Persistent Complex Bereavement Disorder
PCBD is a psychiatric diagnosis that is made when a person has become stuck in their grieving process for a period of at least 12 months since the death of the loved one
This diagnosis would be appropriate in situations in which an individual is:7
- Suffering from intensely distressing grief, related to the death of a loved one
- Experiencing difficulties in functioning in one or more areas of their life
PCBD has been found to occur in approximately 2-5% of individuals who are suffering from grief.7
What Is Uncomplicated Grief
Some investigators have attempted to define discrete stages of grief, such as an initial period of numbness leading to depression and finally to reorganization and recovery. However, most modern grief specialists recognize the variations and fluidity of grief experiences, that differ considerably in intensity and length among cultural groups and from person to person , . To date, no grief stage theory has been able to account for how people cope with loss, why they experience varying degrees and types of distress at different times, and how or when they adjust to a life without their loved one over time.
How long does grief last? The intensity and duration of grief is highly variable, not only in the same individual over time or after different losses, but also in different people dealing with ostensibly similar losses. The intensity and duration is determined by mul-tiple forces, including, among others: the individuals preexisting personality, attachment style, genetic makeup and unique vulnerabilities age and health spirituality and cultural identity supports and resources the number of losses the nature of the relationship the relation type of loss . Certainly, many of these factors also contribute to the proclivity for complicated grief, major depression, and other adverse consequences. Nonetheless, there are general guidelines to help the clinician determine the expected phenomenology, course, and duration of uncomplicated grief.
Coping With Bereavement And Loss When You Already Have Depression
Sadly, grief is something we will all face at some point in our lives. Grief can be caused by the death of someone we love, or by other circumstances such as losing a job, losing a pet, the deterioration of our health, moving house, or a relationship ending, the effects are very similar.
When we are already coping with depression, the added pressure of dealing with such a loss can seem too much to bear. We are going to look at the way we cope with grief and give you some tools to help you through.
Everyones response to grief will be different, however, there are many common experiences we share when we lose someone close to us. These can include:
Loss of appetite or overeatingDifficulty making decisionsAggressionSelf-medication
The first thing you need to realise is that all these symptoms, and others, are normal. There is no right way or indeed wrong way to cope with grief. Your body has received a big shock and many of the reactions, particularly the physical ones, are our bodies natural fight or flight reflex kicking in.
By knowing that these reactions are normal and that they will pass, it can make it easier to cope with the process. It will be painful, and nothing we can do or say can take that away. Life will forever be changed. However, you will, in time, learn to accept your new normal and the pain will ease.
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Grieving: Facing Illness Death And Other Losses
Grief is a persons normal, healthy response to a loss. It describes the emotions you feel when you lose someone or something important to you. People grieve for many different reasons, including:
- Death of a loved one, including pets.
- Divorce or changes in a relationship, including friendships.
- Changes in your health or the health of a loved one.
- Losing a job or changes in financial security.
- Changes in your way of life, such as during retirement or when moving to a new place.
The loss that triggers grief isnt always physical. You can experience grief if you or a loved one are diagnosed with a major disease or face a serious illness. You may grieve the future plans you had made, or the ways life will change.
Grief is different for everyone. It can include many emotional and physical symptoms, including:
- Feelings: Anger, anxiety, blame, confusion, denial, depression, fear, guilt, irritability, loneliness, numbness, relief, sadness, shock, or yearning.
- Thoughts: Confusion, difficulty concentrating, disbelief, hallucinations, or preoccupation with what was lost.
- Physical sensations: Dizziness, fast heartbeat, fatigue, headaches, hyperventilating, nausea or upset stomach, shortness of breath, tightness or heaviness in the throat or chest, or weight loss or gain.
- Behaviors: Crying spells, excessive activity, irritability or aggression, loss of energy, loss of interest in enjoyable activities, restlessness, or trouble sleeping.
Emotional Symptoms Of Grief
Shock and disbelief. Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If a pet or someone you love has died, for example, you may keep expecting them to show up, even though you know theyre gone.
Sadness. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.
Guilt. You may regret or feel guilty about things you did or didnt say or do. You may also feel guilty about certain feelings . You may even feel guilty for not doing more to prevent your loss, even if it was completely out of your hands.
Fear. A significant loss can trigger a host of worries and fears. If youve lost your partner, your job, or your home, for example, you may feel anxious, helpless, or insecure about the future. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
Anger. Even if the loss was nobodys fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.
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What Things Might Help Resolve Grief
Acknowledge and accept both positive and negative feelings.
Allow plenty of time to experience thoughts and feelings.
Confide in a trusted person about the loss.
Express feelings openly or write journal entries about them.
Find bereavement groups in which there are other people who’ve had similar losses.
Remember that crying can provide a release.
Seek professional help if feelings are overwhelming.
Practice These Coping Skills Every Day
I recommend doing many if not all of the following coping skills and techniques once a day when experiencing depression. Its important to know you probably wont be motivated to do any of them at first because depression frequently saps motivation. In other words, know that its normal to feel unmotivated until youre halfway done.
The patients I work with who frequently practice these coping skills get better.The seven techniques can be memorized with the acronym MY PEERS.
1. Meaning: Find small ways to be of service to others.
Find personal meaning by serving something larger than yourself. Remember service doesnt have to be big to count. Consider this, Success, like happiness, cannot be pursued it must ensue as the unintended side effect of ones personal dedication to a course greater than oneself. Viktor E. Frankl, Mans Search for Meaning
2. Your goals: Find workable goals that give you a sense of accomplishment.
Most people feel guilty when talking about goals because they set unreasonable or unworkable goals. A goal is workable if its:
If something goes wrong with your goal, adopt a what can I learn from this? attitude . Also, be careful when comparing your progress with others. We usually compare our biggest weakness with another persons biggest strength. This is unfair .
3. Pleasant Events: Schedule pleasant activities or events.
4. Engagement: Stay in the present.
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How Psychologists Can Help
Psychologists are trained to help people better handle the fear, guilt or anxiety that can be associated with the death of a loved one. If you need help dealing with your grief or managing a loss, consult with a psychologist or other licensed mental health professional. Psychologists can help people build their resilience and develop strategies to get through their sadness. Practicing psychologists use a variety of evidence-based treatments most commonly psychotherapy to help people improve their lives. Psychologists, who have doctoral degrees, receive one of the highest levels of education of any health care professional.
This article was adapted from a March 2011 post by Katherine C. Nordal, PhD.
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The Importance Of Support During The Grief Process
During the time of bereavement and throughout the grief process, a grieving person needs a lot of emotional support. You can read more in Grief and Bereavement. Finding support can be the key to a persons recovery and acceptance of the loss. Family members, friends, support groups, community organizations, or mental health professionals can all help.
The grieving person must travel through the grief process, and should be allowed to move through it at their own pace. For some people, the grieving process can go on for a long time. This happens more often when a person was very close to the deceased. Sometimes this leads to what is known as complicated grief.
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Depression Caused By Grief
Grief is a sadness caused due to loss of family member or friend. It is an emotional and psychological condition due to loss of loved one. Different individuals suffer grief in different ways. Some grieve on the death or loss of loved one and then overcome it after some time. Some might grieve for the loved one for very long time. This can lead the griever, effects of depression and onto the depression stage. If you want to get depression information, then various books, websites are available to help you out.
Losses Within The Loss
When someone dies you might experience many losses. Part of grieving is about recognizing what you have lost, and loss comes with many changes that are not always immediately visible. There is the physical loss of the person and their presence, and other less tangible losses such as:
- The loss of a shared life, consisting of the things you did together and for each other.
- The loss of a shared future together, including all of your shared hopes, dreams, and plans for the future.
- The loss of your shared social life.
- The loss of all that your loved one did for you. They might have been the one who fixed problems around the house, or who managed your finances.
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Grief Vs Depression: Similarities & Differences
Uncomplicated grief and depression share some similarities in symptoms which can often lead to confusion about whether one is dealing with grief, depression, or both.
Symptoms which are shared by both include:6,17
- Low mood
|If there are Suicidal Thoughts||
Psychological Treatments For Grief
If you feel that you are struggling to come to terms with your loss you may find it helpful to speak to someone about how you are feeling. Many people find bereavement counseling helpful, and you may be able to find a specialist bereavement counselor near you.
If you are struggling with symptoms of prolonged grief or traumatic bereavement, specific psychological interventions are recommended for these conditions.
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When Should I Seek Help For My Grief
If you are experiencing persistent feelings of sadness and despair, and are unable to experience happiness, you may be experiencing the symptoms of depression. If your feelings are getting in the way of your everyday life, then its important to seek help.
Signs that you may need to seek help include:
- appetite changes
- intense sadness
- feelings of emptiness feelings of despair
- thoughts of harming yourself
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The Stages Of Depression
The depression is known as one of the stages of grief. The grief when leads to isolation, crying spells, and feeling hopeless to live can mean that the depression symptoms are crawling up in the life of the individual. The depression due to some event is also known are reactive depression.
The loss of the loved one can make one depressed. This depression can overcome after some time when the individual gains strength to accept the situation. This is known are reactive depression. The reactive depression and understanding why do teenagers get depressed is a part of grief and it is a temporary phase. You can get reactive depression information from your doctor or online. This can turn into major depression if the grief lasts longer and this can also trigger if the similar unfortunate symptoms is again witnessed.
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Get In Touch With The Parts Of Your Grief
It is normal to struggle with different emotions when you are grieving: one minute you might feel angry and outraged, and the next minute ridden with guilt and regret. Psychologists encourage people to find ways to feel and process their emotions: to acknowledge and work through your thoughts and feelings. Many of us are used to avoiding or suppressing how we feel, so it might feel quite strange and unfamiliar to face your emotions at first.
One way of working with your emotions is to imagine each emotion as one part of yourself. For example, there is one part of you that feels angry that your loved one has gone, another part that is sad, and perhaps another part of you that is scared.
Sometimes our emotions conflict with each other. For example, your angry part might be angry with the part of you that feels scared. Or the part of you that feels guilty might get in the way of the part of you that accepts what has happened. Here is an exercise to help you to work with these conflicts. In your own time, work through the steps below:
Dealing With Regret And Guilt
When someone whom we love dies it is common to feel some regret and guilt. You may recall things you did or said, or that you failed to do or say. Events that might ordinarily have seemed trivial may take on a new meaning in the light what has happened. Over time most people find ways of resolving these emotions. However sometimes guilt and regret can get stuck: as though it keeps looping on a circuit. This can be very distressing, and can get in the way of grieving in a healthy way. If you are feeling guilt or regret, here are some things that you might try:
- Write down your regrets.
- See if you can bring to mind a compassionate and warm outlook. We all have regrets and make mistakes, but thats not the whole story of you and your loved one. See if you can take a wider perspective and offer yourself some kindness, like you would to a dear friend. Ask yourself:
- If your loved one could hear and see you regretting and feeling guilty, what would they say to you? How would they reassure and comfort you?
- What would a dear and wise friend say to you?
- If this was another person that was feeling regret and guilt, what would you say to them?
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Anxiety And Depression Caused By Grief
Although grief is unpleasant for all, for some, it can go on to develop into anxiety or depression. Sometimes, the thought of dealing with grief can feel threatening and this can then lead to avoidance.
The avoidance of feelings or expression can create a harmful habit that develops into anxiety or depression.
Many people think that if they make efforts to avoid their feelings for long enough, they will then go away. In reality, the attempt to suppress certain thoughts often makes them more likely to surface.