Bereavement and Complicated Grief


Published: 13 November 2022

Grief is a natural response to loss.

It occurs in response to the state of being bereaved or ‘deprived’, most commonly when someone close to us passes away. However, it’s not limited to that experience only.

The definition of ‘bereave’ is:

  1. To deprive ruthlessly, especially of hope or joy.
  2. To make desolate through loss, especially by death.

(Macquarie Dictionary 5th Edition)

As well as occurring in the aftermath of the death of a loved one, feelings of grief can also accompany losses such as the diminishing of one’s health or the health of someone close, or the end of a significant relationship (Psychology Today 2021).

Grief is a difficult concept to grapple with because it’s not only dependent on physical and psychological factors, but is also influenced by social and cultural manifestations of emotion. Furthermore, this manifestation is influenced by circumstance as well as a person’s values and beliefs (Wake 2019).

As a healthcare professional, you will witness loss and grief on a more frequent basis than people working in other professions. Therefore, it’s crucial for you to be able to understand, identify and advise on grief. It’s also important to acknowledge the impact that witnessing loss and grief on such a large scale will have on your own wellbeing.

Man being comforted
Grief is a natural response to loss.

The Nature of Bereavement

Bereavement is often used interchangeably with the terms ‘mourning’ and ‘grief’. In essence, these are all related to the experience of a loss. However, they have slightly different definitions:

  • Grief is the internal emotions experienced after a loss
  • Mourning is the outward expression of grief (e.g. attending a funeral)
  • Bereavement is the period of time after a loss, during which a person may experience grief and partake in mourning.

(Roldan 2022)

Everyone has their own unique and personal sense of what grief feels like. That perspective influences the way we respond to others when they experience loss. This is a core foundation of empathy (Wake 2019).

Symptoms of Grief

Grief is associated with difficult emotions such as sadness, longing, preoccupation with thoughts and recollections of the past, as well as feelings of guilt and inadequacy (Wake 2019).

For most people going through bereavement, grief symptoms will usually decrease between six months and two years following the loss (Psychology Today 2021).

Psychological manifestations of grief may include:

  • Overwhelming sorrow
  • Continual sadness
  • Anger directed inwardly or outwardly
  • Fear of consequences in the short and long-term
  • Guilt, particularly if a person feels they may have contributed to the loss in some way
  • Relief, which often occurs following a loss that happened after a long period of anticipation
  • Loneliness and a sense of isolation and disconnect
  • Emotional numbness
  • Longing for things to be as they once were
  • Anxiety about current events and the future in general
  • Apathy, arising from the loss of a sense of meaning, which may manifest in a lack of interest in participating in regular life
  • Feelings of vulnerability when a person’s private loss becomes public
  • Abandonment - the feeling that the loss they encountered left them deliberately in some way.

(Wake 2019; CareSearch 2021)

Man sitting down in despair
For most people going through bereavement, grief symptoms will usually decrease between six months and two years following the loss.

Somatic manifestations of grief may include:

  • Crying
  • Infections
  • Headaches
  • Gastrointestinal upsets
  • Elevated heart rate
  • Shortness of breath
  • Chest tightness
  • Weakness of limbs
  • Loss of appetite
  • Inability to concentrate
  • Poor memory
  • Insomnia
  • Non-specific malaise.

(Wake 2019; Care Search 2021)

Complicated Grief

Most people experiencing bereavement will come to cope with their loss over time. However, in some cases, grief is so debilitating that the bereaved person will have difficulty recovering from the loss and resuming their life, even after a significant period of time. This is known as complicated grief or persistent complex bereavement disorder (Mayo Clinic 2021).

Complicated grief impacts negatively upon a person’s relationships, employment and life. Generally, it is characterised by a sustained intensity of grief over a very long period of time (Wake 2019).

Risk factors for complicated grief include:

  • Traumatic loss
  • Sudden loss
  • Witnessing extreme distress in a fatal event
  • The loss of a child
  • Multiple losses either over time or all at once
  • A history of depression
  • Coexisting stressors
  • An insecure childhood
  • Early separation from one or both parents
  • Insomnia.

(Wake 2019; Mayo Clinic 2021)

Woman at a cemetary holding flowers
Most people experiencing bereavement will come to cope with their loss over time.

Treatment for Grief

People who are experiencing normal grief will not necessarily require specialist counselling. However, they may benefit from reassurance, acknowledgement of their losses, and access to information (CareSearch 2021).

For others, grief counselling or therapy may be beneficial. Counselling may help a person to work through the grieving process by voicing their emotions and identifying ways of coping (Psychology Today 2021).

In the case of complicated grief, therapy may be beneficial in the form of specialist bereavement counselling; palliative care services; cognitive behavioural therapy (CBT); or complicated grief therapy (CGT) (Psychology Today 2021; CareSearch 2021).

CBT focuses on changing a person’s thought patterns in order to alter their response to situations. CGT involves coming up with recovery goals, talking about the loss and making plans for the future (Psychology Today 2021).

Acknowledging the Effect Loss has on You

Healthcare professionals are constantly confronted with loss and grief in both their personal and professional roles. You not only witness the grief of friends and family members of the deceased, but may have formed a strong relationship with the patient yourself, and therefore, are grieving them too (Wake 2019).

As a healthcare professional, you are in a unique position to reduce the effect of grief on all concerned. However, such support can be emotionally exhausting and throughout this experience,you need to understand not just the needs of those experiencing loss, but how you deal with that loss yourself (Wake 2019).


Bereavement does not follow a set pattern - it is experienced differently from person to person and across cultures. For many, the effects of bereavement will become more manageable over time. In the case of complicated grief, there are treatment options available.


Test Your Knowledge

Question 1 of 3

True or false: Usually, grief symptoms will lessen between six months and two years following the loss.


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