What are the key signs that indicate a patient is experiencing complicated grief rather than normal bereavement?

Key clinical signs that differentiate complicated grief from normal bereavement include persistent, intense yearning or longing for the deceased that lasts beyond six months and significantly impairs daily functioning. Unlike normal bereavement, complicated grief is characterised by intrusive, distressing thoughts about the deceased and difficulty accepting the death, often accompanied by feelings of disbelief or numbness. Patients may also exhibit marked avoidance of reminders of the loss or, conversely, excessive proximity seeking. There is often a profound sense of emptiness, identity disruption, and difficulty engaging in new relationships or activities that were previously meaningful.

In contrast, normal bereavement typically involves a gradual reduction in acute grief symptoms over time, with the individual maintaining the capacity to experience positive emotions and continue with daily life.

Complicated grief symptoms are more persistent and severe than those seen in normal bereavement and may overlap with but are distinct from depression and PTSD, requiring careful clinical assessment.

These distinctions are emphasised in UK clinical guidelines, which highlight the importance of duration (symptoms persisting beyond six months), functional impairment, and the intensity of grief reactions as key differentiators ¹. The seminal work by Shear et al. (2011) further delineates complicated grief as a distinct syndrome characterised by these persistent, impairing symptoms, supporting the clinical criteria used in DSM-5 and informing UK practice (Shear et al., 2011).