Grief is a natural response to the loss of a loved one that often causes intense longing, longing, and concern for the deceased person, as well as sadness, anger, anxiety, and loneliness. . Over time, the grief changes and usually resolves with the support of family and friends.
Although grief and mourning are common rituals after the loss of someone, when intense grief persists for more than a year, you may be suffering from a prolonged grief disorder. The American Psychiatric Association has classified this form of prolonged grief as its own mental disorder and added it to its official psychiatric diagnostic manual.
As the country faces nearly one million deaths from COVID-19, prolonged grief is becoming more prevalent than ever. “The rising number of deaths during the pandemic has made bereavement more common and talked about in mainstream media,” says Dr. Katherine Shear, professor of psychiatry at Columbia University School of Social Work in New York. “The ways people have died during the pandemic are particularly challenging and will likely lead to higher rates of prolonged grief disorder.”
Dr. Amy Bloch, a psychiatrist in Westchester, New York, has seen more bereaved people in the past two years. “Along with people losing loved ones to COVID-19, I see a number of people coming in with intense, lingering grief that has lasted over 12 months.”
What is prolonged mourning?
Prolonged grief occurs after the loss of a loved one and is characterized by a persistent and debilitating grief reaction that lasts at least 12 months for adults or six months for children and adolescents. Research on prolonged grief began in the 1980s when doctors noticed that some bereaved people did not respond to antidepressants or interpersonal psychotherapy for depression. “This has led to a worldwide wave of research that includes over 1,000 papers on this area of bereavement research,” Shear adds.
In Prolonged Grieving Disorder, the grieving person experiences intense longings for loved ones or is preoccupied with thoughts and memories nearly all day, nearly every day for at least a month. The persistence of intense grief exceeds social, cultural or religious norms and is not linked to other mental disorders such as major depression, anxiety and post-traumatic stress disorder, or PTSD.
Health risks of severe bereavement
Prolonged grief disorder can sometimes lead to other serious health consequences – from heart disease to other mental health disorders. Studies show that people with prolonged bereavement disorder have a significantly increased risk of hospitalization for heart attack, an increased risk of high blood pressure and cancer, trouble sleeping, and are susceptible to substance abuse.
“We also found a significant risk of suicidal thoughts and behaviors, so recognizing this condition is critical to help avoid these physical and mental effects,” says Dr. Holly Prigerson, professor of geriatrics and co-director of Cornell’s Center for Research. on End. -of-Life Care in New York.
Prolonged grief symptoms
The researchers looked at the results of 14 separate studies and found that about one in 10 people grieving the loss of a loved one may experience prolonged grief. The study found that people with prolonged bereavement are generally older and at higher risk for long-term mental and physical health problems.
In addition to intense longing for the deceased or preoccupation with their thoughts and memories, symptoms of a prolonged grief disorder may include:
- Avoid reminders that the loved one has passed away.
- Feel detached from others.
- Difficulty moving forward in life, including problems engaging with friends, pursuing interests, and planning for the future.
- Emotional pain, including anger, bitterness and grief.
- Extreme loneliness.
- Feeling that life has no meaning.
- Identity issues, including feeling that part of yourself is dead.
- Interruption of daily operation.
Diagnosis of prolonged grief disorder
Doctors have several tools to screen for prolonged grief disorder. The most widely used questionnaire is the Complicated Grieving Inventory which includes 19 questions rated on a five-point scale. There is also a five-question self-assessment that is available through the Center for Prolonged Grievance.
Acute grief usually does not require treatment or support from a mental health professional, as people learn to cope over time and the intensity of grief lessens. However, a prolonged grief disorder usually requires diagnosis and treatment by a doctor or other mental health professional.
Dealing with Prolonged Grief
There are many ways to deal with prolonged grief. Psychotherapy is considered the standard treatment for prolonged grief. Additionally, psychiatrists have developed a bespoke therapy called Treatment of Complicated Grief that has been tested under three grants funded by the National Institute of Mental Health and studied extensively in global research. This approach aims to help people identify and resolve their grief, accept the reality of the loss and restore their capacity for well-being.
The way it works, Shear describes, is for a therapist to work with the bereaved over a 16-week period to help them come to terms with their loss and restore their ability to thrive. They strive to learn to accept grief as a natural and lasting response, to find ways to deal with the emotions of grief, to begin to see promise in the future, to strengthen their relationships, to tell a story of death, to gain a level of comfort in living with reminders of their loss and connecting with memories of the deceased.
Shear conducted a study that looked at about 150 grieving older people receiving psychotherapy for depression compared to personalized grief treatment. The study showed that both treatments helped, but people who received personalized grief treatment were more than twice as likely to experience improvement in their grief.
Some people find help through bereavement support groups where they meet other people facing similar grief issues. These groups are usually available at community centers or local churches. Mindfulness and meditation exercises can also be helpful, and self-care practices such as nutritious eating, adequate rest, exercise and socializing are recommended, Prigerson says.
“We find that those who use daily journaling have significant reductions in the intensity of their symptoms in a short period of time,” says Prigerson.
Antidepressants are often used in the management of prolonged grief disorder, but only a few studies have tested their effectiveness. One study divided nearly 400 bereaved adults into four groups: those receiving the antidepressant citalopram alone, placebo alone, complicated grief treatment with citalopram, and complicated grief treatment plus placebo. At the end of the study, the researchers showed that citalopram did not improve the response rate to treatment for complicated grief.
A follow-up article to this study looked at 58 people who lost someone to suicide. Patients were treated with citalopram plus complicated grief support compared to those treated with placebo with simple grief support or complicated grief support. The study showed that adding the antidepressant to complicated grief support provided no additional benefit over placebo and grief support.
“These studies show that treating complicated grief is the optimal therapy for prolonged grief and that the addition of citalopram only helps co-occurring symptoms of depression,” Shear says.