Recognizing and Treating Complicated Grief: Timing and Severity of Symptoms Can Help Identify This Distinct Syndrome

By Robinaugh, Donald J.; Marques, Luana et al. | Current Psychiatry, August 2012 | Go to article overview

Recognizing and Treating Complicated Grief: Timing and Severity of Symptoms Can Help Identify This Distinct Syndrome


Robinaugh, Donald J., Marques, Luana, Bui, Eric, Simon, Naomi M., Current Psychiatry


Nearly 2.5 million persons die each year in the United States, (1) For the bereaved, these deaths may be among the most painful and disruptive events they will experience. In this article, we evaluate the growing body of research on complicated grief (CG)--which also has been called prolonged grief, chronic grief, traumatic grief, and pathological grief--with an emphasis on how to identify CG and distinguish it from other adaptive and maladaptive reactions to the loss of a loved one. In addition, we review empirical evidence on treating CG, including psychotherapy, pharmacotherapy, and combined treatment approaches.

The bereavement-specific syndrome we refer to as CG currently is being reviewed for possible inclusion in DSM-5 as an official diagnosis. At press time, proposals for DSM-5 included a bereavement-related adjustment disorder within the new Trauma-and Stressor-Related Disorders category, as well as a provisional diagnosis of CG entitled Persistent Complex Bereavement-Related Disorder, which, upon acceptance, would be listed in Section III. (2)

[ILLUSTRATION OMITTED]

What is 'normal' grief?

Grief is highly variable across individuals and time and may range from an absence of distress to severe and persistent pain and anguish. There's no simple definition of "normal grief." However, as clinicians, it's necessary to understand the range of usual reactions. We recommend 2 considerations when evaluating grief reactions.

First, be aware that grief encompasses a range of cognitions, emotions, and behaviors. It may range from a relative lack of painful thoughts and emotions to intense and disruptive sadness, loneliness, anger, guilt, intrusive thoughts, difficulty concentrating, preoccupation with loss, social withdrawal, and a sense of being overwhelmed by the loss and its consequences. In the months after a loss, bereaved individuals may look for the deceased in a crowd, speak to them, or even experience auditory or visual hallucinations of the deceased. Nonetheless, positive feelings such as relief, peace, and happiness also are common following a loss. (3) Moreover, laughter and smiling when discussing a lost loved one predicts reductions in grief symptoms over time (4) Overall, grief research suggests that, far from proceeding along standard and uniform stages, (5) grief is complex and comprises a broad spectrum of thoughts, feelings, and behaviors that vary within and among individuals.

Second, note that in the absence of complications, grief progresses. For those who experience elevated levels of distress, the pain and disruption of loss initially may feel overwhelming but will subside in intensity over time for most individuals. (5) This is not to say that an individual will never again feel sadness or longing for the deceased; elements of grief are likely to remain. Although the trajectory of grief symptoms varies among individuals and may progress in fits and starts, over time grief becomes more intermittent, less interfering, and is balanced with a sense of interest and purpose in life.

What is CG?

As research on grief experiences has grown, there's increasing recognition that a minority of bereaved individuals experience more extreme grief symptoms that cause substantial, persistent distress and impairment despite the passage of many months or years. Shear et al (6) proposed a set of CG diagnostic criteria (Table, page 33) in which a cluster of symptoms of intense and persistent separation distress are defined as core symptoms. Similar to other psychiatric diagnoses, the symptoms must be associated with significant distress or impairment.

Table

Proposed diagnostic criteria for complicated grief

Symptom     Criteria
domain

Separation  The patient has [greater than or equal to]1 of the
distress    following 4 symptoms:

            1) Persistent, intense yearning or longing for the
            deceased

;           2) Frequent feelings of intense loneliness or emptiness

            3) Recurrent negative thoughts about life without the
            deceased or recurrent urge to join the deceased

            4) Preoccupying thoughts about the deceased that impair
            daily functioning

Thoughts    The patient has [greater than or equal to]2 of the
            following 8 symptoms:

            1) Rumination about circumstances of the death

            2) Frequent disbelief or inability to accept the death

Feelings    3) Persistent feeling of being shocked, stunned, or
            emotionally numb since the death

            4) Recurrent feelings of anger or bitterness regarding
            the death

            5) Difficulty trusting or caring about others since the
            loss

            6) Experiencing pain or other somatic symptoms the
            deceased person had, hearing the voice of the deceased,
            or seeing the deceased person

            7) Intense emotional reactions to memories of the
            deceased

Behaviors   8) Excessive avoidance or excessive preoccupation with
            places, people, and things related to the deceased or
            death

Source: Adapted from reference 6

Assessing CG symptoms

Among those with persistent elevated distress, a CG diagnosis must be considered in the context of the individual's social and cultural environment, time since the loss, and duration of symptoms. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Recognizing and Treating Complicated Grief: Timing and Severity of Symptoms Can Help Identify This Distinct Syndrome
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.