Complicated grief There is no established correct or wrong grieving procedure. Everyone responds differently to death, and it's common to feel like one is riding on a rollercoaster of various emotions. How a person responds to death can be affected by a lot of things, such as the type of relationship the mourner had with the person, the gender, cultural background, and age of the bereaved. However, research has shown that there are abnormal bereavement patterns that differ from the typical grieving process. Abnormal bereavement is the basis of the nature of Complicated grief and encompasses the following: ● Chronic grief: grieving that lasts for a prolonged or extended period. Emotional distress does not appear to be substantially reduced. Over time, it does not seem to stop or lessen in frequency. An individual who has this experience continues to feel intense distress. The loss of this person feels as fresh as when it first happened, given the passing of some time. ● Delayed grief: grief that is not fully experienced until quite a while after your loss. It can be described as a devastating sadness that hits a bereaved person out of the blue. It may begin a few weeks or months, or even years after the loss of a loved one. ● Inhibited or absent grief involves inhibition of the normal behaviors that are associated with bereavement. Many who do not allow themselves to directly experience the pain of grief may develop some form of physical symptoms or disease. During this type of grief, it is common for the mourner to choose to grieve some aspect of the deceased and not the other. ● Distorted grief: a response where the grieving person experiences an intense, extreme, or atypical reaction to the loss such as self-destructive actions or extreme changes in behavior. Hostility and anger towards themselves and others are common. Symptoms of Complicated Grief A person suffering from complicated grief would display the following symptoms: ● Indefinitely missing for the deceased ● Obsessing over the manner of death of the deceased ● Intense grief and anxiety which does not get better over time ● Difficulty in developing trust with others ● Depression ● Alienation and detachment ● Challenge pursuing interests or hobbies ● Eagerness to join the deceased ● Recurrent feelings of loneliness or isolation ● Problems in social, occupational, or other forms of life (Wakefield, 2017). As these symptoms are also often indicative of grief, a person must show such symptoms over a prolonged period to be Normal grief differs from the complicated grief in that normal grief is not chronic, not as severe, is not impairing or life-altering, and is not perceived by the bereaved person as a serious threat. Individuals with complicated grief are engulfed with grief and centered on the loss to the detriment of other priorities and concerns. There is an obsession with the demise and the desire to reunite with the deceased, lack of certainty about identity, failure to acknowledge the loss, anhedonia (inability to experience pleasure from activities usually found enjoyable), resentment, difficulty in developing trust, and a sense of being "stuck" in the mourning process. These symptoms are present day by day, cause depression or functional disability, and continue after bereavement for more than six months. Individuals with complicated grief may experience loss of self- worth and self-esteem, feel emotionally detached from others, struggle with moving on from the suffering, and may feel that doing so will signify betrayal to the deceased. diagnosed with complicated grief. Normal vs. Complicated Grief
To distinguish between normal and complicated grief, The American Psychiatric Association proposed a diagnostic criterion. According to the 5 th edition of the Diagnostic and Statistical Manual of Mental disorders (DSM-5), the diagnosis assigned to individuals who experience abnormally disabling or prolonged response to bereavement is Persistent complex bereavement disorder. Persistent complex bereavement disorder, previously known as complicated grief disorder, causes individuals to experience an intense longing for a deceased loved one, usually for a prolonged time. Longing emotions are frequently followed by harmful thoughts and behaviors, as well as general difficulty in restoring normal life (American Psychiatric Association, 2013). Diagnostic Criteria for Complicated Grief/ Persistent Complex Bereavement Disorder Given that persistent complex bereavement disorder is a relatively new condition and yet to be categorized, a group of mental health professionals from around the world has proposed a variety of diagnostic criteria. Generally speaking, these are: ● The individual lost a loved one at least six months prior At least one of the symptoms listed below has to be present longer than usual considering the social or cultural environment of the person: ● Severe and persistent longing for the dead loved one ● A persistent desire to join the deceased in death ● Recurrent impressions, that life without the deceased is pointless or cruel For at least one month, two or more of the following symptoms were recorded: ● Feeling surprised saddened or numb by the death of a loved one ● Feeling disbelief or inability to acknowledge the loss ● Obsession regarding the circumstances or implications of the death ● Frustration or resentment regarding the death ● Experiencing pain endured by the deceased or having visual ● Frequent preoccupation with the deceased ● Intense feelings of emptiness or loneliness and auditory hallucinations involving the deceased ● Difficulty trusting or caring about other people ● Feeling surprised, saddened or numb following the loss of a loved one ● Intense responses to thoughts or images of the deceased ● Avoiding reminders of the deceased, or the reverse-finding reminders to feel connected to the dead. These symptoms cause severe distress to the bereaved or substantially affect functional areas and cannot be attributed to other factors. Risk Factors for Complicated Bereavement A variety of risk factors for developing complicated grief after bereavement have been reported. These may include: ● First-degree relation with the departed ● Separation anxiety in infancy ● Overbearing parents ● Assault by or death of parents during early life ● Dysfunctional marriage or insecure marriage style before widowhood ● Emotional dependence on the deceased ● Lack of planning for death ● Death of the loved one in a hospital (Ott, Lueger, Kelber & Prigerson, 2007). Unlike in depression, the symptoms of complicated grief are not accompanied by changes in sleep physiology, alluding to a different causative mechanism other than mood disturbance (Germain et al., 2006).
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