Thanatology - Psychology - Chapter 7 - Complicated Grief

Define complicated grief

Is more intense than normal grief, yet different than clinical depression

What are some AKAs for complicated grief according to the text?

Pathologic, Chronic, Delayed, Masked, or
Exaggerated Grief

Define chronic grief

Reaction that is prolonged, excessive in duration, and

never comes to a satisfactory conclusion

Define delayed grief

• A.K.A. Inhibited, suppressed, or postponed grief
• A reaction that does not occur in a normal timeframe but occurs at a later time

Define masked grief

Occurs when a person experiences symptoms and
behavior which causes them difficulty but they do not
recognize the fact these are related to the loss.

Define exaggerated grief

Occurs when the reactions to the loss are excessive and
disabling

Define disenfranchised grief

• Coined by Kenneth Doka
• Loss that society believes does not deserve mourning.
• Loss is not openly acknowledged, socially sanctioned, or publicly shared.

What are the 4 types of death that lead to disenfranchisement

Relationship is not socially recognized
- Homosexual relationships, extramarital relationships,
heterosexual cohabitation

Loss is not acknowledged by others as being a genuine
loss.
- Abortion, miscarriage, pet loss, death of a former spouse

Grievers are unrecognized
- Death of a friend, co-worker, someone mentally disabled

Death is not socially sanctioned
- Suicide, auto-erotic asphyxia, legal execution

When disenfranchisement occurs, how is the grief response affected?

Grief response is further intensified due to lack of
normally expected support

What are some factors than can complicate grief?

Relationship factors
• Ambivalence, etc

Circumstantial Factors
• Uncertainty, multiple losses, sudden death, traumatic
death, shocking/horrific death

Personality Factors
• Inability to tolerate extreme emotional issues, negative
self concept

Social Factors
• Shame, embarrassment, social stigma, no strong support group
Historical Factors
• Previous complicated grief, influence of early parental
loss
Complicated grief can develop physical symptoms
• Suicide, substance abuse, or even heart disease

Experts say that left untreated, complicated grief can lead to what?

Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future). Emotional numbness (absence or marked reduction of emotional experience). Feeling that life is meaningless. Intense loneliness (feeling alone or detached from others).

Are indications for complicated grief the same for everyone?

Varies with individual and situation

In order to be considered complicated grief, how long must have the feelings been manifested?

To be true complicated grief:
• person must have experienced symptoms for a significant period of time (minimum several months).
• Unable to move forward toward recovery or make
adjustments to accept reality of loss

What are the 18 symptoms your book lists?

Possible Symptoms:
1. Difficulty speaking to the deceased without experiencing renewed and intense grief
2. Constantly bring up themes of death and loss in even the most casual conversations
3. Ongoing sleep problems for more than 6 weeks
4. Sudden, radical changes to their lifestyle

5.Exhibit self destructive behavior
6. Develop same symptoms the deceased had without any medical issues
7. Continued disbelief in the death

8. Inability to accept the death
9. Persistent nightmares, flashbacks, and/or intrusive
memories
10. Magnified and prolonged grief symptoms

11. Maintenance of a fantasy relationship with the deceased with feelings that deceased is always present and watching (Could also mean talking to the deceased)
12. Continuous yearning and searching for the deceased
13. Unusual symptoms that seem unrelated to the death
14. Breaking off all ties to social contacts

15. Avoid anything associated with the deceased (friend,
family, shared activities)
16. Minor events trigger major grief response
17. Exhibit consistent symptoms of depression, extreme guilt, hopelessness, and lowered self esteem
18. Ability to manage everyday responsibilities at work,
school, or home is significantly impaired

What are some counseling treatments for complicated grief according to your textbook?

Two pronged therapy
• Patient revisits the death
• Patient resumes pleasurable activities and social contacts

• This type of research is based on a concept that you
resolve your grief as you move on with your life, rather
than resolving your grief and THEN moving on.

• Patients are urged to retell the story of the death,
produce an audio recording of their story, and listen to
it repeatedly to reduce their aversion to talking or
thinking about it.
• Patients also participate in an imagined conversation with the person they have lost speaking openly about shared
experiences.
• Doctors also urge patients to re-engage the world in
normal activities

Why do people suffering from complicated grief have difficulty finding answers for their problems?

Important findings because complicated grievers have
difficulty finding help for their problems because they
look physiologically sound.