Grief - Complicated Grief

Complicated Grief

Prolonged Grief Disorder (PGD), formerly known as complicated grief, is a pathological reaction to loss representing a cluster of empirically-derived symptoms that have been associated with long-term physical and psycho-social dysfunction. Individuals with PGD experience severe grief symptoms for at least six months and are stuck in a maladaptive state. An attempt is being made to create a diagnosis category for complicated grief in the DSM-V. Critics of including the diagnosis of complicated grief in the DSM-V say that doing so will constitute characterizing a natural response as a pathology, and will result in wholesale medicating of people who are essentially normal.

Shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions.

Complicated grief is not synonymous with grief. Complicated grief is characterised by an extended grieving period and other criteria, including mental and physical impairments. An important part of understanding complicated grief is understanding how the symptoms differ from normal grief. The Mayo Clinic states that with normal grief the feelings of loss are evident. When the reaction turns into complicated grief, however, the feelings of loss become incapacitating and continue even though time passes. The signs and symptoms characteristic of complicated grief are listed as "extreme focus on the loss and reminders of the loved one, intense longing or pining for the deceased, problems accepting the death, numbness or detachment . . . bitterness about your loss, inability to enjoy life, depression or deep sadness, trouble carrying out normal routines, withdrawing from social activities, feeling that life holds no meaning or purpose, irritability or agitation, lack of trust in others." The symptoms seen in complicated grief are specific because the symptoms seem to be a combination of the symptoms found in separation as well as traumatic distress. They are also considered to be complicated because unlike normal grief these symptoms will continue regardless of the amount of time that has passed and despite treatment given from tricyclic antidepressants.

In the study "Bereavement and Late-Life Depression: Grief and its Complications in the Elderly" six subjects who had symptoms of complicated grief were given a dose of Paroxetine which is a selective serotonin reuptake inhibitor and showed a 50% decrease in their symptoms within a three month period. The Mental Health Clinical Research team theorizes that the symptoms of complicated grief in bereaved elderly are an alternative of post-traumatic stress. These symptoms were correlated with cancer, hypertension, anxiety, depression, suicidal ideation, increased smoking, and sleep impairments at around six months after spousal death.

A treatment that has been found beneficial in dealing with the symptoms associated with complicated grief is the use of serotonin specific reuptake inhibitors such as Paroxetine. These inhibitors have been found to reduce intrusive thoughts, avoidant behaviors, and hyperarousal that are associated with complicated grief. In addition psychotherapy techniques are in the process of being developed.