Loss, bereavement and grief

Question 1

What is loss?

Answer 1

• deprived of something/someone

- separation from loved thing/one

Question 2

When can loss happen?

Answer 2

• losses = can be multiple e.g. lose partner, then lose financial income
• loss out of sequence= greater impact e.g. child dying

Question 3

What is bereavement?

Answer 3

• Loss of a loved one through death

Question 4

What is grief?

Answer 4

• Emotional reaction to loss
  1. psychological (cognitive, social, behavioural)
  2. physical (physiological, somatic).
• emotions are associated with bereavement
  sadness, anger, guilt, shame and anxiety

Question 5

What is mourning?

Answer 5

• process of adapting to loss
• includes cultural and social rituals
• includes expectations
• Psychological processes triggered by loss and process of recovery. The act of expressing grief.

Question 6

What is the acute grief response?

Answer 6

• Disbelief/ shock/ numbness/yearning
• Agitation/anger/hostility/irritability
• Crying, tearful, sadness
• Disrupted sleep
• Aimless activity / inactivity
• Illusions or hallucinations
• Preoccupation with images of the lost person

Question 7

How long does acute grief response last?

Answer 7

• hard to say
• no set time
• people differ
• about 6 weeks

Question 8

What are long term grief responses?

Answer 8

• Social withdrawal
• Sleep disturbance
• Restlessness or anxiety
• Decreased concentration
• Decreased or increased food intake
• Reduced libido
• Depressed mood

Question 9

How long do long term grief responses last?

Answer 9

• 3 -12 months plus
• individuals vary.
• BUT minimal/absent grief response not unusual

Question 10

How do children respond to grief?

Answer 10

• they need support
• allow to make their own meaning
• some children are resilient
• support from family, friends, school

Question 11

What are the 5 stages of grief model?

Answer 11

D - Denial
A - Anger
B – Bargaining, Reason with the situation
D – Despair and Depression
A – Acceptance

Question 12

What is the dual process model of grief? (CAME UP IN SEM 2 EXAM)

Answer 12

• Dynamic

- Oscillation between Loss Oriented and Restoration Oriented coping

Question 13

What are loss oriented aspects of grief?

Answer 13

• denial
• thinking about relation
• avoiding restoring changes
• grief

Question 14

What is the restoration orientated coping of grief?

Answer 14

• attending to life changes
• doing new things
• distracting from grief
• new roles
• keeping occupied

Question 15

What are modern changes to grief models?

Answer 15

 Newer grief theories = maintain bond with dead people
 Facilitating grief = hold relationship in new perspective
 Cognition and meaning in addition to emotion (post traumatic growth)
 Challenges concept of endpoint in grieving – no ‘back to normal’ rather a ‘different normal’.

Question 16

What is pathological grief?

Answer 16

• absent grief

- prolonged grief

Question 17

What is absent grief?

Answer 17

• Failure to display symptoms of grief

- can result in ‘delayed’ grief or anxiety problems e.g. during anniversary

Question 18

What is prolonged grief?

Answer 18

• initially seems normal grieving
• intense grief persists
• distressing and disabling
• persist more than 6 months with FUNCTIONAL IMPAIRMENT
• searching for the person who has died
• persistent intrusive images/ideas/nightmares/dreams
• actively avoiding communication and actions associated with loss

Question 19

How does bereavement compromise people and how does it cause increased mortality?

Answer 19

• more mental illness
• more physical illness likely
• higher medications used
• neglect early signs of disease
• can’t manage current diseases like diabetes
• have alcohol
• self harm
• suicide

Question 20

How is the immune system affected with grief and bereavement?

Answer 20

• bereavement causes
• high ACTH and cortisol
• reduced NK cells
• vulnerable immune system
• increase morbitiy and hospitalisation

Question 21

What are the risk factors for complicated grief?

Answer 21

1. Circumstances surrounding loss:
   • Sudden / unexpected bereavement / Violent /Multiple bereavements /Not told – delay in finding out/ Excluded
2. Individual circumstances:
   • Previous problems coping/ Previous history of mental health problems/ Separation/ anxiety / Unable to understand loss/ Dependent children/ People with intellectual disability
3. Social support unavailable:
   • Loss disrupts routines & relationships/ Others make choices and decisions
   • Limited opportunities for new roles/status
   • Positive family/social support = important protective factor.
4. Quality of lost relationship:
   • Very close, dependent relationship
   • Difficult, ambivalent, abusive or violent relationships
5. Disenfranchised grief - loss that cannot be openly acknowledged, publicly mourned or socially supported

Question 22

How do you deal with loss and grief in a clinical setting?

Answer 22

• commone experience
• deal with patients and relatives
• recognise signs and symptoms of complicated grief
• address and listen
• dont ignore

Question 23

What support services are given to those grieving?

Answer 23

• social network
• family, friends, colleagues
• faith based network
• Docs/GP
• wandworth bereavement centre
• in hospital counselling services
• self- help groups