Complicated grief: Is there a place in psychiatry?

2017 ◽  
Vol 41 (S1) ◽  
pp. S458-S458
Author(s):  
S.L. Azevedo Pinto ◽  
J. Soares ◽  
A. Silva ◽  
R. Curral
Keyword(s):  
Depressive Disorders ◽  
Complicated Grief ◽  
Adjustment Disorder ◽  
Classification Systems ◽  
Post Traumatic Stress ◽  
Adequate Treatment ◽  
Psychiatric Syndrome ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder

IntroductionGrief is as normal reactive to a significant personal loss. It is characterized by affective, cognitive, behavioural and physiological symptoms. The grieving process is usually divided in five different stages, but in most cases presents a benign course, with decreased suffering and better adaptation to the new context. However, when high levels of emotional suffering or disability persist over a long time period, it becomes a case of complicated grief (CG), which should be adequately addressed.ObjectivesTo review the characteristics of CG, the evidence that supports it as an individual pathological entity, and its place in current classification systems.MethodsWe performed a bibliographic search in Pubmed and PsychInfo, of articles written in English, Portuguese and Spanish, containing the key words: grief, bereavement, psychiatry, classification.ResultsThe main issue regarding grief is the degree to which it is reasonable to interfere with a usually benign process. Since DSM-III bereavement has been referred to as an adaptive reaction to an important loss, which should not be diagnosed as major depressive disorder or adjustment disorder. However, DSM-5 has stated persistent complex bereavement disorder as an independent entity. In fact, CG fulfils the general criteria of every psychiatric syndrome, namely regarding specific diagnosis criteria, differential diagnosis from depressive disorders and post-traumatic stress disorder, and improvement with adequate treatment.ConclusionIt is important to correctly approach CG, since it presents with characteristic diagnosis features and much improvement may be achieved once adequate treatment is provided.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions

2021 ◽  
pp. 104990912198902
Author(s):  
Ron Acierno ◽  
Brooke Kauffman ◽  
Wendy Muzzy ◽  
Melba Hernandez Tejada ◽  
Carl Lejuez
Keyword(s):  
Cognitive Therapy ◽  
Behavioral Activation ◽  
Controlled Trial ◽  
Patient Characteristics ◽  
Department Of Veterans Affairs ◽  
Post Traumatic Stress ◽  
Significant Treatment ◽  
Persistent Complex Bereavement ◽  
Treatment Gains ◽  
Persistent Complex Bereavement Disorder

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.

Genetic determinants of psychic resilience after a diagnosis of cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S596-S596
Author(s):  
M. Christensen ◽  
A. Drago
Keyword(s):  
At Risk ◽  
Psychiatric Disorders ◽  
Depressive Disorders ◽  
Adjustment Disorder ◽  
Genetic Determinants ◽  
Co Morbidity ◽  
Patients At Risk ◽  
Diagnosis Of Cancer ◽  
Competing Interest ◽  
Definition Of

IntroductionCo-morbidity between cancer and psychiatric disorders including adjustment disorder, depressive disorders or angst can seriously influence the prognosis and the quality of life of patients.AimThe identification of the psychological and biological profile of patients at risk for such co-morbidity is not yet available. Classical candidate genes such as the BDNF, the 5-HTLPR and genes whose products are involved in inflammatory events have received some attention, but results are inconclusive.Object and methodsIn the present review the association between cancer and psychiatric disorders is reviewed, a focus on the investigation of the Gene X environment and the epigenetic control over the activation of the HPA axis is proposed as a tool to refine the definition of the biologic profile at risk for co-morbidity between psychiatry and cancer.Results and conclusionA number of genes and socio-demographic variables that may influence risk to suffer from a psychiatric disorder after a diagnosis of cancer is identified and discussed. The identification of such biologic and socio-demographic profile is instrumental in the identification of subjects at risk of a double diagnosis, both somatic and psychiatric. An early identification of such profile risk would pave the way to the implementation of early intervention strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case series: Efficacy of short term EMDR on patients with persistent complex bereavement disorder (PCBD)

2017 ◽  
Vol 41 (S1) ◽  
pp. S360-S361
Author(s):  
F.D. Usta ◽  
A.B. Yasar ◽  
A.E. Abamor ◽  
M. Caliskan
Keyword(s):  
Sleep Disturbances ◽  
Case Series ◽  
Traumatic Loss ◽  
Degree Relative ◽  
Current Case ◽  
Prolonged Grief ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder ◽  
Emdr Therapy

Grief is a normal response to loss of someone to whom a bond was formed; however, prolonged grief is considered pathological. Persistent complex bereavement disorder (PCBD) is defined as a persistent longing for the deceased over 12 months. Several treatment ways have been used for traumatic loss including eye movement desensitization and reprocessing (EMDR). In the current case series, effectiveness of EMDR on three PCBD patients will be indicated. Three patients applied to the clinic with similar complaints based on different traumatic backgrounds; commonly, all experienced death of a first-degree relative. Complaints of the patients were over-thinking about the deceased, sleep disturbances, self-blaming, social isolation, avoiding talks about lost relative, and loss of interest in activities. After pre-interviews, they were advised EMDR therapy. One session of EMDR was applied to two of the patients, and two EMDR sessions were conducted on one of them. After the sessions, the patients reported not feeling guilty about the loss anymore, returning their normal routines, feeling better, and showing decreased avoidance. Additionally, the scores of scales (CAPS, BAI, BDI, and IES-R) significantly declined. EMDR therapy can show successful results in a shorter time than other treatment ways used for PCBD treatment [1].Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder

2021 ◽  
pp. 113916
Author(s):  
Francesca Diolaiuti ◽  
Donatella Marazziti ◽  
Maria Francesca Beatino ◽  
Federico Mucci ◽  
Andrea Pozza
Keyword(s):  
Complicated Grief ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

scholarly journals A cognitive approach to persistent complex bereavement disorder (PCBD)

2017 ◽  
Vol 10 ◽  
Author(s):  
Michael Duffy ◽  
Jennifer Wild
Keyword(s):  
Cognitive Model ◽  
Diagnostic Category ◽  
Post Traumatic Stress ◽  
Cognitive Approach ◽  
Prolonged Grief ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

AbstractPersistent complex bereavement disorder (PCBD) has been included in the appendix of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study, and a new diagnostic category of prolonged grief disorder (PGD) is likely to be added to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) (Maercker et al., 2013). Whilst there is increasing evidence that prolonged grief has distinct characteristics (Bryant, 2012), there are clinical features that overlap with post-traumatic stress disorder (PTSD), such as intrusive memories, emotional numbing, and avoidance of trauma or loss reminders. Here we describe how the cognitive model for persistent PTSD (Ehlers and Clark, 2000) and trauma-focused cognitive therapy for PTSD (Ehlers et al., 2005) have been helpful in treating persistent complex grief.

scholarly journals Complicated grief: recent developments in diagnostic criteria and treatment

2018 ◽  
Vol 373 (1754) ◽  
pp. 20170273 ◽  
Author(s):  
Satomi Nakajima
Keyword(s):  
Diagnostic Criteria ◽  
Complicated Grief ◽  
Behavioural Therapy ◽  
Pathological State ◽  
Human Beings ◽  
Duration Of Symptoms ◽  
Related Disorder ◽  
Biological Studies ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as ‘complicated grief (CG)’. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders , 5th edn) proposed ‘persistent complex bereavement disorder’ as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 ( International classification of diseases , 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG. This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals’.

Therapeutic Approach to Complicated Grief–An Example of Group Psychotherapy in Psychiatric Patients

2017 ◽  
Vol 41 (S1) ◽  
pp. s772-s773
Author(s):  
J. Soares ◽  
S.L. Azevedo Pinto ◽  
A.C. Pinheiro ◽  
S. Pacheco ◽  
R. Curral
Keyword(s):  
Traumatic Stress ◽  
Group Intervention ◽  
Psychiatric Patients ◽  
Complicated Grief ◽  
Assessment Tools ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Competing Interest ◽  
Meta Analyses ◽  
The Impact

Introduction.Complicated Grief (CG) affects 7–10% of the grieving individuals in the general population. However, the incidence is much higher in psychiatric patients, reaching 70% in most samples. These individuals present many risk factors for such condition, demanding a particular attention and treatment approach. Most studies have shown that pharmacological treatment may help relieving depressive and anxiety symptoms, although they do not promote a consistent improvement of the grieving scenario. Several meta-analyses have recognized different psychological interventions as effective in dealing with the loss, decreasing psychological suffering and promoting adaptation. It is accepted that the benefits of the intervention overcome any possible harm.Objectives.To evaluate the impact of a group intervention (12 sessions) in pharmacologically stabilized psychiatric patients presenting with CG.Methods.Patient selection was performed through a clinical interview and the fulfilment of the following psychometric tests: Complicated Grief Inventory; the Impact of Events Scale; Beck Depression Inventory; Social Support Scale. These assessment tools were also used to evaluate the impact of the intervention performed.Results.After the psychotherapeutic intervention, there were significant differences in the levels of depressive and post-traumatic stress symptoms.Conclusion.Group intervention in CG has proven effective in this population, specially regarding depression and post-traumatic stress levels.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis

2018 ◽  
Vol 48 (14) ◽  
pp. 2439-2448 ◽  
Author(s):  
Matteo Malgaroli ◽  
Fiona Maccallum ◽  
George A. Bonanno
Keyword(s):  
Network Analysis ◽  
Graphical Models ◽  
Community Sample ◽  
Self Report ◽  
Post Traumatic Stress ◽  
Dsm 5 ◽  
Persistent Complex Bereavement ◽  
Core Symptoms ◽  
Persistent Complex Bereavement Disorder ◽  
Conjugally Bereaved

AbstractBackgroundComplicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N= 305).MethodsGaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss.ResultsIn the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters.ConclusionsThe network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.

Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients

2016 ◽  
Vol 47 (4) ◽  
pp. 608-615 ◽  
Author(s):  
C. Mauro ◽  
M. K. Shear ◽  
C. F. Reynolds ◽  
N. M. Simon ◽  
S. Zisook ◽  
...  
Keyword(s):  
Clinical Research ◽  
Comparison Group ◽  
Clinical Sample ◽  
Complicated Grief ◽  
Assessment Instrument ◽  
Treatment Seeking ◽  
Prolonged Grief ◽  
Persistent Complex Bereavement ◽  
Clinically Significant ◽  
Persistent Complex Bereavement Disorder

BackgroundPersistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.MethodTwo groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.ResultsPCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2–75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4–65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8–100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.ConclusionsBoth proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.

A Case Study: Effects of EMDR Therapy on a Patient with Persistent Complex Bereavement Disorder (PCBD)

2017 ◽  
Vol 41 (S1) ◽  
pp. S728-S728 ◽  
Author(s):  
A.B. Yasar ◽  
A.E. Abamor ◽  
F.D. Usta ◽  
S. Erdogan Taycan ◽  
M. Zengin Eroglu
Keyword(s):  
Small City ◽  
Working Mother ◽  
Loved One ◽  
Her Family ◽  
Marital Dissatisfaction ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder ◽  
Emdr Therapy

BackgroundLoss of a loved one is a distressing event that may result in grief characterized by emotional distress, longing of the dead, and dysfunctionality. Persistent complex bereavement disorder (PCBD) is differentiated by extended and damaging bereavement [1], which is being treated by some with EMDR [2]. In this study, the effects of an EMDR session on a patient with PCBD will be analyzed.CaseG.Ö. (45) is a married housewife who had been working, mother of a kid and a baby. She has lived with her family and her mother in a metropolitan city until her mother died a year ago, unexpectedly. Then, she quitted her job and they moved in a small city upon her husband's wish. The inpatient had complaints such as active suicidal thoughts, marital dissatisfaction and an ongoing deep sadness. EMDR therapy is applied on her grief and dysfunctional beliefs.ConclusionAfter one session of EMDR, her mood improved, her ruminations declined, she sought job, and became hopeful for the future. In our case, even one session of EMDR let remarkable improvements on PCBD. Indeed, as for other trauma-related issues, EMDR therapy can be utilized on PCBD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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