11 Warning Signs and Symptoms of Unresolved Grief

man with unresolved grief

Grief is a normal reaction to loss. It is also a complex, multi-faceted experience that involves a wide range of bio-psycho-social-spiritual experiences. For example, when you lose a loved one, you may:

(i) experience chest pain, headache, and palpitations (biological/physical) 

(ii) feel sad, angry, and guilty, and find it hard to make simple decisions (psychological) 

(iii) withdraw or cling to others (social) 

(iv) question God or your spiritual beliefs (spiritual) 

All these reactions are signs and symptoms of a normal grieving experience. Most people accept the loss, work through the pain, and eventually adjust and re-establish their lives without the loved one’s presence.

However, for some people, the normal grieving process and healing can become derailed and disruptive – to the extent that they develop a chronic and debilitating condition. In other words, they do not cope effectively with bereavement, and they become entangled and stuck in grief. This is known as unresolved or complicated grief. 

Grief is not a disease. But suppose your grief becomes acute, intense and prolonged, and you are swept away by endless waves of painful thoughts, emotions, and memories. In that case, you may experience unresolved or complicated grief. If that is the case, you may want to seek professional help, such as talking to a grief counsellor to help you come to terms with your loss and regain a sense of peace and hope.

Signs and symptoms 

If you wonder whether you are experiencing unresolved or complicated grief, here are some signs and symptoms using the COMPLICATED acronym. Before you jump to a conclusion, many of these signs and symptoms are also common and expected for normal grieving. What differentiates normal grief and complicated grief is the severity, impact, and duration of your grief. If your grief is causing excessive distress, intense pain, prolonged rumination, persistent disbelief, and significant impairment of your wellbeing and major areas of functioning, you may consider seeking professional help. 

C – Caught up in counterfactual thinking

Counterfactual thinking is thinking about a past that did not happen. It also focuses on how the past might have been or how the present could be different. This is often the “if only” situation, where you wish something had or had not happened.  

When your grief becomes complicated or unresolved, you tend to ruminate in counterfactual thinking, where you relentlessly seek to reverse the tragedy of the loss somehow. As a result, the endless “if only” “scenarios often sustain your pain and suffering. For example, “If only I picked him up, he would not have died in the car accident,” “If only I saw it coming, she would not die by suicide,” or “If only I woke him up in the morning, he would not have a heart attack.”    

O – Obsessed (or rumination) with the deceased

It is common and healthy to form an attachment or emotional connection with your loved one. In other words, you will miss and yearn for them in the years to come. But suppose you persistently desire or long for your loved one and constantly pursue to feel closer to them through rumination, pictures, keepsakes, clothing, or other items. In that case, you may be showing symptoms of unresolved grief. Furthermore, if you frequently seek to see, hear, touch, or smell things that remind you of the deceased and the preoccupying thoughts interfere with your daily functioning, that is another red flag for complicated grief.    

M – Maladaptive coping strategies

Grief is painful, and thus, as a short-term measure, it is natural to do things to ease, numb, avoid or escape the pain. For example, you may engage in maladaptive strategies to help you cope with the death of your loved one, such as consuming drugs (prescribed or illicit) and alcohol, ruminating or shutting down your feelings. You may also self-blame, self-harm, binge eats, disengage from supporting family and friends, and be involved in risk-taking and dangerous behaviours. While such maladaptive behaviours may temporarily relieve the pain, they are not optimally healthy and effective in the long run. 

P – Persistent feelings of loneliness and emptiness 

Some people describe that losing a loved one is like an amputation, i.e., you lost a vital part of your body, and your life is no longer complete. You may experience feelings of loneliness and emptiness, which leave you feeling emotionally numb, despondent, isolated and anxious, which can be expected. However, if you persistently feel disconnected and worthless, you may be at risk of experiencing complicated grief.      

L – Loss of meaning in life

Losing a loved one can shatter your sense of meaning in life. For example, you may ask yourself, “Who am I now that my life has changed? Where do I go from here? How do I find meaning in life again?” The frequent intense feelings of loneliness can also exacerbate the loss of meaning. For example, if you struggle with suicidal thoughts or believe that your life is meaningless and not worth living without your loved one, please seek professional help immediately, such as your doctor, counsellor or call Lifeline Australia at 13 11 14.

I – Intense pain and sorrow that does not improve over time   

You will experience intense pain and heartache when you lose a loved one. But when emotions such as guilt, bitterness, or anger are relentless and excessively painful and devour your ability to enjoy life or experience positive emotions, such as joy, peace, and hope, you may be at risk of complicated grief. 

C – Catastrophizing about the future 

Traumatic experiences such as losing your loved one can predispose you to catastrophise or worry incessantly about a range of bad things that may happen because your loved one is gone. It is a constant rumination about irrational worst-case scenarios, increasing anxiety and stopping you from taking action and doing what matters. For example, “Without my loved one, I will never find love, joy and hope again. Therefore, I will be lonely and miserable for the rest of my life.” Another example is, “My husband died from a car accident. Thus, it is no longer safe for me to drive. If I can’t drive, that means I can’t get to work, and I will end up homeless and in poverty.”  

A – Avoid reminders of the loss 

Losing your loved one is painful. As an instinctive response, you may engage in actions that avoid or escape painful thoughts and feelings, such as places, situations, objects or activities that remind you of the loss. For example, a mother who lost her son might avoid places she used to go (i.e., his school or bedroom), see his friends, or participate in activities they may have enjoyed together. While avoidance is generally considered an adaptive response to loss, persistent and over-reliance on avoidance may prolong the grieving process and contribute to unresolved or complicated grief, especially if the avoidance is due to the inability to accept the death. 

T – Trouble carries out everyday routines 

Grieving can consume most of your physical and psychological energy, especially during the initial period after the loss. Therefore, you may feel exhausted and unmotivated to carry out day-to-day routines, such as waking up, working, cooking, driving, gardening, and caring for others. If you continue to feel tired, lethargic and languish for a long time, and you have trouble carrying out everyday routines, it may be a sign that you are experiencing unresolved grief.

E – Erratic thoughts and behaviours

When you lose someone significant, you may feel like you are losing your mind. For example, you may see, hear, or sense your loved one. Sometimes you may become preoccupied with your loved one to the point that you display symptoms of an illness your loved one had. Or you may attempt to feel closer to them by surrounding yourself with their possessions. Are you losing it? Most likely not. But if you or the people around you notice that you frequently have erratic thoughts or behaviours that are unlike you and potentially harmful to yourself or others, you may want to seek help.      

D – Difficulty accepting the loss

Willian Worden, a renowned psychologist who specialises in grief and loss, advocates that helping people accept the reality of the loss is crucial in healthy grieving. Denial is a common response during the initial phase of the loss. It is a temporary protective mechanism to shield you from the traumatic experience and make sense of the senseless loss. As time goes by, most people will come to terms with the loss. If you are struggling to accept the loss and relentless denied the death, please reach out for support and take the steps that will enable you to heal.