Normal and complicated grief
Complicated grief can be differentiated from normal grief. Normal grief typically involves at least two of Elisabeth Kubler-Ross' five grief stages, though not necessarily in any order. While the experience of grief is a very individual process depending on many factors, certain commonalities are often reported. Nightmares, appetite problems, dryness of mouth, shortness of breath, sleep disorders and repetitive motions to avoid pain are often reported by people experiencing normal grief. Even hallucinatory experiences may be normal early in grief.
Complicated grief typically cycles through these five stages and then some, processing them out of order and often much more rapidly. Examples of complicated grief can often be found in those who have survived a suicide attempt (Hsu, 2002). Complicated grief responses almost always are a function of intensity and timing: a grief that after a year or two begins to worsen, accompanied by unusual behaviors, is a warning sign. Complicated grief is usually grief where the story of the loss is in some ways difficult to tell. Deaths such as suicides, murders, accidents, and other sudden and unexpected deaths can result in complicated grief due to the sudden shock. The surprise makes it difficult to integrate the "story" of the loss, so the person struggles with an initial task of simply believing that the loss has occurred. Variables surrounding the death such as expectedness, naturalness, presence of violence, ambivalence, degree of attachment, and others play into the presence of complicated grief. All too often complicated grief can last for years and most people (friends of the mourner) will recoil when hearing that this sort of grief may still be present after several years.
Additionally, there is a clinical problem of becoming "identified" with the grief. In this situation, mourners are reluctant to release the grief because grieving has been integrated as part of their identity.