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Cancer Health Center

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Grief, Bereavement, and Coping With Loss (PDQ®): Supportive care - Health Professional Information [NCI] - Types of Grief Reactions


Patterns of Complicated Grief

Since the time of Sigmund Freud, many authors have proposed various patterns of pathologic or complicated grief.[1,2] Some proposed patterns come from extensive clinical observation [20] supported by various theories (e.g., psychodynamic defense mechanisms and personality traits associated with patterns of attachment).[21]

These patterns are described in comparison to normal grief and highlight variations from the normal pattern. They include descriptive labels such as the following:

  • Inhibited or absent grief: A pattern in which persons show little evidence of the expected separation distress, seeking, yearning, or other characteristics of normal grief.
  • Delayed grief: A pattern in which symptoms of distress, seeking, yearning, etc., occur at a much later time than is typical.
  • Chronic grief: A pattern emphasizing prolonged duration of grief symptoms.
  • Distorted grief: A pattern characterized by extremely intense or atypical symptoms.

Empirical reviews have not found evidence of inhibited, absent, or delayed grief and instead emphasize the possibility that these patterns are better explained as forms of human resilience and strength.[6] Evidence supports the existence of a minimal grief reaction-a pattern in which persons experience no, or only a few, signs of overt distress or disruption in functioning. This minimal reaction is thought to occur in 15% to 50% of persons during the first year or two after a loss.[6]

Empirical support also exists for chronic grief, a pattern of responding in which persons experience symptoms of common grief but do so for a much longer time than the typical year or two. Chronic grief is thought to occur in about 15% of bereaved persons.[6] It may look very much like major depression, generalized anxiety, and possibly post-traumatic stress.

In addition to these theoretical and empirically supported patterns of grief reactions, much emphasis has been placed on distinguishing normal grief from complicated grief. Most clinicians will be focused on understanding the differences between normal and complicated grief reactions: What is the difference? Under what circumstances should I refer a patient/family member for grief therapy?

Prolonged or Complicated Grief as a Mental Disorder

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