Grief

Grief is a normal psychological process experienced after a loss, that is, the definitive interruption of something, which may be a death, but also an abandonment or absence. Grief is considered a wound, and therefore time is required for it to heal. Some individuals experience the process so intensely that it may become disabling. In these cases—referred to as pathological or complicated grief—specialized care is recommended in order to prevent complications or the chronification of sadness.

During the grieving process, individuals typically go through five phases:

• Denial: The mind protects itself from reality by expressing disbelief and resistance to accepting the loss.
• Anger: Anger is a natural response to loss. It may be directed toward oneself, the deceased loved one, or even a third party.
• Bargaining: An internal dialogue begins in an attempt to make sense of what has occurred. Questions arise that seek ways to reverse reality or to imagine how the loss might have been avoided.
• Depression: This stage involves emotional connection in order to confront the reality of the loss.
• Acceptance: The individual learns to live with the pain in order to move forward. Discomfort gradually diminishes, although it may occasionally reappear vividly.

Whereas normal grief is characterized by sadness, anger, and progression toward acceptance without abandoning daily responsibilities, pathological grief presents persistent symptoms that lead to loss of interest in life and an inability to cope with everyday activities. Although there is no fixed duration for grief, it generally lasts between six months and one year; therefore, if it extends beyond this period, it is considered pathological grief.

To overcome pathological grief, psychological treatment is required to guide the patient through the five stages, as the intensity of emotions prevents independent progression. Prognosis is generally favorable, although recovery may be prolonged.

Symptoms

Sadness is inherent to loss; however, symptoms of pathological grief are more intense. The most significant include:

• Intense pain and sadness.
• Emotional numbness, guilt, and anger.
• Persistent thoughts about the loss or the deceased loved one.
• Excessive focus on memories of the loved one.
• Inability to recall positive experiences shared with the loved one.
• Lack of concentration.
• Difficulty accepting the loss.
• Resentment regarding the loss.
• Distrust of others.
• Social withdrawal.
• Loss of interest in life and difficulty experiencing enjoyment.
• Persistence over time of the above signs.

Causes

Pathological grief arises from a combination of different factors, although the exact cause is not always known. Specialists believe that personality traits, environmental characteristics, family history, and brain neurochemistry influence its development.

Risk Factors

Some factors that increase the likelihood of developing pathological grief include:

• History of mental disorders, such as depression or anxiety.
• Low self-esteem.
• Difficulty managing emotions.
• Traumatic nature of the loss: sudden, violent, or unexpected death.
• Loss of a child.
• Intense bond with the deceased or missing person.
• Death of a child.
• Multiple losses within a short period of time.
• Uncertainty regarding the loved one’s fate (disappearance).
• Lack of social support.

Complications

Complications of chronic grief may be both mental and physical. The most common include:

• Anxiety.
• Sleep disturbances.
• Depression.
• Alcohol use disorder.
• Tobacco use.
• Substance abuse.
• Suicidal ideation.
• Social isolation.
• Difficulty performing daily tasks.
• Increased risk of heart disease, hypertension, and cancer.

Prevention

Preventing pathological grief is difficult, as it is not possible to predict when it may occur. To minimize risk, the following are recommended:

• Seeking psychological therapy after a loss, especially if it is unexpected or traumatic.
• Relying on close social support.
• Speaking openly about pain and loss, without suppressing emotions or tears.

What type of physician treats grief?

Pathological grief is managed within the specialties of Clinical psychology and Psychiatry.