Grief Reaction and Prolonged Grief Disorder

Excerpt

Grief is a natural and universal response to the loss of a loved one. The grief experience is not a state but a process. Most individuals recover adequately within a year after the loss; however, some individuals experience an extension of the grieving process. This condition, identified as prolonged grief disorder, results from failure to transition from acute to integrated grief. Symptoms of acute grief include sadness, tearfulness, and possibly insomnia, and typically require no treatment. Prolonged grief disorder involves intense, painful emotions associated with a lack of adapting to the loss of a loved one that persists for more than 1 year in adults and more than 6 months in adolescents or children. This condition is estimated to affect as many as 7% of bereaved individuals.

The terms grief, mourning, and bereavement have slightly different meanings:

1. Grief is a person's emotional response to loss.

2. Mourning is an outward expression of that grief, including cultural and religious customs surrounding the death. Mourning is also the process of adapting to life after loss.

3. Bereavement is a period of grief and mourning after a loss.

4. Anticipatory grief is a response to an expected loss. It affects both the person diagnosed with a terminal illness as well as their families.

5. Disenfranchised grief, as defined by Kenneth Doka (1989), is "grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported." Some examples could include grief related to the loss of a pet, perinatal losses, and loss of a body part, and this condition can be present in healthcare workers, with losses in the form of patient deaths.

Intense grief can have physical consequences and may trigger the acute onset of myocardial infarction, particularly in people with higher baseline cardiovascular risk. There is a correlation between complicated grief and acute coronary syndrome. Takotsubo cardiomyopathy, also called broken heart syndrome or stress cardiomyopathy, is another cardiovascular syndrome triggered by intense grief. This condition is a weakening of the left ventricle leading to apical ballooning caused by severe emotional or physical stress, such as losing a loved one, sudden illness, a severe accident, or a natural disaster (eg, earthquake). Takotsubo cardiomyopathy occurs in women 90% of the time, most commonly in postmenopausal women, and often resolves within a month.