(Prolonged) Grief Flashcards
1
Q
What is the difference between normal and disturbed grief in the grief task model?
A
- Normal grief: Successfully managing grief tasks (e.g., accepting the reality of the loss).
- Disturbed grief: Persistent distress and difficulty adapting to life after the loss.
2
Q
What are Prolonged Grief Disorder (PGD) and Persistent Complex Bereavement Disorder (PCBD)?
A
Both are conditions of disturbed grief characterized by persistent distress and difficulty coping with loss.
* PGD: Highlighted in ICD-11.
* PCBD: Defined in DSM-5.
3
Q
How common is Prolonged Grief Disorder (PGD)?
A
PGD occurs in about 10% of bereaved individuals and is associated with separation distress lasting more than:
* 6 months in children
* 12 months in adults
4
Q
What other disorders are often comorbid with PGD?
A
- Major Depressive Disorder (MDD)
- Generalized Anxiety Disorder (GAD)
- Post-Traumatic Stress Disorder (PTSD)
- Adult Separation Anxiety
5
Q
What are some risk factors for developing PGD?
A
- Being female.
- Lower educational levels.
- Insecure attachment styles.
- High levels of neuroticism.
- Death of a close relationship (e.g., partner or child).
- Unnatural or violent deaths.
6
Q
What are the differences in symptom duration between PGD and PCBD?
A
PGD: Symptoms must persist for at least 6 months.
PCBD: Symptoms must persist for:
* At least 6 months in children.
* At least 12 months in adults.
7
Q
What is the difference in distress of separation between PGD and PCBD?
A
- PGD: Yearning for the deceased, extreme emotional pain, and obsession with the deceased.
- PCBD: Obsession with how the deceased died.
8
Q
How do the symptoms of PGD and PCBD differ?
A
PGD Symptoms:
* Feeling sad, emotionally numb.
* Inability to feel positive moods.
PCBD Symptoms:
* Wanting to die to reunite with the deceased.
* Difficulty remembering the deceased positively.
* Feelings of emptiness, loneliness, and avoidance of reminders.
9
Q
How do PGD + PCBD symptoms combine?
A
- Difficulty accepting the death.
- Bitterness, anger, guilt.
- Feeling like a part of oneself is missing.
- Trouble planning for the future.
10
Q
What are the impacts of PGD and PCBD?
A
Both impact multiple aspects of life, including personal relationships, education, and functioning.
11
Q
What are effective prevention strategies for PGD?
A
- Psychological interventions: Small to modest effects in secondary prevention for high-risk individuals.
- Self-help interventions: Therapist-assisted interventions reduce symptoms.
- Medication: No established evidence for pharmacological prevention.
12
Q
What treatments are recommended for PGD?
A
- Psychological interventions:
- CBT (Cognitive Behavioral Therapy)
- Exposure interventions (reduce avoidance).
- Cognitive restructuring (address maladaptive beliefs).
- Behavioral activation (adjust to loss).
- Pharmacological interventions: May help depression symptoms but less effective for PGD-specific symptoms.
13
Q
What role does self-help play in PGD treatment?
A
Evidence is limited.
Therapist-assisted self-help shows promise, while standalone self-help has higher dropout rates.
14
Q
What is psychological first aid in grief treatment?
A
Provided by first responders or disaster relief workers to connect individuals with medical and social support while addressing immediate needs.
15
Q
What is cultural bereavement?
A
A form of grief experienced by individuals separated from their home country, often involving guilt, anxiety, and preoccupation with memories of their homeland.
16
Q
What are the different patterns of grief identified in the study? (Bonanno)
A
- Increase in depression after bereavement that declines over time.
- Chronic grief: Persistent grief symptoms (10–20% prevalence).
- Absence of grief: No symptoms, possibly due to quick adjustment.
- Delayed grief: Minimal symptoms at first, later developing grief symptoms (evidence is low).
17
Q
Why is preloss data important in grief studies?
A
- Distinguishes chronic grief from chronic depression.
- Differentiates resilience from improved functioning post-loss.
- Avoids biases in retrospective accounts of grief.
18
Q
What are the key findings about chronic grief?
A
- Chronic grief is distinct from chronic depression.
- Key predictors: High dependency on the partner, low instrumental support, and sudden loss (spouse not sick).
- Chronic grief is not associated with a poor relationship quality.
19
Q
What were the five groups identified in the study?
A
- Resilience (45%): Stable, low depression before and after the loss.
- Chronic grief (15.6%): Persistent high depression post-loss.
- Common grief (10.7%): Temporary increase in depression, then improvement.
- Depression improved (10.2%): High preloss depression, improvement post-loss.
- Chronic depression (7.8%): Persistent high depression before and after the loss.
20
Q
What were the predictors of chronic grief?
A
- High dependency on the partner.
- Low instrumental support (e.g., practical help).
- Loss of a partner who was not seriously ill.
21
Q
What distinguished the resilient group from others?
A
- Low and stable depression levels.
- Well-adjusted, with sufficient coping resources.
- A worldview that helps them accept loss and believe in fairness.
22
Q
What are the characteristics of the “depression improved” group?
A
- Maladjusted and self-absorbed.
- Poor coping resources and negative, ambivalent feelings about marriage.
- Often had ill partners, little instrumental support, and a belief in an unfair world.
23
Q
What hypotheses were supported in the study? (Bonanno)
A
- Chronic grievers show higher dependency on their partner.
- Resilient individuals have a worldview that helps them accept the loss and believe in fairness.
- Chronic grievers have less instrumental support (but not less social support).
24
Q
Which hypotheses were not supported? (Bonanno)
A
- Chronic grief is caused by conflict or ambivalence with the partner.
- Resilient individuals are cold and distant.
- Chronic grief results from fewer coping resources (only chronic depression showed this).
25
What are the main findings about chronic grief?
1. Chronic grief is distinct from chronic depression.
2. High dependency, low instrumental support, and sudden loss are predictors.
3. Chronic grief is not caused by poor relationship quality.
26
Why is the evidence for delayed grief limited?
“Delayed grief” might reflect improved functioning due to relief after caregiving. The study found no evidence of delayed grief patterns.
27
What are the limitations of this study?
Self-reports were used for data collection.
Results are limited to the first 18 months post-loss.
Limited generalizability due to older participants (mean age = 72).
28
What is Prolonged Grief Disorder (PGD), and where is it included?
PGD is a disorder characterized by persistent and intense grief symptoms. It is included in:
* ICD-11
* DSM-5-TR
29
Why was PGD included in the DSM-5-TR and ICD-11?
1. Construct validity: Examines symptom dimensionality.
2. Convergent validity: Correlations with related disorders.
3. Divergent validity: Differentiates PGD symptoms from other disorders.
4. Criterion validity: Predicts symptoms of PGD compared to relevant constructs.
30
What are the potential benefits of including PGD in diagnostic manuals?
Encourages research into risk and protective factors.
Enhances care for severe grief reactions.
Increases recognition of the disorder and helps with reimbursement for health services.
31
What is the required duration of symptoms for a PGD diagnosis in DSM-5-TR?
* 12 months after the loss of a close person (adults).
* 6 months for children.
32
What are the separation distress criteria in DSM-5-TR for PGD?
At least one of the following must be present most of the day, nearly every day:
1. Intense yearning for the lost person.
2. Preoccupation with the deceased through thoughts or memories.
33
What cognitive, behavioral, and emotional symptoms are required for PGD diagnosis?
At least 3 of the following must be present almost every day:
1. Feeling like one’s identity is disrupted.
2. Disbelief about the loss.
3. Avoiding reminders of the deceased.
4. Intense emotional pain related to the loss.
5. Difficulty reintegrating into life post-loss.
6. Feeling emotionally numb.
7. Feeling life is meaningless.
8. Experiencing loneliness.
34
What are the functional and cultural criteria for PGD in DSM-5-TR?
* Functional impairment: Must lead to clinically significant distress in various life areas.
* Cultural criterion: Reaction exceeds expectations based on social, cultural, or religious norms.
35
How does DSM-5-TR differentiate PGD from other mental disorders?
Symptoms cannot be better explained by:
1. Major Depressive Disorder (MDD).
2. Post-Traumatic Stress Disorder (PTSD).
3. Other mental disorders or substance use.
36
What challenges exist in distinguishing PGD from normal grief?
No established definition of normal grief.
PGD is said to differ by intensity, duration, and functional impairment, but evidence remains unconvincing.
37
What are some potential negative societal consequences of including PGD in diagnostic manuals?
1. Overdiagnosis of normal grief.
2. Increased reliance on pharmacotherapy despite limited evidence for medication efficacy.
3. Risk of stigma from labeling grief as a disorder, potentially increasing depression, suicide, and reduced help-seeking.
38
What is the conclusion regarding PGD’s inclusion in DSM-5-TR?
While inclusion has some support, challenges like unclear differentiation from normal grief, potential overdiagnosis, and societal consequences need to be addressed.
39
What is the challenge of adding PGD to the DSM-5?
The primary challenge is creating diagnostic criteria that differentiate PGD from extreme normal grieving, as normal grief can also include intense and prolonged symptoms.
40
What are the two main suggestions for including grief reactions in DSM-5?
Removing the bereavement exclusion for adjustment disorders (AD):
* Would allow diagnosis of AD even for symptoms due to bereavement.
* Risks overdiagnosing normal grief as a disorder due to common symptoms like sadness and insomnia.
Adding a new bereavement-related AD category:
* Diagnosis could be made based on a single symptom, such as yearning, creating a very low threshold for diagnosis.
41
What is the “distinctive symptom argument,” and was it supported?
The argument suggests that specific symptoms like rumination or excessive avoidance distinguish PGD from normal grief.
* Evidence: This argument is unsupported. No clear distinction exists between normal and PGD symptoms.
42
Can symptom severity distinguish PGD from normal grief?
PGD symptoms are said to be statistically extreme compared to normal grief.
* Evidence: The cutoff for “extreme severity” is unclear since even normal grief can include intense symptoms.
43
What is the “interminability argument,” and was it supported?
The argument claims that grief symptoms lasting beyond 6-12 months will persist indefinitely.
* Evidence: Unsupported. Few studies assess grief symptoms beyond 18 months.
* Alternative Hypothesis: Lengthy normal grief may explain prolonged symptoms without indicating pathology.
44
Does PGD predict negative health outcomes that normal grief does not?
PGD is said to predict worse outcomes like mortality, physical disorders, and mental disorders.
Evidence:
1. Mortality: Linked to pre-existing conditions or negative lifestyle factors, not PGD.
2. Physical disorders: Evidence is weak and could be due to stress, not PGD.
3. Mental disorders: Many factors predict these outcomes, so this does not establish PGD as a disorder.
4. Functional impairment: Common in normal intense grief, challenging differentiation.
5. Suicide ideation: Studies use vague measures, leading to overreporting.
45
What is the “wound analogy” argument for PGD, and was it supported?
Grief is compared to a physical wound that, if not healing properly, becomes pathological.
* Evidence: Unsupported.
* Physical wounds result from damage, while grief involves adaptive emotional processes.
* There is no evidence for “infection-like” prolonged symptoms in grief.
46
What are the challenges with including PGD in diagnostic criteria?
1. No distinctive symptoms to differentiate PGD from normal grief.
2. No clear severity threshold for symptoms.
3. The suggested timeframe (6-12 months) does not reliably distinguish maladaptive grief from slow recovery.
4. Negative outcomes attributed to PGD may not be pathogenic.
47
What are the potential risks of including PGD as a mental disorder?
1. Overdiagnosis of normal grieving as pathological.
2. Increased reliance on pharmacological treatments despite limited evidence for their effectiveness.
3. Creation of stigma around grief being labeled as a mental disorder.
48
What is the conclusion regarding PGD as a disorder?
PGD shows significant empirical and conceptual deficiencies. It cannot currently be reliably distinguished from normal grief. Further research and stricter criteria are required before its inclusion as a mental disorder.
49
What are the stages of grief in the stage theory?
The stage theory, developed by Kübler-Ross, describes grief as occurring in 5 distinct stages:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
50
What does the stage theory assume about grieving?
The theory assumes people experience grief in linear and sequential stages that apply universally. Originally developed for dying patients, it was later extended to grieving individuals.
51
What are the 5 main criticisms of the stage theory?
No theoretical depth or explanation:
* No explanation of grief’s function or coping mechanisms.
* Cannot identify high-risk individuals.
Conceptual confusion and misinterpretation:
* Constructs like emotions (e.g., anger) and cognitive processes (e.g., denial) are mixed.
* Poorly defined stages create ambiguity.
No empirical evidence:
* Stages were based on observations of 200 patients, without systematic investigation.
Alternative models are available:
* Other theories offer more depth and practical applications.
Potentially harmful consequences:
* Creates undue expectations for grieving individuals, making them feel they are grieving “wrong” if they don’t follow the stages.
52
Why does the stage theory oversimplify grief?
The stage theory fails to capture the diversity and complexity of grief, presenting grief as a passive and linear process without acknowledging:
* Emotional and cognitive fluctuations.
* Individual variability in coping.
* Social, cultural, and interpersonal factors.
53
How does the stage theory misrepresent grief?
1. Implies smooth progression despite fluctuations in emotions.
2. Poorly defined concepts (e.g., “depression” could mean clinical depression or normal sadness).
3. Neglects social and cultural factors of grieving.
4. Prescriptive statements (e.g., “anger is necessary for healing”) are not universally applicable.
5. Ignores secondary stressors like financial or caregiving challenges.
54
What are the negative consequences of using the stage theory?
1. Creates undue expectations about how people “should” grieve.
2. Makes people feel guilt or inadequacy if they don’t follow the stages.
3. Ignores the active process of coping with loss.
4. Prevents recognition of cultural, interpersonal, and social influences on grief.
55
Why do healthcare professionals still use the stage theory despite its flaws?
The stage theory remains popular because it is:
* Simple to understand.
* Offers a structured model for bereaved individuals to hold onto.
56
What is the recommendation for replacing the stage theory?
There is a need for accessible, informative, and comprehensive models of grief that:
1. Emphasize the variability in grief reactions.
2. Recognize the active and fluctuating nature of coping.
3. Incorporate social, cultural, and interpersonal factors.
57
What is the conclusion of Stroebe et al. (2017) about the stage theory?
While the stage theory has been influential, it is outdated and overly simplistic. Healthcare professionals need to adopt more nuanced and evidence-based models of grief to better support bereaved individuals.
