A Complicated Grief

Grief is often characterized as an emotional roller coaster: On some days, those who have lost a loved one feel incredibly sad and full of pain, while on other days they feel a lightness, or even a strange euphoria that comes from appreciating the person who has passed and reflecting on their own growth in the wake of the loss.

But some people feel consistently upset and preoccupied with the person who has passed away, to the point where their relationships and work suffer for months on end. Such a reaction is known as "complicated grief."

The notion of a particularly sharp and prolonged kind of grief has been floating around for hundreds of years, but it wasn't until the 1990s that a group of bereavement researchers studied it systematically and pinned down its symptoms. They found that "complicated grief" occurs in about 10-20 percent of those who have lost a loved one. The symptoms, says Mary-Frances O'Connor, an assistant professor in psychiatry and biobehavioral sciences at UCLA's medical center, are unique in their intensity. "They include an extreme yearning for the deceased, loneliness, even searching for the deceased in a crowd, and intrusive thoughts about the deceased."

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Complicated grievers may feel that life has lost its meaning. "They will often say, 'I feel like part of myself died with the person,'" O'Connor says. People who were emotionally dependent on the person who passed away particularly at risk of developing complicated grief.

O'Connor conducted a fascinating study in which she scanned the brains of women who had all lost a family member to breast cancer. When reminded of their deceased loved ones, women with "uncomplicated" grief showed activation in their brain's emotional and memory centers. But the primary area that was activated in the brains of women with complicated grief was the nucleus accumbens—the reward center.

"When we are around our loved ones, it is normal for the reward system to be activated," says O'Connor. "So it makes sense that those suffering from complicated grief still expect to be rewarded with contact from their loves ones, on some level." It's as if the complicated grievers hadn't quite processed the fact that their mothers or sisters would no longer be in their lives. "They aren't in denial, in that they are fully aware that the person is deceased, and yet on a subconscious level, they haven't integrated that information. At some point the two 'realities' butt up against each other—and this may cause them to suffer."

Studies on treating complicated grief show that it isn't alleviated with depression treatments such as antidepressants, O'Connor says. "That kind of treatment doesn't hit on the patients' yearnings. What is most effective is talk therapy and exposure therapy that helps the person incorporate the death on a deep level. Also, it's helpful to have the patient focus on her future goals, on what she is going to do now that her loved one is gone."

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