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Grief/Loss

Grief is the response to bereavement, which is the situation in which a loved one has died. Natural acute grief reactions are often painful and impairing with emotional and somatic distress, but should not be diagnosed as a mental disorder. However, bereavement is a stressor that can precipitate or worsen mental disorders (eg, unipolar major depression). In addition, complications (maladaptive thoughts, feelings, or behaviors) may occur, such that acute grief becomes intense, prolonged, and debilitating. This condition is called complicated grief, which is viewed as a unique and recognizable disorder that requires specific treatment.

Complications related to grief/loss

Adverse general medical outcomes — Bereaved individuals are at increased risk of adverse general medical outcomes. Much of this increased risk may be due to complicated grief. 

Mortality — Bereavement is associated with an increased risk of mortality, after controlling for chronic medical conditions and access to resources, as well as age, sex, and smoking status

Morbidity — Bereavement is associated with increased rates of somatic symptoms (eg, chest pain, dizziness, gastrointestinal distress, and headaches), especially during the first several (eg, six) months after the loss. In addition, the loss of a loved one may lead to disability, as well as deterioration of health behaviors, including worsened nutrition, increased alcohol consumption, poor sleep quality, and involuntary weight loss. 

Terminology

●Bereavement – The situation in which someone who is close dies (rather than the reaction to that loss).

●Grief – Grief is the natural response (including thoughts, feelings, behaviors, and physiologic reactions) to bereavement. Although grief can occur in response to other meaningful (non-bereavement) losses, this topic focuses primarily upon grief in response to the death of a loved one.

 

The pattern and intensity of grief varies over time as bereaved individuals adapt to the loss. The experience of grief is influenced by cultural and religious rituals that vary widely, and is unique to each person and each loss. Acute grief can be intense and disruptive but is eventually integrated. Progress from acute to integrated grief is often erratic and hard to discern as it is happening.

 

●Complicated grief – Complicated grief is a form of acute grief that is unusually prolonged, intense, and disabling; troubling thoughts, dysfunctional behaviors, dysregulated emotions, and/or serious psychosocial problems impede adaptation to the loss. The syndrome of complicated grief is a unique and recognizable condition that can be differentiated from other mental disorders. Other terms that have been used to describe complicated grief include chronic grief, complex grief, pathological grief, persistent complex bereavement disorder, prolonged grief disorder, traumatic grief, and unresolved grief.

●Mourning – Mourning is the process of adapting to a loss and integrating grief. Adaptation entails accepting the finality and consequences of the loss, revising the internalized relationship with deceased, and re-envisioning the future such that there is a possibility for happiness in a world without the deceased. When mourning is successful, the painful and disruptive experience of acute grief is transformed into an experience of integrated grief that is bittersweet and in the background. Like grief, mourning is influenced by cultural and religious rituals that vary widely.

Resources: 

uptodate.com

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