Complicated grief
Bereavement can be complicated, complex, and cumulative. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) includes specific diagnostic criteria for what is clinically referred to as prolonged grief disorder (PGD) – a page on this topic is under the heading of education on this site. This condition may lead to poor mental and physical health which affects daily functioning. Symptoms include persistent yearning for the deceased, unending sorrow, ruminating on the deceased, and being unable to see the future without the deceased. This grief can be incapacitating. There are four main categories of the complicated grief associated with PGD: chronic, delayed, exaggerated, and masked.
People who develop complicated grief are more likely to be anxious, insecure, low self-esteem, and negative self-talk and cognition; they also tend to have more anxious and insecure attachment styles. There is a strong correlation between trauma syndromes such as post-traumatic stress disorder (PTSD) and complicated grief; in fact, complicated grief can also be referred to as ‘traumatic grief’. Other associated conditions include major depressive disorder (MDD), substance abuse, and somatic disorders. Differentiating amongst these diagnoses can be difficult.
MDD symptoms include depressed mood, insomnia, fatigue, feelings of worthlessness, inability to concentrate, and anhedonia (lack of joy in life). Grief-associated PTSD symptoms include yearning, a feeling of loss, and emptiness rather than hyperarousal. Somatic disorders are those that cause physical symptoms with no known medical cause that cause distress or impairment. These can be serious and include cardiac disorders caused by stress, and there is even some evidence that ties cancer to the stress of complicated grief.
There are situations which may allow for better adaptation in the bereavement period, and every episode of grief is unique, even in the same person. Complicated grief can be treated but not prevented, and early intervention is key. If this grief is very complex, support groups are not appropriate, and the mourner needs to be referred for professional psychotherapy.
