Bereavement and pathological grief

Question 1

Definition of loss?

Answer 1

experienced when a person we are attached to becomes permanently unavailable

Question 2

Definition of grief?

Answer 2

human reaction to loss. Acute, integrated, complicated

Question 3

Definition of bereavement?

Answer 3

psychological process through which people adapt to loss

Question 4

Why is bereavement important?

Answer 4

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

Question 5

What are the normal physical, emotional, behavioural & cognitive grief reactions?

Answer 5

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

Question 6

What are the five stages of grief?

Answer 6

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 7

How do children grief?

Answer 7

• 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

Question 8

What are the grief models?

Answer 8

• Phase model
• Grief work model
• Dual-process model

Question 9

What is the phase of grief model?

Answer 9

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

Question 10

What is the grief work model?

Answer 10

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

Question 11

What is dual-process model?

Answer 11

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

Question 12

Comparison of models

Answer 12

NOTE: view image on notes

Question 13

Name 4 factors that affect the duration and severity of someone’s grief

Answer 13

1. How attached & what kind of relationship they had.
2. Circumstances of death e.g. sudden, traumatic, unexplained.
3. Amount of time for anticipatory mourning- the grief some people experience when they expect the death of someone w/ terminal illness.
4. Previous unresolved losses

Question 14

What is normal grief?

Answer 14

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

Question 15

What is complicated grief? i.e. how to you diagnose it?

Answer 15

Diagnosis:
- unshakeable grief that does not improve over time
- persistent and intense emotions that cause extreme distress

Question 16

What are the normal physical, emotional, behavioural & cognitive
reactions for complicated grief?

Answer 16

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

Question 17

What are some associated conditions with complicated grief?

Answer 17

• Elevated rate of suicidal ideation & suicide attempts
• Increased incidence of cancer, hypertension & cardiac events after several year
• Immune disorders & dysfunction more frequent

Question 18

Name and define the 5 different types of complex grief.

Answer 18

1. Chronic grief- grief that lasts for a prolonged or extended period of time
2. Delayed grief- grief that has been postponed
3. Disenfranchised grief- grief that may be seen as socially difficult to relate to or are negated by others
4. Compounded grief- grief that occurs following multiple losses
5. Anticipatory grief- grief that occur prior to a known future loss

Question 19

What is the Diagnostic criteria for persistent complex bereavement disorder (PCBD)?

Answer 19

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

Question 20

Differential diagnosis of PCBD?

Answer 20

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

Question 21

What are the risk factors for complicated or persistent grief?

Answer 21

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

Question 22

Barriers to seeking bereavement support ?

Answer 22

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

Question 23

Treatment for complicated grief?

Answer 23

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