grieving process.

But overall, the important thing to know

is that complicated grief
is very, very common

and it can and will get better.

So please reach out because
if its left untreated,

complicated grief can lead
to other mental health issues

that would need their own treatment,

such as depression or anxiety.

And finally, I wanna
just get into something

that you can use today to
help you begin this process.

And one way to do that is to start

working through past losses.

I offer this up as an option

because it can be easier
to start with something

you aren't currently struggling with.

Just like when we go to
process through trauma,

we may start off with a smaller

less emotionally charged
portion of that first.

So take a few minutes and think through

some of the losses you've
experienced in your life.

Do you feel like you've done all the work

of working through those losses?

If not, maybe carve
out some time this week

to journal through those losses

and see what emotions or narratives,

you know, those nasty
stories we tell ourselves

about it, see what comes up for you.

And remember to be
compassionate about this process

and ensure you're talking
kindly to yourself

as you work through it.

Loss is really hard,
so try to pay attention

to the thoughts you have when you

start thinking about your loss.

Are these thoughts about the loss

or are they things that
might be about yourself

and what's keeping you from
actually facing the loss?

Then take some time to
think about the loss itself.

What do you miss about that person?

What do you think feel about that loss?

As you process, just try
to notice any thoughts

that arise when you think about the loss.

Those can be clues to
what may be preventing you

from grieving fully.

Even identifying these will help you

make more space in the
process for your loss

and resolve the complications.

I hope you found this video helpful.

If you want to know more

you can check out the links below

and let us know in the comments

if you've ever experienced
complicated grief.

And if so, how did you
know that's what it was?

Or how did you work through it?

Leave those in the comments below

because you never know
who you're gonna help

and I will see you next time, bye.

(gentle music)