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 must be present longer than usual considering the social or cultural environment of the person:
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 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. ● 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). Increased incidence of adverse health behaviors and health service provision is impaired, health care facilities are used more extensively, and more sick leave is claimed (Lannen, Wolfe, Prigerson, Onelov & Kreicbergs, 2008).
● Frequent preoccupation with the deceased. ● Intense feelings of emptiness or loneliness. ● 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.
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. Complications of complicated grief Elevated rates of suicidal ideation and suicide attempts were associated with a prolonged state of abnormal grief. Cancer, hypertension, and heart problems are more likely to occur after many years, with increased frequency of severe immune deficiencies and reports of immune dysfunction. Disenfranchised grief Disenfranchised grief is grief that is not usually openly acknowledged, socially accepted, or publicly mourned. Examples of disenfranchised grief include loss of a pet, perinatal losses, elective abortions, loss of a body part, loss of a Continuing bonds The Continuing Bonds theory is a new model of grief that was first proposed in the book ‘Continuing Bonds: New Understandings of Grief (Death Education, Aging and Health Care).’ The book was written by authors and grief experts Phyllis Silverman, Dennis Klass, and Steven Nickman to challenge the old grief models (Klass, Silverman & Nickman, 2014). Their argument, as explained in Continuing Bonds, was designed to give voice to a broadened view of the mourning process. The idea is that grief aims to sever the bonds with the dead to free the survivor to create new relationships. The authors propose an alternative model based on the ongoing ties that the mourner has with the deceased (Klass, Silverman & Nickman, 2014). Their grief model emphasizes cultivating a new friendship with the deceased, as opposed to seeking to "move on from" or "let go of" a loved one. It is a valuable model as it profoundly
personality from dementia. It also consists of the loss of a loved one who is not “blood-related,” such as a boyfriend/girlfriend, extramarital lover, in-laws (Cordaro, 2012).
changed the way the effects of loss were observed and analyzed at the time. Under the concept of Continuing Bonds, grief has no "phases," "tasks," or "steps" It is not a linear course, so a person may not begin to feel one set of emotions (sadness, shock) and attempt to work through them to get to another set of emotions (acceptance). The writers claim that earlier theories are attempting to "untie" our relationship with the deceased. Instead, their theory says victims of loss slowly change and adapt their relationship with loved ones when they die. Everybody does this in their way, but it is seen as a safe and natural part of the grieving process to continue their relationship. This cycle of adapting and redefining the relationship with a loved one allows for an eternal bond with them, which will continue throughout their lives. This enduring attachment is considered a natural and human reaction to loss (Klass, Silverman & Nickman, 2014).
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Book Code: FGA0524
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