Grief, Bereavement, Grief Reaction

  • Diagnosis
  • Complicated Grief Reaction
  1. General
    1. Symptoms present for 6 months
    2. Results in functional Impairment
    3. Based on expert opinion (Not defined in DSM IV)
  2. Major Criteria (3 of the following, daily or severe)
    1. Intrusive thoughts about deceased
    2. Yearning for deceased
    3. Searching for deceased
    4. Excessive loneliness
  3. Minor Criteria (4 of the following, daily or severe)
    1. Lacks sense of purpose
    2. Decreased emotional responsiveness
    3. Disbelief about the death
    4. Life feels meaningless
    5. Sense that part of self has died
    6. Lost sense of trust of control
    7. Performs harmful behaviors associated with deceased
    8. Excessive irritability or anger about death
  • Clinical communication strategies
  1. Effective strategies
    1. Use the deceased name in place of they or them below
    2. Acknowledge their death
      1. "I am sorry that they are gone"
    3. Talk about the deceased and memories
      1. "What are you remembering about them today"
    4. Bring closure on their death
      1. "...questions about final illness or treatment?"
    5. Talk about grief feelings
      1. "How has their death affected you"
  2. Harmful strategies to avoid
    1. Avoid being too casual or aloof
      1. Quick "Call me" or "How are you"
    2. Avoid pat answers
      1. "They are happy now" or "It is God's will"
    3. Avoid disallowing patient's feelings
      1. "You should be getting over this by now"
  • Management
  • Complicated Grief Reaction
  1. Cognitive behavior therapy (Traumatic grief therapy)
  2. Selective Serotonin Reuptake Inhibitor (SSRI)