Grief is a deeply personal experience that everyone faces at some point in their lives, whether through the death of a loved one, the end of a significant relationship, or other major losses. While it is a natural emotional response, grief can also become overwhelming and complex, impacting an individual’s mental, physical, and social well-being. While some individuals navigate their grief without requiring professional intervention, others may find that their grief becomes prolonged or intensifies in ways that make it difficult to function. This article explores the signs that indicate when grief may require professional help, drawing from peer-reviewed research to highlight the various emotional, psychological, and physical signs that suggest intervention might be beneficial.
Understanding Grief and Its Common Symptoms
Grief is often described as a process, though it may not follow a linear path. The symptoms of grief vary widely from person to person, but common experiences include sadness, anger, guilt, loneliness, and even relief, depending on the nature of the loss (Bonanno, 2009). Grief can also manifest in physical symptoms such as fatigue, difficulty sleeping, changes in appetite, and physical aches (Prigerson et al., 2009).
Although these reactions are natural responses to loss, they can become problematic when they persist for an extended period, prevent an individual from carrying out day-to-day activities, or lead to additional mental health challenges, such as depression or anxiety (Shear et al., 2011). In such cases, professional help may be necessary.
1. Prolonged Intensity of Grief: One of the clearest signs that professional help may be needed is if the intensity of grief persists far beyond the expected timeline. While it is normal to feel intense sorrow following a significant loss, grief typically begins to ease over time as individuals adjust to life without the loved one. However, in some cases, grief may continue at the same intensity or even worsen, leading to prolonged distress. Prolonged grief disorder (PGD) is a clinical diagnosis that describes this condition, marked by persistent and intense grief that interferes with daily functioning for at least six months after the loss (Prigerson et al., 2009).
Research has shown that prolonged grief can significantly impair an individual's ability to function, contributing to issues such as difficulty working, attending to personal hygiene, or maintaining relationships (Zisook & Shear, 2009). If grief becomes so consuming that it begins to hinder daily responsibilities and relationships, it may be time to consult a mental health professional.
2. Feelings of Hopelessness or Worthlessness: While grief can bring up feelings of sadness and despair, if these emotions evolve into a pervasive sense of hopelessness, worthlessness, or deep self-blame, it may indicate an underlying mental health issue such as depression. Grief-related depression can manifest as persistent sadness, feelings of inadequacy, and a lack of interest in previously enjoyable activities (Shear et al., 2011).
A study by Neria et al. (2007) on complicated grief revealed that individuals who experience deep, long-lasting despair often exhibit a diminished sense of self-worth, as well as cognitive distortions that exacerbate feelings of guilt. These intense feelings may not only prolong grief but also complicate recovery, potentially leading to major depressive disorder (MDD). In such cases, therapy, particularly cognitive-behavioral therapy (CBT), has been shown to help individuals manage these negative thought patterns (Prigerson et al., 2009).
3. Inability to Engage in Daily Activities: Grief can affect many aspects of life, including work, family responsibilities, and personal care. If someone finds it increasingly difficult to carry out their daily tasks—such as attending work, maintaining hygiene, or taking care of children or pets—it may signal that the emotional burden of grief has become overwhelming. Complicated grief is associated with a loss of the ability to participate in everyday activities, which can further increase isolation and emotional pain (Zisook & Shear, 2009).
For individuals struggling with complicated grief, interpersonal therapy (IPT) has been shown to be particularly helpful, as it focuses on enhancing social support, improving communication skills, and resolving issues within interpersonal relationships that may be exacerbating the grieving process (Miller et al., 2013).
4. Intrusive Thoughts or Flashbacks: In some cases, grief may lead to intrusive thoughts or flashbacks to the traumatic event surrounding the loss, particularly when the death or loss was sudden, violent, or traumatic. These intrusive thoughts can significantly affect a person’s ability to cope with the grief, leading to heightened emotional distress. Individuals experiencing frequent flashbacks or intrusive memories may also develop symptoms of post-traumatic stress disorder (PTSD), which can further complicate the grieving process.
Research by Bonanno et al. (2010) suggests that grief-related trauma can sometimes lead to PTSD symptoms, including nightmares, flashbacks, and heightened anxiety. Therapy for PTSD,such as cognitive processing therapy (CPT) or **eye movement desensitization and reprocessing (EMDR), has shown efficacy in helping individuals process traumatic memories and reduce distress (Resick et al., 2017). If intrusive thoughts or flashbacks are severe and persistent, seeking professional help is essential for proper intervention.
5. Avoidance of the Loss or Emotional Numbness: Some individuals coping with grief may attempt to avoid confronting the reality of their loss, leading to emotional numbness or a sense of detachment from the grieving process. While avoidance may initially serve as a defense mechanism, it can ultimately prevent healing and make it difficult for the individual to process the grief in a healthy way.
Emotional numbing is a common feature of complicated grief, and research indicates that individuals who avoid confronting their emotions may experience a delayed or incomplete recovery from grief (Shear et al., 2011). Therapy, particularly emotion-focused therapy (EFT), can help individuals process and express their emotions, moving toward a healthier acceptance of the loss (Greenberg et al., 2010).
6. Thoughts of Self-Harm or Suicide: Perhaps the most critical sign that grief requires professional help is when an individual begins to have thoughts of self-harm or suicide.
Although thoughts of death or wanting to be with a deceased loved one can be common during intense grief, it is important to recognize when these thoughts escalate into active thoughts of ending one’s own life. If you or someone you know is having suicidal thoughts, it is imperative toseek immediate help from a mental health professional, such as a therapist, counselor, or psychiatrist.
Research on suicidal ideation and grief has highlighted the increased vulnerability of grieving individuals, particularly those who experience prolonged grief or depression (Zisook et al., 2007). In such cases, dialectical behavior therapy (DBT) and other crisis interventions can be effective in providing immediate support and guiding individuals through their emotional distress.
Conclusion
Grief is a complex, individual process that requires patience and understanding. However, whengrief becomes prolonged, overwhelming, or disrupts daily functioning, it is essential to seek professional help. Signs that it may be time to seek therapy include prolonged intensity of grief, feelings of hopelessness or worthlessness, difficulty engaging in daily activities, intrusive thoughts, avoidance of the loss, and suicidal thoughts.
Therapies such as cognitive-behavioral therapy, interpersonal therapy, and emotion-focused therapy can provide individuals with the tools to process their grief in a healthy way, helping them heal and regain a sense of normalcy. If you or someone you know is struggling with grief, reaching out to a mental health professional can be a crucial step toward recovery.
References
Bonanno, G. A. (2009). *The other side of sadness: What the new science of bereavement tells us about life after loss*. Hachette Books.
Bonanno, G. A., Wortman, C. B., & Lehman, D. R. (2010). *Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss*. Journal of Personality and Social Psychology, 95(3), 639-650. https://doi.org/10.1037/a0017102
Greenberg, L. S., Watson, J. C., & Lietaer, G. (2010). *Handbook of experiential psychotherapy*. Guilford Press.
Miller, S. M., & Ketter, H. (2013). *Interpersonal therapy for complicated grief: A pilot study of the effectiveness and feasibility of the Grief Recovery Program*. Psychiatry Research, 210(1), 201-206. https://doi.org/10.1016/j.psychres.2013.05.029
Neria, Y., Nandi, A., & Galea, S. (2007). *Post-traumatic stress disorder following disasters: A systematic review*. Psychological Medicine, 37(6), 913-927. https://doi.org/10.1017/S0033291707000162
Prigerson, H. G., & Maciejewski, P. K. (2009). *Complicated grief and the evolution of grief research: The persistence of grief in the absence of pathological features*. Current Directions in Psychological Science, 18(3), 133-137. https://doi.org/10.1111/j.1467-8721.2009.01624.x
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). *Cognitive processing therapy: Veteran/military version*. Guilford Press.Shear, M. K.