Grief, Loss & Bereavement

• Define loss.

  When you no longer have something
• Define grief.

  What we feel when we are bereaved

  'emotional & psychological reaction to loss'
• Define bereavement.

  The process occurring after the death, during which individuals learn to adjust to the loss
• Define mourning.

  Expression of grief

  Outward manifestations
• What are the types of grief?

  Normal

  Anticipatory

  Inhibited

  Complicated/prolonged

  Delayed

  Disenfranchised

  Absent grief

  Exaggerated
• What is normal grief?

  6-12 months

  May find day to day life/activities difficulty

  Numbness, shock, pain

  Waves of emotion
• What is anticipatory grief?

  An impending loss (e.g. terminal diagnosis)

  Can be as intense as other forms of grief
• What is inhibited grief?

  Grief has been held back, restrained or prevented from being fully experienced

  Can manifest physically
• What is complicated/prolonged grief?

  Completely overwhelmed, obsessive, irrational thoughts, catastrophising

  Typically need counselling
• What is delayed grief?

  Initial grief is blocked (e.g. losing a parent at a young age)
• What is disenfranchised grief?

  Grief is not socially acceptable (e.g. abortion, limb)
• What is absent grief?

  No grief

  In denial?
• What is exaggerated grief?

  Grief remains prominent in a person's life years after loss

  May include psychiatric illness
• What are 4 factors that effect a bereaved person?

  Personal vulnerability

  Relationship with the deceased person

  Events & circumstances leading up to death

  Amount of social support
• Cultural & religious beliefs affect how people display grief & feel they should behave during bereavement.

  Rituals offer a sense of stability & security at times of loss.

  Every culture has its own thoughts about the meaning of life & what happens after death
• What is the mourning process?

  A series of phases that must be passed through before grief can be resolved
• What are Parkes' stages of normal bereavement?

  Alarm - high distressed with physiological arousal

  Numbness - state of being emotionally disconnected, form of self-protection

  Pining - constantly reminded of deceased

  Depression - thoughts that they should have died with deceased, loss of appetite, insomnia

  Recovery & reorganisation - acceptance of loss
• What are the 5 stages of grief?

  Denial

  Anger

  Bargaining

  Depression

  Acceptance

  
• What is pathological (abnormal grief)?

  Characteristic as excessive and/or prolonged grief, or even absent grieving with abnormal denial of bereavement

  Usually stuck in grief, with insomnia & repeated dreams of deceased

  Inability to 'say goodbye' to the loved person & dealing with their effects
• What is the dual process of coping with bereavement?

  Bereaved people move between confronting grief & avoiding grief

  Focuses on loss itself (memories, yearning), then restoration (adjusting)

  
• Describe 'growing around grief'.

  Bereaved do not return to the way they were

  Develop a new way of living that incorporates a continuing bond

  Size of grief doesn't change

  
• What are the determinants of grief?

  Preceding the bereavement

  • childhood experience
  • previous life crisis
  • mental illness
  • nature of relationship with deceased

  Present circumstances

  • age
  • gender
  • religion
  • type of personality
  • cultural background

  Circumstances after death

  • amount of support
• What are the differential diagnosis of prolonged grief disorder?

  Typical or 'normal' grief

  Major depressive episode/disorder - bereavement may trigger a depressive episode distinct from grief

  Acute stress disorder/PTSD
• What are the possible treatments for prolonged grief?

  Guided mourning

  Psychoeducation about grief

  Antidepressants can be given (not very effective for grief, but may improve co-occurring depressive symptoms)
• What is Dyer's model of grief?

  6 different domains affected by grief

  • spiritual
  • physical
  • emotional
  • Occupational
  • social
  • intellectual