Bereaveme

nt and
Complex
Grief
 • Grief is the anguish experienced after significant loss,
usually the death of a beloved person.
• Grief often includes physiological distress, separation
anxiety, confusion, yearning, obsessive dwelling on the
past, and apprehension about the future.
• Intense grief can become life-threatening through
What is disruption of the immune system, self-neglect, and
suicidal thoughts.
grief? • Grief may also take the form of regret for something lost,
remorse for something done, or sorrow for a mishap to
oneself

•APA Dictionary of Psychology

 • Shock and disbelief
• Denial
• Guilt
Seven • Anger

Stages of • Depression, loneliness, reflection

• Reconstruction
Grief • Acceptance
• (counselling-directory, 2024)
Impact of Grief

Emotion Anger, sadness, despair, guilt, loneliness, anxiety, yearning

Cognitio Confusion, concentration, intrusive thoughts, memory

ns disturbances

Physical Loss of appetite, Difficulty sleeping, loss of energy, physical pain ,

supressed immune system

Behavio Withdrawing, restlessness, inability to relax, changes to

ur eating habits, change to sleeping habits. Loss of routine
Barbato and Irwin 1992 etc.
 The process of integrating the loss in one’s life and finding ways to
Spiritual trust and have faith in life and love again.

Interpersonal Includes social bonds, social withdrawal, issues of

communicating the grief to others, cultural practices, and
remembrance rituals.

Gilbert 2001
Models of Grief
Bowlby and Park's 4 Stages of Grief
Warden's
Four Tasks
of Mourning
1991
Dual Process Model

Stroebe and Shut 1999

Types of Grief

Bereavement Grief- a Anticipatory Grief-

healthy adaptive grieving not only for
process in response to what one has lost but
a death and its for what one is about
accompanying losses to lose
Types of Grief

Disenfranchised Grief- this

Complicated Grief- This involves
occurs when the grief
symptoms intensifying over time,
experienced is not supported by
instead of subsiding. This can
society or recognised as
lead to mourning for a year after
legitimate or validated. Examples
a loss,and not dealing with other
are- pets, elective abortions, loss
relationships and responsibilities
of a body part, celebrities etc
Complicated Grief

Approximately, 10–20% of bereaved

While most people who lose a loved
individuals develop symptoms of
one instinctively adapt to the loss,
prolonged grief disorder (PGD),
for a substantial minority of the
bereavement-related symptoms of
bereaved the adaptation process is
posttraumatic stress disorder
slowed or halted by complications,
(PTSD), and/or depression
and the symptoms of acute grief
(Kristiansen et al., 2019; Lundorff et
persist indefinitely.
al., 2017).
 Complex Grief

Complicated Grief is
more likely when When the person How the person The relationship
there are issues died died with the person
around:

Existing Mental
Family conflicts Loss of a child
Health issues
 1 .Not based on rigorous empirical evidence

2. Misrepresentation of grief

Criticisms
3. Oversimplicity

Stroebe, Schut and Boerner 2017

DSM CRITERIA PROLONGED GRIEF
DISORDER
The death, at least 12 months ago, of a person who
A. Event and time criteria was close to the bereaved (for children and
adolescents, at least 6 months ago).

Since the death, the development of a persistent grief

response characterized by one or both of the
following symptoms, which have been present most
days to a clinically significant degree. In addition, the
symptom(s) have occurred nearly every day for at
least the last month:
B. Separation distress
1. Intense yearning/longing for the deceased
person.
2. Preoccupation with thoughts or memories of the
deceased person (in children and adolescents,
preoccupation may focus on the circumstances of the
death)
 Since the death, at least three of the following symptoms
have been present most days to a clinically significant
degree. In addition, the symptoms have occurred nearly
every day for at least the last month:
1. Identity disruption (e.g. feeling that a part of oneself
has died) since the death
2. Marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead (in
children and adolescents, may be characterized by efforts
to avoid reminders)
C. Cognitive, emotional and behavioral symptoms
4. Intense emotional pain (e.g. anger, bitterness,
sorrow) related to the death
5. Difficulty reintegrating into one’s relationships and
activities after the death (e.g. problems engaging with
friends, pursuing interests or planning for the future)
6. Emotional numbness (absence or marked reduction
of emotional experience) as a result of the death
7. Feeling that life is meaningless as a result of the
death
8. Intense loneliness as a result of the death
 The disturbance causes clinically significant distress or
D. Functional impairment criterion impairment in social, occupational or other important
areas of functioning.

The duration and severity of the bereavement reaction

E. Cultural criterion clearly exceeds expected social, cultural or religious
norms for the individual’s culture and context.

The symptoms are not better explained by major

depressive disorder, posttraumatic stress disorder or
F. Relation to other mental disorders another mental disorder, or attributable to the
physiological effects of a substance (e.g. medication,
alcohol) or another medical condition.
What to look for
The emotion
expressed is out
of proportion

Feeling like it ​
Deceased ​
happened ​
belongings ​
Yesterday after
untouched​
Avoidance of ​ months/years​
talking about
the ​person

No photos, ​
Alcohol or drug ​
memories on ​
abuse ​
​ display
Phobias about ​
illness and death
Grief and Depression

Grief Depression

Experienced in Moods and feelings

waves are static
Intensity diminishes Consistent sense of
over time depletion
Healthy self image Sense of
worthlesness and
disturbed self image

Rando, T 1993 Treatment of

Complicated Mourning
Grief and Depression

Grief Depression
Preoccupations with Preoccupation with
the deceased self
Guilt is focussed on Guilt is often attached
aspect of loss
to negative self image
Not demoralizing or
humiliating Suicidal ideation not
unusual in depression
Suicidal gestures rare
in uncomplicated grief Elicits less empathy at
Elicits empathy, times
concern and desire to
comfort
 CBT and Grief Treatment Planning

Psychoeducation
Areas to address
and socialising to Exposure
are:
the CBT method

Cognitive Behavioural
Ending therapy
restructuring activation
Interventions

Adjust to the Working on Working on

world without unhelpful beliefs emotions – anger,
the deceased and assumptions guilt, regret

Developing a Writing a journal

Letter writing to
new narrative – telling your
a loved one
story

Behavioural Psychoeducation Dealing with

activation for on the models of Myths about
avoidance grief death
Discussion
Question

Is it right to
pathologise
grief?

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