Complicated Grief

Vignette:

A Palliative Care Team received a call from the mother of one of their patients who died suddenly ten months ago. This 61 year old female reports difficulty staying asleep at night. She expresses no interest in anything outside of work. Chronic rumination about the last day of her daughter's life is present as is a deep yearning for her daughter and intense feelings, as if the death occurred more recently.

How do you assess the situation and what recommendations for treatment would you make?

Discussion:

Given the duration (at least six months post DOD), intensity of her symptoms and her decreased ability to function, suspecting complicated grief is warranted. Further assessment is in order about the quality of life since her daughter died, the meaning she associates with the loss, her ability to cope with prior losses, and any other physical and emotional issues she's experiencing. Secondary losses must also be considered; financial, role changes, spiritual and social disruptions.

Complicated Grief may include chronic and disruptive yearning, difficulty accommodating to the death, rumination about the death, numbness and detachment from daily living, meaninglessness, and agitation. It can be difficult to distinguish between Major Depressive Disorder (MDD) and Complicated Grief. Complicated Grief has been shown to be a distinct syndrome with symptoms not seen in MDD and whose inclusion in the DSM-V as a separate mental disorder is currently under discussion. Unlike MDD, the griever's sense of self-worth is not impacted. Additionally, the disruptive emotions associated with the grieving experience are more variable and less persistent than with MDD.

Studies indicate that psychological treatment is appropriate and beneficial in resolving Complicated Grief. Psychotherapists specializing in the treatment of complicated grief are the appropriate referral for this individual and can provide the best tools for further assessment and intervention.

Please send your comments to info@palliativemed.org

References:
Jacobs, Mazure, & Prigerson, 2000
Prigerson & Maciejewski, 2005; Prigerson et al., 1999

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