Bereavement In Medical Practice

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DEFINING GRIEF

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The psychological response to bereavement
An evolving mental state that changes as a person copes with feelings and new ways of life in the wake of an important loss
Occurs in a primary and integrated form

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GRIEF CONTAINS A MIX OF EMOTIONS both dysphoric and happy. T/F

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T

Front 3

Primary grief

Back 3

the initial psychological response to an important loss

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PRIMARY GRIEF 4 components

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Sense of disbelief; difficulty accepting the death

Little interest in daily activities and relationships with others

A mix of emotions, often intensely painful and unfamiliar

Thoughts and memories of the deceased are preoccupying and “center stage”

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MOURNING

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“the actions and manner of expressing grief, which often reflect the … practices of one’s culture” (Stroebe)
Associated with
-Ritualistic expression of grief
-Structured social support (Often extensive; includes prescribed behaviors and expectations of duration)
Facilitates the evolution from primary to integrated grief

Front 6

Integrated grief

Back 6

is a permanent background mental state

Front 7

Integrated grief 4 components

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Acceptance of the death

Renewed interest in daily activities and relationships with others increases

A range of emotions, usually bittersweet, with positive emotions more dominant

Thoughts and memories of the deceased present and accessible, but no longer “center stage”

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MAJOR DEPRESSION (MDD) and bereavement

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Diagnosed 2 months after bereavement, the diagnosis and course of MDD is the same as for non-bereaved

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POSTTRAUMATIC STRESS DISORDER

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DIAGNOSTIC CRITERIA (> 1 month)
-EXPOSURE involving death or serious injury
-RESPONSE involves intense fear, helplessness or horror
-RE-EXPERIENCING
-AVOIDANCE
-INCREASED AROUSAL

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COMPLICATED GRIEF

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Death experienced as sudden, unexpected,
Response includes numbness, disbelief, unreality; overwhelming emotion
Six months after the death, persistent yearning, longing or searching for the deceased, with ideas such as :
- Grief is all that is left
- Without grief the deceased will be lost forever.
- It is wrong to stop feeling sad
- Lessening of sadness is a betrayal of the deceased
Disturbing intrusive images or nightmares of the person who died, especially images of the death
Avoidance of objects, situations, activities or people associated with the deceased
Feelings of detachment from others; feeling others are not trustworthy
Preoccupation with the deceased, including ruminative thoughts, intense urge to seek proximity through objects, prolonged reveries

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COMPLICATED GRIEF RESEMBLEs depression and post traumatic stress symptom in what ways

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D:
Sadness, loss of interest, loss of self-esteem, guilt

PTSD
Sudden, unpredicted disaster, confusion, shock, anger, disbelief, intrusive images, avoidance

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COMPLICATED GRIEF is different from depression and post traumatic stress symptom in what ways

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D:
Symptoms focused on loss; yearning, longing, for contact, pleasurable reveries; Intrusive images, thought of the deceased; Not responsive to standard antidepressant treatments

PTSD:
Triggering event is a loss; primary emotion is sadness; yearning, pining, longing; preoccupation with the deceased; reminders pervasive, bittersweet, “in the air”

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Grief
Response

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Disbelief, numbness
Shocked, lost, anxious, depressed, physically unwell
Preoccupation with thoughts and images of the deceased
Intense, unfamiliar emotionality

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Secondary
Reaction to Grief Response

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Response is frightening, shameful, or embarrassing
Intensifies the pain of grief
Impedes the integration of grief

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role of physician in secondary reaction to grief response

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 Information and empathic support
can mitigate reactions
 Neglect can exacerbate reactions