Loss, Bereavement Flashcards
Acute grief response?
- Disbelief/ shock/ numbness/yearning
- Agitation/anger/hostility/irritability/guilt
- Crying, tearful, sadness
- Disrupted sleep
- Aimless activity / inactivity
- Illusions or hallucinations
- Preoccupation with images of the lost person
Difficult to estimate duration – no set time –
may last around 6 weeks or so – individuals differ.
Longer term grief response?
- Social withdrawal
- Sleep disturbance
- Restlessness or anxiety
- Decreased concentration
- Decreased or increased food intake
- Reduced libido
- Depressed mood
- Loneliness
May last 3 -12 months plus – individuals vary
BUT minimal/absent grief response not unusual
(Bannono, 2009, The other side of sadness)
Describe children’s grief
Bereaved children are vulnerable to low self esteem & mental health
Anxiety and depression, substance abuse and are 2-3x increased risk of suicide.
Some children are resilient, but not in a vacuum. Support from family, friends,
school is very important.
One of the biggest impediments to children’s healing after bereavement is adults - who may need help in knowing how to support them.
Disadvantaged children at particular risk. They are 6 times more likely to be looked after by local authorities.
5 stages of grief?
Five stages:
Denial, numbness, disbelief, isolation
Anger - blame
Bargaining ‘If I can live longer ………..’
Depression, despair
Acceptance
Not linear. Stages may repeat/omit
What is the dual process model of grief?
Emphasises healthy grieving= a dynamic oscillation between Loss Oriented and Restoration Oriented coping
Loss-oriented coping: dealing with emotional aspects of grief eg expressing feelings of sadness, talking about person who passed away
- focusing on loss itself + allowing oneself to grieve
Restoration-oriented coping: dealing with practical aspects of grief + adjusting to life without the person who passed away.
- inc tasks like returning to work, managing daily responsibilities
What is a more recent focus in grief history?
The focus on facilitating grief is now on how to change connections to hold the relationship in a new perspective, rather than on how to separate.
Incorporate grief into self. (Lois Tonkin)
Expanding focus on cognition and meaning in addition to emotion (post traumatic growth)
No ‘back to normal’, rather a ‘different normal’
There is increased mortality after bereavement. What are the possible causes for this?
Change in usual health practices - adherence behaviour
Neglect early signs disease onset
Unstable management chronic diseases, e.g. diabetes
Alcohol / drug abuse
Loss of care provided by the deceased
Stress and impact on immunity
Depression, suicide
Insomnia
up to 10% of ppl experience complicated grief. What is this?
Abnormally severe after first few months, abnormally prolonged beyond 6 months
- Preoccupation with longing and yearning for deceased which doesn’t lessen with time
- Interference with daily functioning
- Persistent symptoms
- Suicidal ideas
- Persistent intrusive images, ideas, recurrent dreams
- Active avoidance of thoughts, communication or action associated with the loss
Risk factors for complicated grief?
- Environmental circumstances surrounding the loss- sudden, traumatic, violent, multiple bereavements, not told when finding out.
- Individual circumstances- MH history, separation anxiety
- Social support unavailable
- Quality of the lost relationship
- Disenfranchised grief- A loss that cannot be openly acknowledged, publicly mourned or socially supported
What is the difference between grief and depression?
How would you experience loss and grief in clinical practice?
Common experience
Recognising and dealing w grief of patients & relatives
Address and listen; don’t ignore or immediately refer on, don’t recommend meds straight away
Recognise and attend to your own grief responses
