Prolonged Grief Disorder: A New Mental Health Diagnosis
Written by: Erin Mitchell, MSW, LCSW and Kat Harris, PhD, LCP
While grief and the process of grieving can be a normal and a healthy experience, sometimes a significant loss and the grief associated with it can become a problem for someone in that it starts to seriously impact their ability to function, their ability to maintain relationships, etc. and may cause significant related symptoms such as depression, anxiety, post traumatic stress, substance use, etc. Therefore, clinical intervention may be useful or needed in order to help support the individual in processing the loss and re-creating meaning in their lives and to help reduce symptoms such as depression and anxiety.
Previously, grief reactions that caused significant distress or impairment were designated under the “Other Specified Trauma - and Stressor-Related Disorders” category within the diagnostic criteria for mental health disorders. The technical term for it had sometimes been referred to as “Persistent Complex Bereavement Disorder” and denoted as a specifier under the trauma and other stressor related category. Sometimes significant and persistent grief reactions were also referred to as “Complicated Grief.”
Prolonged Grief Disorder
In the new text-revision of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR), “Prolonged Grief Disorder” has officially been added to better represent significant and persistent grief reactions and highlight how impairing and devastating complex grief reactions can be. Symptoms might include: identity disruption (e.g., feeling as though part of oneself has died), denial or disbelief about the death, avoidance of reminders that the person is gone, intense emotional pain (e.g., anger, bitterness, deep sorrow), difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future), emotional numbness, feeling that life is meaningless, and intense loneliness (i.e., feeling alone or detached from others). An individual with Prolonged Grief Disorder may experience intense yearning for their lost loved one and may become preoccupied by memories of their loved one or have intrusive distressing memories of their loved one.
While intense grief at the loss of a loved one can be very normal, for some individuals, their experience of grief and the intensity and duration of their symptoms may suggest that they may have Prolonged Grief Disorder. Everyone’s journey through grief is as unique as the type of loss and the value that an individual placed on what or who they lost.
Treating Grief Might Include the Following:
Helping the individual reach out to supportive people and decrease isolation from others. A supportive person may include a family member, a friend, spouse, or support group. Social support can be a significant protective factor against unhelpful ways of coping and more serious symptoms of depression or anxiety. Support systems also provide the opportunity for healthy processing of the loss.
Express feelings in a healthy way and help manage difficult and intense emotions. This might also include talking about the loss and the circumstances surrounding the loss. In the past, grief was thought to have steps that an individual would walk through until acceptance was obtained. Now it is seen as a fluid state that allows for variance and fluctuation. This means that the emotions experienced as a result of grief may ebb and flow. Grief episodes may be triggered by a predictable person, event, or item; or may be completely unpredictable and seemingly strike out of the blue. Grief features a wide variety of emotions, sometimes even within a day. For many people, grief may feel like it takes over their lives for a time. A therapist can gently walk alongside you through this turbulent time and help you find ways to express these difficult emotions.
Help the individual take time to heal. This is easier said than done. Ultimately, in order to be successful at being patient with yourself after loss, it is important to have healthy expectations of how long the process of reaching acceptance will take. There is no timeline for grief, however for many people the intensity of the grief they feel decreases over time as they work to process their feelings and work through the loss. How long this may take depends on a wide variety of factors including: relationships, grief experiences, the nature of the loss, and many more variables. One’s experiences with grief should not be compared to anyone else’s individual experience of grief. Again, an individual’s experience of grief is uniquely theirs.
Help the individual start thinking about the future and establish new meaning in their lives without their loved one. For some individuals, imagining a meaningful life without their loved one might seem impossible. A therapist can help the person slowly start to allow themselves to start thinking about the future. Finding meaning can mean very different things to everyone and is not something that anyone else can determine for you. It might mean re-evaluating your own values, purpose, or life. It might mean examining your beliefs around death and life. It might mean finding ways to honor and remember your loved one and carry on their memory and legacy.
Help the individual stop or reduce avoidance of reminders of the loved one. While avoidance might work in the short-term, it can cause problems in the long term, including keeping the person stuck and isolated. Avoidance may reduce opportunities for re-establishing meaning, and learning that they are capable of getting through the loss and navigating memories of their loved one. It's important that the person find a way back into living.
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