Prolonged grief disorder

• Prolonged grief disorder is characterized by this intense and persistent grief that causes problems and interferes with daily life.
• Normal grief:

  • Typical symptoms: disbelief, shock, numbness, anger, guilt, sadness and fearfulness, disturbed sleep and appetite, seeing or hearing the dead
  • Usually symptoms gradually reduce in intensity
  • Typically lasts up to 12 months
  • Intensity of grief is usually greatest for the loss of a child
• Abnormal grief:

  • Very intense, prolonged, or delayed (or absent), or where symptoms outside the normal range are seen
  • Preoccupation with feelings of worthlessness
  • Thoughts of suicide
  • Excessive guilt
  • Marked slowing of thoughts and movements
  • Hallucinations (other than the image or voice of deceased)
• DSM-5:

  • Significant loss and at least 5 of the following symptoms at least daily or to a disabling degree
  • Feeling emotionally numb, stunned, or life is meaningless
  • Experiencing mistrust
  • Bitterness over the loss
  • Difficulty accepting the loss
  • Identity confusion
  • Avoidance of the reality of the loss
  • Difficulty moving on with life
• Management:

  • Generally normal grief does not require specific treatment
  • If there are symptoms of anxiety/depression that are significantly impacting the patient, treatment with antidepressants should be considered regardless of diagnostic criteria
  • Abnormal grief - antidepressants alongside counselling e.g. grief counselling that incorporates components of CBT