Pathological grief: Persistent Complex Bereavement Disorder (PCBD)

Question 1

What disorder is complicated/prolonged grief classed as, and what classification system is used?

Answer 1

Persistent Complex Bereavement Disorder (PCBD) or Prolonged Grief Disorder (PGD)

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)

Question 2

What is the difference between normal and complicated grief, in terms of their timeframes?

Answer 2

Normal grief lasts 6 months-1 year

Complicated grief lasts many months-years

Question 3

Give examples of physical responses to complicated grief?

Answer 3

Fatigue, digestive problems, depressions

Question 4

Give examples of emotional responses to complicated grief?

Answer 4

Intense sadness and distress, anger, loneliness

Question 5

Give examples of behavioural responses to complicated grief?

Answer 5

Social withdrawal, not functioning, avoid reminders of loss, can’t work

Question 6

Give examples of cognitive responses to complicated grief?

Answer 6

Emptiness, suicidal ideation, self-blame, desire to be with the deceased, hallucinations of the deceased, constantly thinking/talking about death

Question 7

How does PCBD initially affect the time frame of normal bereavement?

Answer 7

Grief is unshakable and doesn’t improve over time

Question 8

How does PCBD initially affect major functioning of an individual?

Answer 8

Causes unusual, severe symptoms that impair major functioning

Question 9

How does PCBD initially affect moods and emotions?

Answer 9

Causes intense emotions/moods

Question 10

Give examples of other health conditions that PCBD is associated with causing?

Answer 10

Suicidal ideation and attempts, cancer, hypertension, cardiovascular events, immune dysfunction, poor health behaviours

Question 11

How does PCBD affect the rates of service use and sick leave?

Answer 11

Makes rates higher

Question 12

What are the 5 types of complicated grief?

Answer 12

Chronic grief: Lasts for prolonged/extended time period

Delayed grief: Postponed so that it occurs after person dies

Disenfranchised grief: Unacknowledged/unvalidated by social norms

Compounded grief: Occurs after multiple losses

Anticipatory grief: Occurs prior to a known future loss eg. knows that person is going to die soon

Question 13

In the diagnostic criteria for PCBD, what disorder does the person need to currently have and for how long after bereavement?

Answer 13

Current diagnosis of grief disorder due to prolonged symptoms causing significant, functional impairment

for at least 1 month after 6 months of bereavement

Question 14

In diagnostic criteria of PCBD, which one of 4 symptoms needs to be persistent, along with a current grief disorder and 2 other symptoms for at least 1 month?

Answer 14

One of the following persistent symptoms:

Intense yearning for the deceased

Preoccupations with the deceased

Recurrent thoughts that life is meaningless without deceased

Urge to join deceased in death

Question 15

In the diagnostic criteria of PCBD, which 2 of the following symptoms need to present for at least 1 month, along with current grief disorder and another persistent symptom?

Answer 15

Shocked, stunned, numb since death

disbelief/inability to accept loss

Rumination about circumstances/consequences of death

Experiencing pain that deceased suffered from, or hearing/seeing deceased

Anger/bitterness about death

Hard to trust/care for others

Intense reactions to reminders/memory of deceased

Avoidance of reminders of the deceased, or the opposite: seeking out reminders to feel close to the deceased

Question 16

How can PCBD be differentiated from normal grief?

Answer 16

PCBD symptoms usually last longer and cause functional impairment for much longer time after death

Question 17

How can PCBD be differentiated from depressive disorder?

Answer 17

PCBD sadness focused on loss of deceased

Question 18

How can PCBD be differentiated from PTSD?

Answer 18

PTSD causes intrusive thoughts about traumatic event but PCBD causes thoughts about deceased/circumstances of death

Question 19

How can PCBD be differentiated from Separation Anxiety Disorder?

Answer 19

SAD is from separation from living individual but PCBD is from separation from deceased

Question 20

In which kinds of deaths are risk factors most often linked to development of PCBD?

Answer 20

untimely, unexpected or violent death

Question 21

Give examples of risk factors that indicate pre-loss PCBD?

Answer 21

pre-existing mental health conditions or inadequate coping mechanisms, lack of knowledge about death, has previous experience, conflict/difficult relationship with deceased

Question 22

Which 4 populations have higher risk of pre-loss PCBD?

Answer 22

children, adolescents, young spouses, elderly in long-term relationships

Question 23

Give examples of risk factors that indicate during-loss PCBD?

Answer 23

Loss caused by violence, trauma, accident eg. suicide, others can’t offer support and comfort, loss caused by inheritable disease or long-term illness, death associated with stigma/shame eg. AIDS

Question 24

Give examples of risk factors that indicate post-loss PCBD?

Answer 24

inadequate family or community support, traumatic reminders eg. anniversaries, birthdays, future losses and bereavement

Question 25

Give examples of talking therapies used to treat PCBD?

Answer 25

CBT, ACT, cognitive restructuring, psychoeducation and medication

Question 26

Which drug class is typically used to treat PCBD?

Answer 26

SSRIs

Question 27

How can multiple people with PCBD help each other recover?

Answer 27

Complicated grief group therapy

Question 28

How can self-referring oneself for PCBD affect the outcome of their treatment?

Answer 28

People who self-refer tend to have better outcomes