L19: Normal and Complicated Grief

Question 1

Define disenfranchised grief. Provide examples

Answer 1

• Loss of partner not socially accepted - Loss of divorced spouse - Loss of pet - Loss of health to a chronic, disabling, but non-terminal illness - Miscarriages - Elective terminations - Infertility - Giving child up for adoption

Question 1

Our role when seeing someone grieving

Answer 1

• Acknowledge loss - Try understand what person is feeling, validate those feelings - Invite person to share a little bit about person, story of death if closer (PCP) - Avoid trying to fix problem - Offer resources (if pt seeks, only after listening) - Avoid telling ppl to let go or to replace loved one

Question 2

What are needs of bereaved children?

Answer 2

• Know they will be cared for - Know they did not cause death - Understand causes/circumstances of death - Feel involved and important - Continuation of stable routine - Need someone to listen to questions - Ways to remember loved one

Question 3

Distinguish between grief and depression

Answer 3

• Share: disturbances in sleep, appetite, lack of energy, fatigue, trouble concentrating - Differences: pervasive loss of capacity to enjoy life (grief has periods of this), sense of self as worthless, global guilt (vs isolated / related to death), overt suicidality, psychomotor retardation that is significant, long-lasting impairment, hallucinations (non-fleeting)

Question 3

Signs that grief is complicated

Answer 3

• Bereaved person unable to talk about their loved one without intense and fresh grief (even years after loss) - Minor event triggers intense grief - Maintaining all of loved one’s possession exactly as they were - Unexplained somatic symptoms - Phobia of death, illness - Symptoms of grieving not decreasing after normal grief period - Significant ongoing functional impairment

Question 4

How should complicated grief be treated?

Answer 4

• Assess if comorbid substance abuse/major depressive disorder? - Community support - Refer to therapy - Therapists emphasize processing loss, restructuring life - Discourage avoidance of things that remind - Benzos not helpful, SSRIs/SNRIs benefit, preferable as adjunct

Question 6

Tasks of mourning.

Answer 6

• Accept reality of loss - Work through pain of grief - Adjust to environment in which deceased is missing - Finding enduring connection with loved one while moving on with life

Question 8

Are people more or less likely to see their doctors when they are grieving? Why or why not?

Answer 8

• Yes, more likely. - Attachment increases during times of grief

Question 9

Describe normal grief (length, emotions, physical sensations, cognitions)

Answer 9

• Length: subsides within 6-12 months, after there is some longing and sadness, but not central experience - Emotions: sadness, anger, guilt, loneliness, anxiety, yearning, relief, numbness - Physical sensations: abdominal distress, tightness chest/throat, hypersensitivity, SOB, weakness, lack of energy - Cognitions: disbelief, confusion, preoccupation, sense of presence, hallucinations (fleeting) - Behaviors: sleep disturbance, appetite disturbance, dreams of deceased, crying, treasuring objects

Question 10

Factors that complicate grief

Answer 10

• Highly conflicted/dependent relationship - Sudden, violent, traumatic death - Death of child - Multiple losses in short period - Ambiguous deaths - History of depression, psychiatric illness - History of trauma or unresolved loss - Lack of social support

Question 11

Special cases of grief

Answer 11

• Suicide - Sudden death - Stillbirth or SIDS

Question 12

What does no grief mean?

Answer 12

• Pathological