Prolonged Grief Disorder-Complicated Grief ; What is it and (PDF)

Prolonged Grief Disorder/Complicated Grief : What is it and how can we help? Dr Susan Delaney Copyright Susan Delaney 2021. This copy provided for reference only – do not edit, adapt or reuse  To understand grief we have to understand attachment Bowlby was right!  We are hard-wired to attach to others. We first attach for our very survival, but we continue to attach to people throughout our lives. We have our “go- to” people. Bereavement by its nature, disrupts the grieving person’s attachment to their person. The yearning and preoccupation we experience compels us to try to find ways to restore our connection to them  So if we are hard wired to attach, how do we ever cope with the death of someone close to us? Excellent question, so glad you asked…..  LOSS TRIGGERS AN INSTINCTIVE HEALING PROCESS Acceptance of the painful reality, including 1. Finality and consequences of the death (all that it means to the bereaved person) 2. A way to stay connected to the deceased 3. A way to go on with life that seems purposeful, and that includes experiences of joy and satisfaction ACUTE GRIEF EVOLVES INTEGRATED GRIEF • Information about the death is assimilated; • Emotional pain and positive feelings are gradually integrated resulting in bittersweet acceptance of the loss • Grief is not “completed” but it is transformed  Growing around grief; Lois Tonkin    RECOGNISING OBSTACLES – when grief gets stuck Intrusive troubling rumination about the circumstances or consequences of the death Intense reactivity to reminders of the loss and/or excessive avoidance of reminders Unrelenting yearning, longing; despairing sadness Preoccupation with thoughts and memories of the deceased, or compulsive proximity seeking Feeling life has no purpose or joy ACUTE GRIEF, COMPLICATED BY 1. Rumination, e.g. counterfactual “if only” thinking 2. Excessive avoidance 3. Ineffective emotion regulation 4. Inadequate companionship THE TERM “COMPLICATED” is used in the medical sense of a superimposed problem that interferes with healing BEREAVEMENT  ICD-11 Guidelines Prolonged grief disorder is a disturbance in which, following the death of a partner, parent, child, or other person close to the bereaved, there is persistent and pervasive grief response characterized by longing for the deceased or persistent preoccupation with the deceased accompanied by intense emotional pain (e.g. sadness, guilt, anger, denial, blame, difficulty accepting the death, feeling one has lost a part of one’s self, an inability to experience positive mood, emotional numbness, difficulty in engaging with social or other activities)..  The grief response has persisted for an atypically long period of time following the loss (more than 6 months at a minimum) and clearly exceeds expected social, cultural or religious norms for the individual’s culture and context. Grief reactions that have persisted for longer periods that are within a normative period of grieving given the person’s cultural and religious context are viewed as normal bereavement responses and are not assigned a diagnosis. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning  Graphic from Irish Hospice Foundation  Grief and depression are not the same thing MDD • Pervasive loss of interest or pleasure • Pervasive dysphoric mood across situations • General sense of guilt or shame PGD • Loss of interest or pleasure related to missing loved one • Pangs of emotion triggered by reminders of loss • Preoccupation with the deceased; guilt and self blame focused on death  DIFFERENCES BETWEEN PTSD AND PGD • Triggering event: threat • Primary emotion: fear • Intrusive thoughts of event • Avoidance: fear-based • Nightmares prominent • Reminders linked to event (not pervasive), evocative of fear or anger • No proximity seeking • Triggering event: loss • Primary emotion: sadness • Intrusive thoughts of person • Avoidance: loss-based • Nightmares rare • Reminders linked to the person (pervasive) bittersweet, • Proximity seeking is prominent and associated with yearning  Risk Factors