Bereavement and pathological grief Flashcards
Definition of loss?
experienced when a person we are attached to becomes permanently unavailable
Definition of grief?
human reaction to loss. Acute, integrated, complicated
Definition of bereavement?
psychological process through which people adapt to loss
Why is bereavement important?
Compared to non bereaved, bereaved people have:
- Higher mortality after loss of spouse (elderly)
- Higher levels of morbidity & mortality (elderly)
- Increased risk of accidents
- Increased physical & emotional problems- aches, pains, disturbed sleep, panic attack, depression
- Higher suicide rates
What are the normal physical, emotional, behavioural & cognitive grief reactions?
Physical:
- appetite change
- palpitations
- shaking
- sleep disturbances
Emotional:
- depression
- anxiety
- anger
- loneliness
Behavioural:
- crying
- irritability
- socially w/drawn
- difficulty in fulfilling normal roles
Cognitive:
- Poor concentration
- short attention span
- memory loss
- confusion
What are the five stages of grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
How do children grief?
- feelings of sadness- on & off- over a long period
- fear of being alone
- anger, nightmares, irritability, bed wetting
- regression to earlier developmental stages- needing more attention, acting younger, unreasonable demands
- may need psychological support
What are the grief models?
- Phase model
- Grief work model
- Dual-process model
What is the phase of grief model?
Initial period of shock, disbelief & denial
Acute grief- intermediate acute mourning, physical & emotional discomfort, social withdrawal
Integrated grief- attention shifts back to reengaging with the world. adaptation & recovery
What is the grief work model?
Model described cognitive process of confronting the reality of a loss & adjusting to life w/ loss
process involves tasks of grief rather than stages (TEAR)
- T- to accept the reality of the loss
- E- experience the pain of loss
- A- adjust to new environment w/out lost person
- R- reinvest in new reality
What is dual-process model?
2 different ways of behaving: less oriented & restoration-oriented
Grief is not linear- you oscillate (switch) between less oriented & restoration-oriented
Loss-oriented- things that make you think about loved one & their death- make you focus on grief & pain
- intrusion of grief
- denial/avoidance of restoration changes
- continuing or relocating bonds/ ties
Restoration-oriented- things that let you get on w/ daily life & distract you from grief for a while
- doing new things
- distraction from grief
- denial/ avoidance of grief
- new roles/ identities/ relationships
Comparison of models
NOTE: view image on notes
Name 4 factors that affect the duration and severity of someone’s grief
- How attached & what kind of relationship they had.
- Circumstances of death e.g. sudden, traumatic, unexplained.
- Amount of time for anticipatory mourning- the grief some people experience when they expect the death of someone w/ terminal illness.
- Previous unresolved losses
What is normal grief?
adaptation & integration over time- 6 months- 1y
When grief does not resolve w/in reasonable time, or individuals have extreme experiences- process is no longer adaptive
What is complicated grief? i.e. how to you diagnose it?
Diagnosis:
- unshakeable grief that does not improve over time
- persistent and intense emotions that cause extreme distress
What are the normal physical, emotional, behavioural & cognitive
reactions for complicated grief?
Physical:
- Digestive issues
- Fatigue
- depression
Emotional:
- Loneliness
- anger
- intense sadness & disress
Cognitive:
- Constantly ruminating on death
- emptiness
- hallucinations of deceased
- social ideation
Behavioural:
- w/drawn
- not functioning
- unable to work
What are some associated conditions with complicated grief?
- Elevated rate of suicidal ideation & suicide attempts
- Increased incidence of cancer, hypertension & cardiac events after several year
- Immune disorders & dysfunction more frequent
Name and define the 5 different types of complex grief.
- Chronic grief- grief that lasts for a prolonged or extended period of time
- Delayed grief- grief that has been postponed
- Disenfranchised grief- grief that may be seen as socially difficult to relate to or are negated by others
- Compounded grief- grief that occurs following multiple losses
- Anticipatory grief- grief that occur prior to a known future loss
What is the Diagnostic criteria for persistent complex bereavement disorder (PCBD)?
For those who are significantly impaired by prolonged grief symptoms
- symptoms present for at least 1 month after 6 months of bereavement
PLUS 1 of:
- Intense, persistent yearning for deceased.
- Intense feelings of emptiness or loneliness
- Recurrent thoughts that life is meaningless & unfair without the deceased.
- A frequent urge to join the deceased in death
AND 2 of following symptoms a month:
- Shocked, stunned or numb at death
- Disbelief or inability to accept loss (denial)
- Trouble trusting or caring about others
- Anger or bitterness
Differential diagnosis of PCBD?
Normal grief- both have similar symptoms, but PCBD usually lasts longer & interferes w. sufferer’s functioning long after death
Depressive disorder- share features like sadness w/ major or persistent depressive disorder but this depressed mood is characterised by focus on loss
PTSD- suffer intrusive thoughts about traumatic event, whilst those w/ PCBD suffer thoughts about deceased or circumstances of death
Separation anxiety disorder- related to separation from a living individual, whereas sufferers of PCBD experience anxiety when separated from deceased
What are the risk factors for complicated or persistent grief?
Pre-loss:
- Lack of knowledge & info about death
- Previous experience of trauma & loss + multiple stressors
- Pre-existing mental health problems & inadequate coping mechanisms
When loss occurs:
- Loss is result of violence, trauma or accident e.g. suicide
- Others unable to offer support & comfort
- death is associated w/ stigma or shame e.g.g AIDS
Post-loss:
- Inadequate family or community supports or physical & emotional care
- Traumatic reminders, anniversaries
- Further losses of bereavements
Barriers to seeking bereavement support ?
Difficult for older LGBT people
- -ve responses from faith communities- can lead to complicated grief
- LGBT specific bereavement support should be available provided by culturally sensitive health & social care providers
Migrants in UK experience loneliness & social isolation following death of loved one
- Loneliness exacerbated by previous negatives e.g, unhappy marriages
People w/ learning disability not well supported when someone close to them dies
- excluded from convo about death
- React in same manner as those w/out learning disability but struggle to express & articulate grief in meaningful way
Treatment for complicated grief?
Combination of talking therapy + medication
Complicated grief group therapy
Self referrals- better outcome
Not every bereaved person will want professional support
- majority will rely on family and friends, or find ways of coping
tools available to identify people at risk of abnormal grief reaction
Refer the person to bereavement counselling, clinical psychologist, psychiatrist
