What happens when grief doesn’t fade

Death is often viewed as a natural part of life. But for many, the grief that follows can run deep and linger—long after experiencing a loss. Grieving is a process, and it takes time. It’s important to recognize this and take the appropriate steps to mourn because grief has consequences.

Regardless of its cause, grief takes a mental and physical health toll. It is associated with a range of emotions, including denial, shock, confusion, sadness, anger, guilt, and despair. Some people may also develop physical symptoms, such as pain, changes in sleeping and eating habits, digestive issues, and fatigue. In more extreme cases, people may experience anxiety, depression, and thoughts of suicide.

Grief and stress may go hand in hand. Grief can trigger a surge in stress hormones associated with the body’s “fight-or-flight” response. Research suggests that grief weakens the immune system while ramping up inflammation throughout the body. Over time, chronic stress has been linked to a range of health issues, including high blood pressure. There is also evidence that soon after the death of a spouse or child, people’s risk for heart disease or heart attack are considerably higher.

When grief doesn’t fade

Everyone experiences grief differently. Healing doesn’t always follow a linear path. Waves of grief may come and go at various times. Some people may be able to compartmentalize their loss and move forward in a matter of months. For others, this could take years.

For example, grief stemming from the COVID pandemic may be felt for decades. For every U.S. life lost to COVID, there are approximately nine close family members grieving, according to a July 2020 study in PNAS. So, even now that the COVID pandemic has ended, some 9 million people may still be grieving the death of a loved one, including more than 140,000 children who’ve lost a caregiver. Complicating matters, the grieving process— which is fundamental to healing—was disrupted during the pandemic. People couldn’t sit with their loved ones in hospital rooms or be by their side during their final moments.

The great number of deaths that result from pandemics may serve as a “gateway” to complicated grief, or what is now known as prolonged grief disorder (PGD), according to a January 2021 article in the Indian Journal of Psychological Medicine. Complicated grief may also develop in the wake of a sudden, unexpected, or violent death, such as a car accident. It may also arise following the loss of a child or a very close loved one. Others at risk include those with a history of anxiety, depression, or trauma as well as those experiencing extreme stress or social isolation.

For those affected, their pain becomes debilitating and long-lasting, preventing them from healing and moving on with their lives. In September 2021, PGD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a publication of the American Psychiatric Association (APA), which defines and classifies mental disorders.

Signs that more support is needed

Incapacitating grief that consumes most of a person’s waking hours on most days is one telltale sign of PGD. For those with the condition, grief disrupts their other relationships, their job performance, and other areas of their lives.

Other symptoms of PGD:

• Feeling as though you’ve lost part of yourself along with your loved one
• Experiencing disbelief about your loss
• Avoiding any reminders about what has happened
• Severe emotional pain associated with the death, such as bitterness or anger—or no feelings at all
• Problems resuming other normal activities, such as engaging in hobbies, being social, or making plans
• Loss of sense of purpose
• Extreme loneliness or feelings of detachment

If left untreated, PGD could lead to other serious problems, such as substance abuse, suicidal thoughts, and a weakened immune system.

How to heal and move forward

Even if you think of lost loved ones every day, the acute pain associated with their absence tends to diminish over time. The journey, however, may be winding and look different for different people. You may have ups and downs and changes in your feelings or behavior at various times. But there are five stages many people experience at one point or another along the way:

Denial: you don’t want to believe that it has happened

Anger: you lash out at others or even objects

Bargaining: you wonder what you could have done differently

Depression: you experience sadness, fatigue, loss of motivation

Acceptance: you begin to adapt and reconnect with others

These stages may vary from one person to the next and you may not experience them in any particular order. Some may experience multiple stages at one time or move between them in a non-linear way or in no-particular order. Every person will experience grief in their own way but each stage may have a protective effect. And being aware of them can help you recognize and understand what you’re going through.

There are also some strategies that can help you cope with your grief, including:

Don’t be afraid to talk about it. You may want to bury your feelings and not relive something hard but talking about the person you lost with friends and family can help you process what’s happened. It can also keep you connected to others at a time when you may feel isolated.

Acknowledge your feelings. Grief can trigger a wide range of emptions. Whatever you’re feeling is okay and it’s important to recognize it.

Don’t abandon self-care. Grief takes a toll on the body. It’s important to follow a healthy diet, get quality sleep, and do even little things to protect your health and well-being, such as taking a walk or a hot shower.

Cherish your memories. Celebrating people’s lives rather than dwelling on their death is a way to honor them. Planting a garden in someone’s memory, starting a charity, passing down heirlooms, and passing on a name to a new baby are all things you can do to remember a loved one who has died.

Find a support group. Interacting with others who are also coping with loss can help you feel less alone. You could learn what has worked for others and try to apply these coping strategies to your own life.

Avoid making rash decisions. During the grieving process, it may be wise to hold off on making major life decisions, such as moving, changing jobs, or having a child. Try to be patient as you learn to adapt.

Don’t hesitate to seek help. If your grief is interfering with your ability to function in your daily life, if you have symptoms of PGD, or if need help managing your loss, it’s time to talk to a healthcare professional, such as a trained psychologist. Your primary care physician (PCP) can help you find someone who specializes in grief. Talk therapy and other treatments could help you manage your feelings and improve the quality of your life.