In the same Johns Hopkins White Papers on Depression and Anxiety, Karen Swartz, the Director of the Affective Disorders Consultation Clinic, distinguishes between “complicated grief” (also called traumatic grief), which occurs in approximately 10 to 20 percent of bereaved persons, from both major depressive disorder (MDD) and post-traumatic stress disorder (PTSD).

A person who is suffering from complicated grief attempts to do two things: 1) deny, repress, or avoid aspects of the loss, the pain it is causing, and the full realization of its implications for the mourner; and 2) hold on to and avoid relinquishing the lost love one.

Not the same as depression

MDD is marked by a pervasive sad mood, a general loss of interest or pleasure in previously enjoyed activities, a pervasive sense of guilt, and rumination about one’s own perceived past failures or misdeeds.

In contrast, in complicated grief, the person’s emotions revolve around the lost loved one. Feelings of sadness are related to missing the person who died; the mourner experiences intense longing and yearning for contact with and interest in memories of the deceased; and any feelings of guilt are focused on interactions with the person who died. In addition, the mourner is preoccupied with positive thoughts of the deceased and/or intrusive images of the person dying.

Not the same as post-traumatic stress

In PTSD, the person’s feelings are triggered by a physical threat, and the primary emotion is fear. Nightmares are very common, and any painful reminders are specifically linked to the actual traumatic event.

In contrast, in complicated grief, feelings are triggered by the actual loss and the primary emotion is sadness. Nightmares are rare, and painful reminders are more pervasive and unexpected. And, as noted above, the mourner feels considerable longing for the lost loved one and experiences persistent obsessive thought about, and preoccupation with, the deceased and elements of the loss.