Prolonged Grief, a New Psychological Disorder?

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Say it's been two years since your father died and your mom still won't socialize or quit talking about wanting to join him. Or you can't shake a sense of meaninglessness to your life as the anniversary approaches of the death of someone close to you. Sounds like prolonged grief disorder, psychiatrists might say.

Prolonged grief disorder (PGD)* -- previously called "complicated grief" – may soon be a recognized mental disorder. Researchers at the Dana-Farber Cancer Institute in Boston developed and tested standard criteria for identifying the condition, based on the input of a team of experts in bereavement and mood/anxiety disorders. That's a major hurdle on the way to inclusion in the next edition of the Diagnostic Statistical Manual of Mental Disorders (DMV-5), the psychiatric care bible for diagnosing problems. The research was done with widows and widowers but is thought to be applicable to the general population.

None of this is to say that grieving is unhealthy or unnatural. To the contrary: Mourning is a necessary process that also happens to be hard and horrible, and takes many different shapes, depending on the individuals and their relationship. But with prolonged grief disorder, the grief reaction is so prolonged and causes such psychological distress as to create substantial disability. Laypeople tend to say someone is "paralyzed with grief" or "unable to move on."

Wait, you may be thinking. Is this just medicalizing grief? The psychiatrists make a persuasive case that the answer is no. For one thing, along with poorer quality of life, the health risks associated with prolonged grief disorder include increased rates of suicide, cancer, immunological dysfunction, hypertension, heart problems, and other adverse health behaviors.

And the good news: Talk therapy geared to this prolonged grief can successfully treat it. (Not a new "instant-fix" pill.) Not to make the griever "get over" the loved one, but to allow him or her to be able to cope with the loss in functional, healthful ways. That's why diagnosis is so important. It can steer those in need to the right kind of support.

What to watch out for

Warning signs of prolonged grief disorder include yearning to be reunited to the extent that it causes physical or emotional suffering, as well as at least five of the nine following symptoms still being experienced six or more months after the loss:
• Emotional numbness
• A stunned, dazed, or shocked feeling
• A feeling that life is meaningless
• Bitterness or anger over the loss
• Mistrust of others
• Difficulty accepting the loss
• Avoidance of reminders of the deceased
• Difficulty moving on with life
• A feeling that part of oneself has died

Some people don't begin to have symptoms until six months after the loss; they have higher incidence of thinking about suicide and lower quality of life. Others experience acute symptoms immediately that continue for a year or more; they also tend to experience major depression, post-traumatic stress disorder, and generalized anxiety. People in both situations have a 10-times higher risk for a depressive disorder than those whose grief runs a more conventional course or who are treated.

Final food for thought:

Is our current "way of death" contributing to an uptick in prolonged grief disorder? There's no data (because this isn't yet a recognized disorder). But that's what Canadian doctor Stephen Workman theorizes in a related commentary ** in the journal Public Library of Science. He notes that the modern emphasis at the end of life on hope, survival, and high-tech "fighting" to prolong life, even in final-stage disease where the prognosis is clear, may leave families all the more unprepared for eventual death.

Workman writes: "I remember a middle-aged man whose father was dying; each day shorter of breath and one day closer to death. His son was continually requesting treatments his father did not want or need. “How long do you hope for your father to live?” I asked.

“I don't ever want my father to die," [the man said].

Therein lies a rough road.
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* http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000121;jsessionid=4ED1FA2260A0EF5C70A09022DBEAA23D

** http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000122;jsessionid=2F6A8B5C49B5BABE206F2287FCA02395