A small proportion of people may be overwhelmed by their grief and unable to move on with their lives – a syndrome described as complicated bereavement. Other terms that have been used in the literature include complicated grief, traumatic grief, prolonged grief disorder or chronic grief.

Other psychiatric problems related to bereavement can result from exacerbation of pre-existing mental health problems.  Major depression and post-traumatic stress disorder can occur in bereaved patients, and should be distinguished from complicated bereavement.

Risk factors
Risk factors for complicated bereavement may include:

• Childhood experiences of the bereaved person, including death of a parent, childhood sexual abuse or childhood separation anxiety
• Insomnia
• Levels of closeness with the deceased, time since death, and relationship with the deceased
• Younger age of the deceased
• Violent death
• Gender of the bereaved person – women show greater grief.

Some patients may be extremely resilient, even when they have multiple risk factors that would suggest possible vulnerability, and so assessment should be individualised.

Complicated bereavement
Diagnostic criteria for complicated bereavement have been proposed for listing in the forthcoming DSM V: 

• Event: Bereavement
• Separation distress:  Yearning daily
• Cognitive, emotional and behavioural symptoms: Five or more of the following 
  • Confusion about life's role and diminished sense of self
  • Trouble accepting the death
  • Avoidance of reminders
  • Inability to trust others
  • Bitterness or anger about the death
  • Difficulty with moving on
  • Numbness since loss 
  • Feeling life is empty or meaningless
  • Stunned, dazed and shocked by loss
• Timing: At least six months have elapsed since loss
• Impairment: Dysfunction in social or occupational domains
• Relation to other disorders: Not accounted for by other major disorders (eg major depression, post -traumatic stress disorder or generalised anxiety)
  Source: Prigerson, Horowitz, Jacobs et al 2009

 A number of options for referral for complicated bereavement exist:

• Specialist bereavement counsellors
• Palliative care services usually offer bereavement follow up to their clients, often based on a risk assessment, and may accept referrals from other sources
• Other mental health professionals.

 

More detailed information …

 

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This page was created on 26 May 2009 and is due for review in May 2011
Last updated 25 January 2010