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Tests and diagnosis
By Mayo Clinic staffComplicated grief isn't yet recognized by mental health providers as an actual disorder. Because there are many similarities between complicated grief and major depression, researchers are working to clarify the key differences between these conditions so that firm diagnostic criteria can be established.
Studies of people grieving the death of a loved one suggest that two primary symptoms make complicated grief unique:
- Continued disbelief that the death has occurred
- Intense yearning for the deceased that disrupts your ability to function in daily life, such as at work or in social engagements
Other factors that suggest a diagnosis of complicated grief include:
- Inability to trust others
- Difficulty moving forward with life
- Excessive bitterness or anger related to the death
- Feeling emotionally numb or detached from others
- A feeling that life is now meaningless
- A belief that the future won't be fulfilling
- Increased agitation or jumpiness
- Social withdrawal
Many of these symptoms are common during the normal process of grieving. In complicated grief, however, they show no signs of improvement over time.
There's currently no consensus among mental health experts about how much time must pass, exactly, before complicated grief can be diagnosed. Some experts recommend diagnosing complicated grief when two or more months have passed without any improvement in symptoms, while others recommend waiting six or more months. While researchers continue to try to pin down a time frame for this diagnosis, their work is made challenging by the knowledge that grieving is a highly individual process.
Rather than looking at the exact time period, a mental health provider is more likely to diagnose complicated grief based on:
- A lack of any improvement in your symptoms over time
- A significant impact on your ability to function in daily life
- Bereavement. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed July 13, 2009.
- Lipsitz JD. Interpersonal theory of depression. Gabbard GO, ed. Textbook of Psychotherapeutic Treatments. Arlington, VA: American Psychiatric Publishing; 2009. http://www.psychiatryonline.com. Accessed July 13, 2009.
- Marchand L. End-of-life care. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/149504704-3/862284999/1494/128.html#4-u1.0-B978-1-4160-2954-0..50085-5_4160. Accessed July 13, 2009.
- Block SD. Grief and bereavement. http://www.uptodate.com/home/index.html. Accessed July 13, 2009.
- Kendler KS, et al. Does bereavement-related major depression differ from major depression associated with other stressful life events? American Journal of Psychiatry.2008;165:1449.
- Abrahm JL. Caring for patients at the end of life. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008. http://www.mdconsult.com/das/book/body/149504704-4/862286866/1709/49.html#4-u1.0-B978-0-443-06694-8..50048-8_1340. Accessed July 13, 2009.
- Siegel MD, et al. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Critical Care Medicine. 2008;36:1722.
- Complicated grief. National Cancer Institute. http://www.nci.nih.gov/cancertopics/pdq/supportivecare/bereavement/Patient/page8. Accessed July 13, 2009.
- Major depression and complicated grief. American Cancer Society. http://www.cancer.org/docroot/MBC/content/MBC_4_1X_Major_Depression_and_Complicated_Grief.asp. Accessed July 13, 2009.
- Simon NM, et al. Complicated grief: A case series using escitalopram. American Journal of Psychiatry. 2007;164:1760.
- Prigerson HG, et al. Inventory of complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research. 1995;59:65.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. July 15, 2009.
