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

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The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) includes bereavement as a diagnosable code to be used when bereavement is a focus of clinical attention following the death of a loved one. In current form it does not consist of formal diagnostic criteria and is generally considered a normal reaction to loss via death. In an attempt to clearly distinguish between normal grief and complicated grief, a consensus conference [22] has developed diagnostic criteria for a mental disorder referred to as prolonged grief disorder, proposing that it be included in the next revision of the DSM.[23]

Following are the proposed diagnostic criteria for complicated grief:[24]

  • Criterion A: Person has experienced the death of a significant other, and response involves three of the four following symptoms, experienced at least daily or to a marked degree:
    • Intrusive thoughts about the deceased.
    • Yearning for the deceased.
    • Searching for the deceased.
    • Excessive loneliness since the death.
  • Criterion B: In response to the death, four of the eight following symptoms are experienced at least daily or to a marked degree:
    • Purposelessness or feelings of futility about the future.
    • Subjective sense of numbness, detachment, or absence of emotional responsiveness.
    • Difficulty acknowledging the death (e.g., disbelief).
    • Feeling that life is empty or meaningless.
    • Feeling that part of oneself has died.
    • Shattered worldview (e.g., lost sense of security, trust, control).
    • Assumption of symptoms or harmful behaviors of, or related to, the deceased person.
    • Excessive irritability, bitterness, or anger related to the death.
  • Criterion C: The disturbance (symptoms listed) must endure for at least 6 months.
  • Criterion D: The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

These criteria have not been formally adopted, and thus there is no formal diagnostic category for prolonged grief disorders in the DSM. However, these criteria help in specifying symptoms, the severity of symptoms, and how to distinguish complicated grief from normal grief. Not all health care professionals agree that the duration of "at least 6 months" is the most accurate number, suggesting that the time period may be too short and that 6 months to 2 years may be more accurate.[25]

References:

  1. Bonanno GA, Kaltman S: The varieties of grief experience. Clin Psychol Rev 21 (5): 705-34, 2001.
  2. Jacobs S: Pathologic Grief: Maladaptation to Loss. Washington, DC: American Psychiatric Press, Inc., 1993.
  3. Stroebe MS, Hansson RO, Schut H, et al., eds.: Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. Washington, DC: American Psychological Association, 2008.
  4. Stroebe MS, Hansson RO, Stroebe W, et al., eds.: Handbook of Bereavement Research: Consequences, Coping, and Care. Washington, DC: American Psychological Association, 2001.
  5. Maciejewski PK, Zhang B, Block SD, et al.: An empirical examination of the stage theory of grief. JAMA 297 (7): 716-23, 2007.
  6. Bonanno GA: Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol 59 (1): 20-8, 2004.
  7. Bonanno GA, Neria Y, Mancini A, et al.: Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. J Abnorm Psychol 116 (2): 342-51, 2007.
  8. Casarett D, Kutner JS, Abrahm J, et al.: Life after death: a practical approach to grief and bereavement. Ann Intern Med 134 (3): 208-15, 2001.
  9. Corr CA, Nabe CM, Corr DM: Death and Dying, Life and Living. 2nd ed. Pacific Grove, Calif: Brooks/Cole Publishing Company, 1997.
  10. Knott JE, Wild E: Anticipatory grief and reinvestment. In: Rando TA, ed.: Loss and Anticipatory Grief. Lexington, Mass: Lexington Books, 1986, pp 55-60.
  11. Glick IO, Weiss RS, Parkes CM: The First Year of Bereavement. New York: Wiley-Interscience Publication, 1974.
  12. Parkes CM, Weiss RS: Recovery from Bereavement. New York, NY: Basic Books, 1983.
  13. Silverman PR: Widow-to-widow. Springer Series on Social Work. Vol 7. New York: Springer Publishing Company, 1986.
  14. Bowlby J: Attachment and Loss. Volume III: Loss: Sadness and Depression. New York, NY: Basic Books, Inc., 1980.
  15. Parkes CM: Bereavement: Studies of Grief in Adult Life. New York, NY: International Universities Press, Inc., 1972.
  16. Rando TA: The increasing prevalence of complicated mourning: the onslaught is just beginning. Omega (Westport) 26 (1): 43-59, 1992-1993.
  17. Worden JW: Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. New York, NY: Springer Publishing Company, Inc., 1982.
  18. Kubler-Ross E: On Death and Dying. New York: Macmillan Publishing Company Inc.,1969.
  19. Silver RC, Wortman CB: The stage theory of grief. JAMA 297 (24): 2692; author reply 2693-4, 2007.
  20. Bonanno GA, Boerner K: The stage theory of grief. JAMA 297 (24): 2693; author reply 2693-4, 2007.
  21. PARKES CM: BEREAVEMENT AND MENTAL ILLNESS. 2. A CLASSIFICATION OF BEREAVEMENT REACTIONS. Br J Med Psychol 38: 13-26, 1965.
  22. Prigerson HG, Shear MK, Jacobs SC, et al.: Grief and its relation to post-traumatic stress disorder. In: Nutt D, Davidson JRT, Zohar J, eds.: Post-traumatic Stress Disorder: Diagnosis, Management and Treatment. London, United Kingdom: Martin Dunitz, 2000, pp 163-86.
  23. Prigerson HG, Vanderwerker LC, Maciejewski PK: A case for inclusion of prolonged grief disorder in DSM–V. In: Stroebe MS, Hansson RO, Schut H, et al., eds.: Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. Washington, DC: American Psychological Association, 2008, pp 165-86.
  24. Prigerson HG, Jacobs SC: Perspectives on care at the close of life. Caring for bereaved patients: "all the doctors just suddenly go". JAMA 286 (11): 1369-76, 2001.
  25. Gibson L: Complicated Grief: A Review of Current Issues. White River Junction, Vt: Research Education in Disaster Mental Health, 2003.

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

WebMD Public Information from the National Cancer Institute

Last Updated: September 04, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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