Abnormal reactions to the loss of a loved one

Abnormal Grief

Abnormal, often referred to as complicated grief, is found in only 3 to 25 percent of loss survivors.

Such grief is manifested in behaviours such as the person not acknowledging the reality of the loss, not allowing him/herself to experience the pain of grief, being unable to adjust to living without the deceased loved one, or being unable to move on and thus not having the energy to adjust to life without the loved one.

Risk factors for abnormal grief:

- Social isolation

- History of mental illness

- Presence of previous unresolved grief

- Suddenness of the loss

- Gender of the bereaved

- Existence of an intense, overly close or highly ambivalent relationship with the loved one

There are different types of abnormal grief:

• Absent grief – when there appears to be no signs of grief in the person following the loss.
• Inhibited grief – there are some signs that the person is grieving, but fewer than you expect, given the nature of the loss.
• Unbalanced grief – the person is clearly grieving, but seem to be stuck in a particular emotion.
• Chronic/dependent grief – the grieving person has trouble finding closure and returning to normal activities over an extended amount of time. Occurs when grieving person’s identity and self-imaged are too heavily enmeshed in the lost loved one. This is the most common form of abnormal grief, and typically affects long time married women who were homemakers.
• Delayed grief – the intentional postponement of grief. Sometimes this is related to other life events or losses that drain one’s ability to work through the grief process. Person usually finds him/herself overwhelmed with grief after a few months.
• Disenfranchised grief – often occurs when a grieving person’s loss can’t be openly acknowledged or is one that society does not accept as a real. Examples include losses related to AIDS, miscarriage, or loss of a homosexual partner.
• Exaggerated grief – intense reactions of grief that may include nightmares, delinquent behaviors, phobias (abnormal fears), and thoughts of suicide.
• Distorted/unexpected loss/sudden grief – when death takes place very suddenly without warning, with sudden and unnatural causes like suicide, homicide and accidents. Sudden grief can lead to exaggerated reactions and PTSD. Women are more prone to PTSD, and can experience easy startling, flashbacks, nightmares, and recurrent thoughts of the death, as well as flattened emotional response and numbing. Required participation in official investigations or trials related to the death can promote this sort of grief. The three Vs -- violence, violation, and volition make a woman high risk. That means if the death was caused by violence, if the loved one was a victim in some way, and/or woman gets preoccupied with establishing blame or bringing justice to her loved one. If there is media coverage of the death and/or illegal or socially unacceptable behaviours of the loved one involved, women are also at higher risk.
• Conflicted grief – when the grieving person has mixed feelings about the loss. Typical situations involve death of a parent, particularly for women who are caregivers for the parent. Often today’s middle-aged women have done more than their share of caring for their aged parents, yet they grew up in families where their brothers were favoured. This gap, as well as any unresolved issues with parents, causes unresolved conflict that may arise at the parent’s death. Unexpressed anger can turn towards the person him/herself and lead to depression. Another common situation for women is death of a child through violence, suicide or accident. She may experience anger at the child for his/her role in the death, but also feel that her upbringing of the child was inadequate.
  
  

Adjustment disorders (especially depressed and anxious mood or disturbance of emotions and conduct), major depression, substance abuse, and post-traumatic stress disorder are some of the more common psychiatric sequelae of complicated bereavement. Grief that becomes pathologic is often identifiable by lingering symptoms (listed below), increased disruption of psychosocial functioning caused by the symptoms, or the intensity of subsyndromal symptoms (e.g., intense suicidal thoughts or acts upon the loss).

Grief can take a toll on a person’s emotional health, and the grieving person should see a doctor if they experience any of the following symptoms for more than two weeks:

• Memory gaps

• Distraction or lack of concentration

• Irritability

•Sadness, hopelessness or depression

• Euphoria

•Violent, weeping rages

•Passive resignation

•Numbness

•Tightness in the throat or chest

•Shortness of breath

•Sensitivity to loud noises

•Agitation and restlessness

•Exhaustion

•Headaches

•Upset stomach

http://yourhealth.goodshepherdhealth.org/HealthTopics/caregiver/Oct03ccMain.htm

http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/HealthProfessional/page8

www.library.nhs.uk/SpecialistLibrarySearch/Download.aspx?resID=79799

http://dying.about.com/od/thegrievingprocess/a/griefprocess.htm

http://www.womenshealth.org/a/women_grief_mourning.htm

http://www.norfolk.nhs.uk/specialist_directory/bereavement/grieving_tasks.htm#What%20is%20complicated%20grief