Psychologists and psychiatrists at Shier Private Practice in Scottsdale, AZ specialize in the treatment of persistent complex bereavement disorder/complicated grief. Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.
Grief is the standard reaction to loss whereas bereavement is the process of one recovering from the death of a loved one. Grief and Bereavement may both be expressed by a range of emotions from sadness to denial or anger. The process of recovering from the death of a loved one may vary significantly from one person to another depending on the relationship with the deceased, time since the loss, as well as the bereaved individual’s background and beliefs. Most bereaved adults report distress, yearning, intense grief, intrusive thoughts somatic distress and interpersonal disconnection in the weeks and months following a loss. In normal grieving, it is expected that symptoms of grief and bereavement will reduce over time. For most, the intensity of these thoughts and emotions diminish within 6-18 months after the loss. As time progresses, individuals are more likely to feel more contentment surrounding the loss, and are better able to reminisce on good memories with the deceased.
Persistent complex bereavement disorder, otherwise known as complicated grief, describes bereavement in which feelings of loss interfere with daily functioning and do not improve after time passes. The risk of developing persistent complex bereavement disorder is heightened by an increased dependency on the deceased prior to the death and by the death of a child. Those with complicated grief experience more severe symptoms that are distressing and persistent; these individuals have more trouble in coming to accept the loss and resuming their daily activities/lifestyle. Persistent complex bereavement disorder is often associated with deficits in social and occupational functioning, increased drug and alcohol use, and increases in risks for serious medical conditions such as hypertension, cancer, and immunological deficiency, overall affecting quality of life. Individuals with persistent complex bereavement disorder frequently report suicidal ideation.
The approximate prevalence of persistent complex bereavement disorder is 2.4%-4.8% and is more common in females than in males.
The proposed DSM-5 criteria for persistent complex bereavement disorder are as follows:
The individual experienced the death of someone with whom he or she had a close relationship
Since the death, at least one of the following symptoms is experienced on more days than not and to a clinically significant degree and has persisted for at least 12 months after the death in the case of bereaved adults and 6 months for bereaved children:
- Persistent yearning/longing for the deceased.
- Intense sorrow and emotional pain in response to the death
- Preoccupation with the deceased
Preoccupation with the circumstances of the death. Since the death, at least six of the following symptoms are experienced on more days than not and to a clinically significant degree, and have persisted for at least 12 months after the death in the case of bereaved adults and 6 months for bereaved children:
Reactive distress to the death
- Marked difficulty accepting the death.
- Experiencing disbelief or emotional numbness over the loss
- Difficulty with positive reminiscing about the deceased
- Bitterness or anger related to the loss
- Maladaptive appraisals about oneself in relation to the deceased or the death (self-blame)
- Excessive avoidance of reminders of the loss
- A desire to die in order to be with the deceased
- Difficulty trusting other individuals since the death
- Feeling alone or detached from other individuals since the death
- Feeling that life is meaningless or empty without the deceased or belief that one cannot function without the deceased
- Confusion about one’s role in life, or a diminished sense of one’s identity
- Difficulty or reluctance to pursue interests since the loss or to plan for the future
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The bereavement reaction is out of proportion to or inconsistent with cultural, religious, or age-appropriate norms.
Grief-targeted psychotherapy is most effective in learning to cope with loss. In grief counseling, therapists help individuals work through bereavement through memories, dialogue, and reflections about the deceased. Group therapy may be beneficial for the bereaved to connect with individuals who have experienced similar loss. Family therapy may be helpful for family units adapting to the loss of their family member.
Last update: February 25, 2019
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