Persistent Complex Bereavement Disorder

DisclaimerThis page is not here to be used as a self-diagnosis, self-identification, or promotion - it's simply here to be informational. Whether or not one self-diagnoses, self-identifies, and/or seeks a professional diagnosis is up to them.Self-HermThe following page includes discussions of self-harm and suicide. If you are uncomfortable or get triggered by this topic, it is recommended to not read this page.

**Persistent Complex Bereavement Disorder**, also called **Complicated Grief** or **Prolonged Grief Disorder**, is when feelings of loss are debilitating and don't improve after time passes. Losing a loved one is a distressing and unfortunate experience that most individuals face, and most individuals experience grief and bereavement when faced with it. Gradually, these feelings ease and it's possible to accept loss and move forward. Complicated grief is when these painful emotions are long lasting and severe enough that one has trouble recovering from loss and resuming daily life.

Prolonged grief disorder was added to the DMS in the fifth edition in the section of "Conditions for Further Study" with an estimated prevalence of 2.4-4.8%.

## Signs & Symptoms

Different individuals follow different paths through the grieving process. The order and timing of these phases may vary from individual to individual, but typically one will follow these stages:

* Accepting reality of loss
* Allowing oneself to experience the pain of loss
* Adjusting to a new reality in which the deceased is no longer present
* Having other relationships

When one is unable to move through these stages for more than a year after the death of a loved one, it may be complicated grief.

During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. However, while normal grief symptoms gradually fade over time, those of complicated grief linger or get worse.

Signs and symptoms of complicated grief may include:

* Intense sorrow, pain and rumination over the loss of a loved one
* Focus on little else but the loved one's death
* Extreme focus on reminders of the loved one or excessive avoidance of reminders
* Intense and persistent longing or pining for the deceased
* Problems accepting death
* Numbness or detatchment
* Bitterness about one's loss
* Feeling that life holds no meaning or purpose
* Lack of trust in others
* Inability to enjoy life or think back on positive experiences with the loved one

One experiencing complicated grief may also:

* Have trouble carrying out normal routines
* Isolate from others and withdraw from social activities
* Experience depression, deep sadness, guilt or self-blame
* Believe that one did something wrong or could have prevented the death
* Feel as though life isn't worth living without the loved one
* Wish one had died alongside the loved one

### Diagnosis

In children, a diagnosis of persistent complex bereavement disorder can be made after six months of symptoms. A diagnosis is made after twelve months in adults.

Symptoms must include at least one of the following:

* Persistent yearning for the deceased
* Intense sorrow or emotional pain in response to the death
* Preoccupation with the deceased
* Preoccupation with the circumstances of death

Additionally, at least 6 of the following must be experienced as well, from either of the following two categories:

* Reactive distress to the death:
	+ Marked difficulty accepting the death
	+ Experiencing disbelief or emotional numbness over the loss
	+ Difficulty with positive reminiscing about the deceased
	+ Bitterness or anger related to the loss
	+ Self-blame or guilt about the death
	+ Excessive avoidance of reminders of the loss

* Social/identity disruption
	+ A desire to die with the deceased
	+ Difficulty trusting other individuals since the death
	+ Feeling alone or detached from others since the death
	+ Feeling that life is meaningless or empty without the deceased, or the belief that one cannot function without the deceased
	+ Confusion about one's role in life
	+ Difficulty or reluctance to pursue interests since the loss or to plan for the future

## Causes

It is unknown why some develop complicated grief. As with many other mental health disorders, it may involve one's environment, personality, inherited traits and body's natural chemical makeup.

Factors that may increase the risk of developing complicated grief include:

* An unexpected or violent death
* Death of a child
* A close or dependent relationship with the deceased
* Social isolation or loss of a support system
* Past history of depression, separation anxiety or PTSD
* Traumatic childhood experiences
* Other major life stressors, such as major financial hardships

## References

https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374

https://www.psychiatry.org/patients-families/prolonged-grief-disorder

https://projectteachny.org/persistent-complex-bereavement-disorder/