Characteristics of Complicated Grief
Dr. Randi Fredricks, Ph.D.
Grief counseling is one of the most common types of counseling. Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which an attachment or bond was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, philosophical, and spiritual dimensions.
While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss. Bereavement is the process of grieving and letting go of a loved one who has died.
Complicated grief is a recently recognized condition that occurs in approximately 7% of bereaved people seeking help for anxiety. People with complicated grief ruminate about the circumstances and consequences of the death of a loved one. In response to their inability to comprehend the finality of the loss, they partake in excessive avoidance of reminders and are frequently overwhelmed by intense emotions.
The treatment of complicated grief is important not only because it produces tremendous sadness, but it has been identified as a contributing factor in hospitalizations, suicide, increased health risks, and use of outpatient mental health services.
It is worth noting that the treatment and categorization of grief and bereavement by psychotherapists are not without controversy in the mental health field. Bereavement is a diagnostic category currently identified with a V code in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
In the DSM-IV, V codes identify conditions other than a disease or injury, but are not necessarily a primary diagnosis. The American Psychiatric Association (APA) has proposed two important changes to bereavement in the next edition of the DSM: 1) removal of the bereavement exclusion in the diagnosis of major depression, and 2) adding complicated grief as a new diagnosis.
Complicated Grief Therapy
Complicated grief is typically treated with a type of psychotherapy called complicated grief therapy. It’s similar to psychological counseling techniques used for post-traumatic stress disorder (PTSD). In the therapy sessions, the client usually explores topics as grief reactions, complicated grief symptoms, adjusting to loss and redefining life goals.
Other techniques include having conversations with lost loved one and discussing the circumstances of the death to help reduce distress. Psychotherapy can also improve coping skills and reduce feelings of blame and guilt.
This controversy highlights the difficulty that therapists have in diagnosing and treating complicated grief. It also suggests that the APA’s newly proposed diagnostic criteria might encourage doctors to prescribe antidepressants for bereavement and grief. Of course, it is reasonable to assume that this is already occurring.
Research has indicated that antidepressants are currently prescribed primarily on the basis of anecdotal evidence shared between patient and doctor. Since 50% of all depressed patients fail to respond to antidepressant medication of any kind, these drugs may have a similar failure rate in treating complicated grief and associated disorders.
Boelen PA, et al. “Complicated Grief, Depression, and Anxiety As Distinct Postloss Syndromes: A Confirmatory Factor Analysis Study,” American Journal of Psychiatry (November 2005): Vol. 162, No. 11, pp. 2175-77.
Didion J. The Year of Magical Thinking. Alfred A. Knopf, 2005.
Glass RM. “Is Grief a Disease? Sometimes,” Journal of the American Medical Association (June 1, 2005): Vol. 293, No. 21, pp. 2658-60.
Hensley PL. “Treatment of Bereavement-Related Depression and Traumatic Grief,” Journal of Affective Disorders (May 2006): Vol. 92, No. 1, pp. 117-24.
Horowitz MJ, et al. “Diagnostic Criteria for Complicated Grief Disorder,” American Journal of Psychiatry (July 1997): Vol. 154, No. 7, pp. 904-10.
About the Author
Randi Fredricks, Ph.D. is a practicing therapist, researcher and author specializing in the treatment of anxiety, depression, addiction, eating disorders, and related disorders. Dr. Fredricks is a best-selling author of several books on complementary and alternative treatments for mental health. For more information on Dr. Fredricks work, visit her practice website www.DrRandiFredricks.com.