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Complicated grief
About 10% of bereaved people experience complicated grief (also referred to as prolonged grief disorder and persistent complex bereavement-related disorder).34,51,52 This is a syndrome of prolonged (ie well beyond six months) or intense grief, resulting from a failure to transition from acute to integrated grief. Complicated grief is associated with substantial impairment in work, health and social functioning.34 Some feel that complicated grief is not a separate condition but a component of PTSD.53,54
Symptoms of complicated grief include:
- difficulty accepting the death
- separation distress (recurrent pangs of painful emotions with intense longing for and preoccupation with the deceased and over-involvement in activities related to the deceased)
- traumatic distress (eg disbelief, anger and bitterness, pronounced avoidance of reminders of the loss).34,51
People with complicated grief are at increased risk for cardiac disease, cancer, hypertension, substance-use disorders and suicidality.34
Several assessment instruments have been developed to screen and diagnose people with complicated grief. The Inventory of Complicated Grief55is the instrument that has been most commonly used to identify complicated grief symptoms in research.52
Standard grief-focused supportive psychotherapies and psychotropic medications such as antidepressants do not appear to be effective for complicated grief. However, targeted complicated grief treatment has shown significant benefit.39,52,56–58There do not appear to be effective preventive interventions.59
References
- Zisook S, Shear K. Grief and bereavement: What psychiatrists need to know. World Psychiatry 2009;8(2):67–74.
- Shear MK. Complicated grief treatment: The theory, practice and outcomes. Bereave Care 2010;29(3):10–14.
- Jordan A, Litz B. Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. Prof Psychol Res Pr 2014;45(3):180–87.
- O'Connor M, Lasgaard M, Shevlin M, Guldin MB. A confirmatory factor analysis of combined models of the Harvard Trauma Questionnaire and the Inventory of Complicated Grief-Revised: Are we measuring complicated grief or posttraumatic stress? J Anxiety Disord 2010;24(7):672–79.
- Ehlers A. Understanding and treating complicated grief: What can we learn from posttraumatic stress disorder? Clin Psychol (New York) 2006;13.
- Prigerson HG, Maciejewski PK, Reynolds CF 3rd, et al. Inventory of complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry Res 1995;59(1-2):65–79.
- Glickman K, Shear MK, Wall M. Exploring outcomes related to anxiety and depression in completers of a randomized controlled trial of complicated grief treatment. Clin Psychol Psychother 2016 Mar;23(2):118–24.
- Wetherell JL. Complicated grief therapy as a new treatment approach. Dialogues Clin Neurosci 2012;14(2):159–66.
- Shear K, Frank E, Houck PR, Reynolds CF. Treatment of complicated grief – A randomized controlled trial. JAMA 2005;293(21):2601–08.
- Wittouck C, Van Autreve S, De Jaegere E, Portzky G, van Heeringen K. The prevention and treatment of complicated grief: A meta-analysis. Clin Psychol Rev 2011;31(1):69–78.