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Complicated Grief
Complicated or pathological grief reactions are maladaptive extensions of
normal bereavement. These maladaptive reactions overlap psychiatric disorders
and require more complex, multimodal therapies than do uncomplicated grief
reactions. Adjustment disorders (especially depressed and anxious mood or
disturbance of emotions and conduct), major depression, substance abuse, and
even posttraumatic stress disorder (PTSD) are some of the more common
psychiatric sequelae of complicated bereavement. Grief that becomes pathologic
is often identifiable by lingering symptomatology, increased disruption of psychosocial functioning caused by the symptoms, or the
intensity of subsyndromal symptoms (e.g., intense suicidal thoughts or acts
upon the loss).[1]
Complicated or unresolved grief can take many forms.[2,3] Complications may
manifest as absent grief (i.e., grief and mourning processes are totally
absent), inhibited grief (a lasting inhibition of many of the manifestations of
normal grief), delayed grief, conflicted grief, or chronic grief. Risk factors
for pathologic grief include suddenness of loss; gender of the bereaved; and
the existence of an intense, overly close, or highly ambivalent relationship to
the deceased. Pathologic grief reactions that extend to major depressive
episodes should be treated with combined drug and psychotherapeutic
interventions, though the efficacy of these combined approaches is untested.
The bereaved who maintain long-standing avoidance of any and all reminders of
the deceased, who re-experience the loss or the presence of the deceased in
illusions or intrusive thoughts or dreams, and who startle and panic easily at
reminders of the loss might be considered for a diagnosis of PTSD (even without
meeting all the criteria for a psychiatric diagnosis).[4] Substance abuse in
the bereaved is frequently an attempt at self-medication of painful feelings
and symptoms (such as insomnia) and can be targeted for drug and
psychotherapeutic intervention.
References
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Rando TA: Treatment of Complicated Mourning. Champaign: Research Press, 1993.
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Rando TA: Grief, Dying, and Death: Clinical Interventions for Caregivers. Champaign: Research Press Company, 1984.
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Raphael B: The Anatomy of Bereavement. New York: Basic Books, Inc., 1983.
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Parkes CM, Relf M, Couldrick A: Counselling in Terminal Care and Bereavement. Baltimore: BPS Books, 1996.
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