Complicated grief vs normal grief: how do you know when to get help?
I have been grieving in some form for most of my life.
I was 11 when two of my classmates died. I did not have the language for what that was at the time. I just knew that something had shifted in the world that was not going to shift back, and that the adults around me did not quite know what to do with kids who were grieving their friends.
I’ve also lost three family members to suicide. I watched what that did to our extended family, and I carried my own version of it. None of us had anywhere near enough support for what we were experiencing.
And then in 2014, my biggest year in business, I burned out. All I did was work and go to funerals. I was running a successful business. I was doing all the things. What I did not understand at the time, and what I have come to understand both personally and clinically since, is that I was not just burned out. I was grieving. I had been grieving, in one form or another, for most of my life, and none of it had ever had a proper place to land.
I am telling you this because I want to be honest about why I work in this area, and because I think it matters that the person writing a post about complicated grief has some idea of what it actually feels like from the inside.
Grief does not follow a schedule. Most people who have lost someone know this in theory and then find themselves surprised, months or years later, that they are not further along than they are. That the loss still hits without warning. That certain days are still impossible. That the person is still gone in ways that keep catching them off guard.
This is normal. The idea that grief moves in predictable stages, peaks, and then resolves is not well supported by the research and has caused a significant amount of harm to people who are grieving normally but measuring themselves against a timeline that was never accurate to begin with.
So when people ask me how they know if their grief is complicated, my first answer is usually: complicated grief is not grief that is taking a long time. It is grief that has stopped moving.
What normal grief actually looks like
Normal grief is not tidy. It is not linear. It does not respect your schedule or your sense of when you should be over something.
In the early period after a loss, grief can be all-consuming. Difficulty sleeping, difficulty eating, difficulty concentrating, an inability to imagine the future. A sense that the world has fundamentally changed and nobody around you quite understands how. All of this is expected. All of this is the mind and body responding to something genuinely enormous.
Over time, for most people, the acute grief begins to integrate. Not disappear. Not resolve into acceptance. But find a place. The person who died becomes part of the texture of your life rather than an open wound at the centre of it. You can think about them without being levelled. You can make plans for the future. You can feel moments of genuine happiness without it feeling like a betrayal.
This process takes longer than most people expect and longer than most of the world around you will be comfortable with. The research suggests that for most people, the most acute phase of grief lasts somewhere between six months and two years, though grief in some form never fully ends and does not need to. Grief is the appropriate response to love. It does not have an expiry date.
What changes is not the love or even the grief. What changes is the relationship to it. Most people, over time, find that the grief becomes something they carry rather than something that carries them.
When grief becomes complicated
Complicated grief, now formally recognized in the DSM-5-TR as Prolonged Grief Disorder, is what happens when that integration does not occur. When the acute phase of grief does not ease but remains persistent, intense, and disabling well beyond what would be expected given the loss.
The diagnostic threshold for Prolonged Grief Disorder is grief that is significantly impairing daily functioning and that persists for at least twelve months after the loss in adults, according to criteria described in research by Maciejewski and Prigerson, who were central to developing the diagnosis. In the general bereaved population, approximately 12% of people meet the threshold for Prolonged Grief Disorder. Among people bereaved by suicide loss, that rate has been found to be as high as 43%.
But I want to be careful here, because the clinical criteria are not the whole picture and they are not the reason most people come to therapy.
Most people who come to me with complicated grief do not arrive having read the DSM. They arrive because something feels stuck. Because they are still not able to imagine a future. Because the loss is still at the centre of everything. Because the people around them have moved on in ways that feel like an accusation. Because they are exhausted in a way they cannot explain to anyone who has not been inside it.
That last one I recognize. In 2014, I could have told you I was tired and overwhelmed, but I did not have time to figure out what I was feeling beyond that. It took losing three people in one year, and burning out so completely that functioning was no longer possible, for me to understand that what I had been carrying was grief, multiple losses, accumulated and unprocessed, waiting for the moment when I finally could not outrun them anymore.
What complicated grief actually feels like
The distinction that tends to matter clinically is not the intensity of grief but its movement. Normal grief, even when it is severe, tends to shift over time. It comes in waves. There are hard days and slightly less hard days. The acute pain is punctuated by moments of ordinary life, and those moments gradually become more frequent.
Complicated grief tends not to shift in that way. It stays. The waves do not ease much. The acute longing, the difficulty accepting the reality of the loss, the feeling that life cannot go on without the person, these remain central and disabling in a way that does not change significantly with time.
Some of the specific features that distinguish complicated grief from normal grief, drawn from the clinical literature on Prolonged Grief Disorder, include an intense, persistent yearning for the person who died, difficulty accepting that the death happened, bitterness or anger about the loss that does not ease, feeling that part of yourself died with the person, an inability to engage with life or relationships, and a sense that the future is meaningless without them.
What is important to know is that complicated grief is not a sign that you loved the person more, or that you are weaker than people who are not experiencing it. It is a recognized clinical condition that responds to specific treatment. The grief is not the problem. The stuckness is something that can be worked with.
Why some grief becomes complicated
Not every loss leads to complicated grief, and not every person who experiences the same kind of loss will respond the same way. The research points to a few factors that increase the risk.
The nature of the loss matters. Sudden, violent, or traumatic deaths carry higher risk, which is part of why suicide bereavement, as well as loss by accident or homicide, is associated with elevated rates of complicated grief. When there is no warning, when the circumstances are shocking, when there are no answers to the questions that keep coming, the mind has more difficulty finding a way to integrate what happened.
The relationship matters. Losing a partner, a parent, or a child tends to carry higher risk than losing a more distant relation, though this is not absolute and does not diminish any loss.
Pre-existing mental health history matters. People with a history of depression, anxiety, or previous losses that were not processed are at higher risk.
And the presence or absence of support matters enormously. Grief that has nowhere to go, that is carried in silence, that is surrounded by people who do not know how to be near it, is more likely to become complicated. This is one of the reasons the social silence around certain kinds of loss, around suicide in particular, compounds the grief rather than simply accompanying it.
How you know when to get help
I am hesitant to give a checklist for this, because grief is not a checklist kind of experience and the decision to come to therapy should not feel like failing a test. But there are things worth paying attention to.
It may be worth talking to someone if the grief has not shifted at all over many months and is still as acute as it was in the first weeks. If you are unable to function in your daily life, to work, to maintain relationships, to take care of yourself, in ways that have persisted well beyond the acute phase. If you are having thoughts of suicide or self-harm. If the loss is affecting your physical health in significant ways. If you are using alcohol or substances to manage the grief. If you have found yourself cutting off from the people around you, not because you need time alone but because connection no longer feels available to you.
But also, and I want to say this clearly: you do not need to meet the threshold for complicated grief to benefit from therapy. You do not need to be in crisis. You do not need to have tried everything else first. Grief that is moving normally is still grief, and it is still hard, and having somewhere to bring it is not a sign that something is wrong with you. It is a sign that you understand what you are carrying.
The question I would ask is not whether your grief is complicated enough to warrant help. It is whether you are carrying it alone when you do not have to.
What therapy actually offers
Grief therapy is not about accelerating grief or moving you toward acceptance on a timeline. It is about creating the conditions for the grief to move, in whatever direction and at whatever pace your nervous system can actually tolerate.
For complicated grief specifically, there are treatment approaches, including Complicated Grief Treatment developed by Katherine Shear and colleagues, that have been shown in research to be significantly more effective than standard depression treatment for this population. These approaches work with the specific features of complicated grief rather than treating it as depression with loss at its centre, which is a meaningful distinction.
For grief that is moving but hard, therapy offers something different, which is somewhere to bring it that is not a burden on the people around you. An hour that belongs entirely to the interior. A space where the loss can be exactly as complicated as it actually is.
I know what it is to carry grief for a long time without having the support or the tools to process it.
I work with adults across Ontario who are grieving in all kinds of ways. Some have lost someone recently. Some are grieving a loss from years or decades ago that was never fully processed. Some have lost someone to suicide and are navigating a grief that is specific and hard to explain. Some are grieving something that does not have a funeral: a relationship, an identity, a version of their life that did not happen.
You do not need to know whether your grief qualifies. You just need to know that you are ready to bring it somewhere.
I offer virtual grief therapy for adults across Ontario and in-person sessions in Ottawa.