Factors that can lead to complicated grief

Factors that can lead to complicated grief

We summarize the 7 factors that can lead to a complicated grief journey. These factors are integrated into our workshops and based on the work of Dr. J.W. Worden.

Factor 1:  The relationship with the deceased

  • Closer kinship relationships will probably produce more intense grief
  • The type of relationship each person had with the deceased can vary even within families

Factor 2:  The nature of attachment with the deceased

  • Strength of attachment, intensity of love
  • Security of attachment . . . how necessary was the deceased to the well-being of the survivor?
  • Ambivalence in the relationship—when relationships had a similar amount of positive and negative feelings, the grief reaction will be more difficult (usually positive feelings outweigh the negative feelings)
  • Conflicts and history of conflict in the relationship with the deceased—many times there are unresolved issues that make mourning more difficult
  • Dependence in the relationship with the deceased—if a person is highly dependent on the person who died, it will be more difficult to adapt to normal life tasks

Factor 3:  What type of death occurred and circumstances surrounding the death

  • Type of death: Natural, Accidental, Suicidal, Homicidal
  • Proximity of death
  • Sudden or unexpected—when a death is unexpected, it is usually more difficult to cope
  • Violent or traumatic deaths—these types of death are very difficult to deal with and may lead to complicated mourning, posttraumatic stress disorder may occur
  • Multiple losses—bereavement overload can occur when several loved ones are killed at the same time or close together in time, each loss needs to be mourned separately for healing to occur
  • Preventable deaths—if a person perceives that the death was preventable, there are often feelings of guilt and blame experienced
  • Ambiguous deaths—missing in action, prisoner of war, kidnapping, plane crashes, each of these types of situations leave loved ones wondering if the deceased may still be alive and struggle to find closure
  • Stigmatized deaths—when a death is stigmatized (such as suicide, AIDS, abortion, etc.), social support is often less sufficient

Factor 4:  History of coping with previous losses

  • Mental health history
  • Family issues

Factor 5:  Personality variations

  • Age and gender—males and females often grieve differently, maturity may help with better coping skills
  • Coping style—losing a loved one is a very difficult stressor, how a person manages stress will influence the handling of grief
  • Attachment style
    • Secure attachment style: individuals feel valued and are worthy of support, concern, and affection.  These individuals feel pain and sorry after loss but process the grief more effectively
    • Insecure attachment styles: more feelings of anger and guilt when a death occurs, mental illness struggles can become intensified
  • Cognitive style—optimistic persons will cope better than those who are prone to negativity, rumination tends to lengthen the grieving experience as the person keeps thinking about their grief-related symptoms
  • Self-esteem and ego strength—feelings of low self-worth may hamper the survivor’s ability to move forward in life, some people may feel a loss of control which makes it more difficult to manage stressors
  • Beliefs and values—people with strong spiritual beliefs often cope with death more effectively, faith is often shattered from death

Factor 6:  Social variables

  • Perception of social support
  • Social roles—those who feel they have varied social roles tend to cope better
  • Religious resources and ethnic expectations—religions and ethnic groups have rituals and expectations for coping with death, these can be positive or negative

Factor 7:  Concurrent stressors

  • Many individuals and families experience high levels of secondary losses after a death has occurred, for example, financial distress may occur after someone has died


Worden, J. W. (2009).  Grief counseling and grief therapy: A handbook for the mental health practitioner (fourth edition).  New York, NY: Springer Publishing.