Rethinking Grief


Grief, say researchers, deserves a second look.

While we commonly associate the condition with obvious losses, the course of grief does not always follow a pattern or predictable timeline, as we might think.

Sometimes grief is complicated, and sometimes it is prolonged. For this reason, the diagnosis of persistent complex bereavement disorder (PCBD), was recently added as a condition for further study in the Diagnostic Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Also referred to as prolonged grief disorder or complicated grief, PCBD is associated with long-term intense distress and suffering. It affects about seven to 15 percent of those grieving the loss of a loved one, and is typically diagnosed when persistent and severe grief continues beyond twelve months after the death of a loved one, resulting in functional impairment.

In looking to assess these criteria, Dr. Stephen Cozza and his team examined responses of study participants from USU’s National Military Family Bereavement Study, which is examining the impact of military service member death on family members. Participants included surviving family members of military members who died, by any cause, since Sept. 11, 2001.

What the researchers found should have us all reconsidering grief: even with the proposed DSM-5 criteria for PCBD, the individual’s actual experiences of clinically impairing grief were not accurately captured (Cozza et al., 2016).

What Dr. Cozza suggests is that when assessing grief, and a diagnosis of PCBD, symptoms such as prolonged distress and disability associated with the death of a loved one, persistent yearning or sorrow, and preoccupation with the deceased should be considered.

However, where a diagnosis of PCBD requires that six of twelve additional symptom criteria be required as currently proposed by DSM-5, we should be requiring a much less stringent criteria – such as meeting only one criteria. Further, the researchers encourage clinicians to remain vigilant to suicidal thinking, which is prevalent in those with persistent and impairing grief.

“It is imperative for clinicians to have reliable criteria to accurately identify and diagnose those individuals suffering from prolonged and impairing grief,” notes Dr. Cozza.

Related Online Continuing Education (CE) Courses:

Grief: The Reaction to LossGrief: The Reaction to Loss is a 2-hour online continuing education (CE/CEU) course that teaches healthcare professionals how to recognize and respond to grief.

Grief is the reaction to loss, and any kind of loss can trigger grief. People grieve for the loss of someone they love, but they also grieve for the loss of independence, usefulness, cognitive functioning, and physical abilities. Grief is also a lifelong process: a journey rather than a disease that is cured. It changes over time to deal with different kinds of losses. It is an experience that is intellectual, physical, spiritual, and emotional. It is affected by the person’s culture, support system, religious beliefs, and a host of other factors.

Grief is often not recognized by healthcare professionals, in patients or themselves. This course will teach healthcare professionals to recognize grief, as well as how to respond appropriately to the grieving person. The progression of aging and dying will be discussed in order to normalize the process, one of the most important aspects of working with a grieving person. Screening guidelines for depression, suicide risk, and grief are included, as are treatment strategies for anticipatory and complicated grief. A final section on compassion fatigue, burnout, and secondary stress includes strategies for professional self-care. Course #21-25 | 2018 | 35 pages | 15 posttest questions

Caregiver Help: Depression and GriefCaregiver Help: Depression and Grief is a 2-hour online video-based continuing education (CE/CEU) course that addresses caregiver depression and grief and provides strategies to help the caregiver cope.

The emotional stress of caring for persons who are aging, chronically ill or disabled can be debilitating for family members as well as professional caregivers. This course addresses caregiver depression and grief and provides a three-step process that can help develop an attitude of creative indifference toward the people, situations and events that cause emotional stress. It offers suggestions for dealing with preparatory grief, an experience shared by families and professionals as they cope with the stress of caring for someone who will never get well. In the process, it also explains the differences between reactionary depression and clinical depression. By gaining insights into the process of losing someone over an extended period of time, the mental health professional will be in a better position to understand the caregiver’s experience with depression and grief and provide both empathy and strategies for implementing a self-care plan. This course includes downloadable worksheets that you can use (on a limited basis) in your clinical practice. The course video is split into 3 segments for your convenience. Closeout course #20-92 | 2014 | 20 posttest questions

The Grieving SelfThe Grieving Self is a 3-hour online continuing education (CE) course that looks at stories of the bereaved to determine the major issues to address to reconnect those who grieve to a stable sense of self.
The annual number of deaths reported in the United States in the early part of this century was 2.4 million, about four per minute. This course looks at the stories of a few of those who are recently bereaved to determine the major issues for those who grieve: aloneness, loss of self, social connections, anniversaries and holidays, self and others’ expectations, the need to continue living, ambivalence of recovery, grief dreams, medical problems. Studies are reviewed which indicate some researchers’ conclusions as to: 1) Gender differences between men and women who grieve; there are important questions regarding the recruitment of subjects and the data gathering process for gender differences research. 2) And, who among the grief survivors are best served by counseling and psychotherapy. This author, while agreeing with much of the research, challenges the belief that the emotional loneliness suffered by the bereaved is the single, major dynamic of the bereaved, and can only be alleviated through passage of time. It is felt that an effort to reconnect those who grieve to a stable sense of self can help the bereaved regain better function and reduce the length of the time they are consigned to painfully distressing lives. Course #30-49 | 2010 | 34 pages | 20 posttest questions

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