The permanent absence of a loved one can seem endless. The mornings are full of mourning and emptiness no amount of OJ or coffee or alcohol can fill.
If the sadness appears to extend to infinity, therapists have a less poetic task. They must determine whether your extreme unhappiness fits the criteria for Prolonged Grief Disorder (PGD). This diagnostic category is new, but the ailment is as old as human history.
To start, here are some of the symptoms of PGD in the American Psychiatric Association’s September 23, 2021 press release describing the soon-to-be-published complete formulation. A prior draft indicated that at least three of the eight must be present for the diagnosis to apply:
- Identity disruption (e.g., feeling as though part of oneself has died).
- Marked sense of disbelief about the death.
- Avoidance of reminders that the person is dead.
- Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
- Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future).
- Emotional numbness.
- Feeling that life is meaningless.
- Intense loneliness (i.e., feeling alone or detached from others).
They also state the following:
The bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death.
These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Moreover, the length of the condition goes beyond cultural norms.
Experienced therapists know people are not so easy to categorize as labels suggest. Many times counselors encounter individuals with more than one psychological concern. For example, depression might be coupled with substance abuse or PTSD.
In the case of forms of bereavement, many have questioned the appropriateness of putting an identifying sticker on an almost inevitable experience in life. Our time by itself has created nearly five million deaths from COVID-19 and a much larger number of their loving survivors.
However, the APA emphasizes that Prolonged Grief Disorder goes farther than the normal grieving observed within one’s community. To the good, the health care field will help you take on your heartache and impairment, whatever name is given to it.
The APA’s announcement and a publicly available 2020 draft do not mention causes of extended lamentation other than death. A few come to mind.
We might include those who become caretakers to their radically changed lifelong partners, parents, or children. Transforming accidents, dementia, or lasting vegetative afflictions often create a world of joylessness in those who take on a job for which they did not apply.
Calamity takes too many faces. Mortals needn’t die to cause dear ones the realization they are no longer interacting with the “same person.”
While discussions about lengthy sorrows have been ongoing, the APA’s decision to recognize and define PGD can be expected to produce more words and productive research.
Even now, if you find yourself among those suffering from unrelenting adversity of the kind suggested here, professional consultation is recommended to discover if you fall into the new category.
Finding the best treatment options for PGD — something distinct from conditions like Major Depressive Disorder or Dysthymia — is a first step in the direction of recovery.
Click here for an infographic on Prolonged Grief Disorder
The first of two works by the Ecuadorian artist Oswaldo Guayasamin is called Spring. The second is Project for a Poster. Both of these date from 1956.
Thanks for discussing this issue, Dr. Stein. The pandemic has taken thousands of lives in our communities. Some families have lost both parents. In my view, the chances of more individuals suffering from PGD may be closer to home than we imagine. I dislike prying into the lives of others, but remain available and to listen.
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No doubt, Rosaliene. Unless our human sisters and brothers come together enough to push back sufficiently on climate change, much else is ahead. To the good, we still have some time …
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Hi Gerry How are you? Things here are ok generally. I enjoyed this article and tried to post a brief comment but the technology overwhelmed me. Maybe we can talk some time this week Greetings to you and family
El dom., 26 de septiembre de 2021 1:42 p. m., Dr. Gerald Stein escribió:
> drgeraldstein posted: ” The permanent absence of a loved one can seem > endless. The mornings are full of mourning and emptiness no amount of OJ or > coffee or alcohol can fill. If the sadness appears to extend to infinity, > therapists have a less poetic task. They must determin” >
Could a perceived sense of “betrayal trauma” be a contributing factor for PGD?
Can PDG also include losses other than bereavement?
Additionally, can the type of death coupled with the closeness one had with the deceased also be contributing factors toward PGD?
If we are talking about Covid, people who traumatically lose someone so fast without saying good-bye, without being validated by others, without being able to perhaps attend the funeral or wake in the early times of this ongoing pandemic, without being comforted by society who politicized the disease that killed their loved one, and/or with the perception that this is a preventable disease that others keep spreading?
Can comorbid PTSD from reading the news concerning traumatic medical procedures like the ventilator and ICU-based traumas also create painful images in the minds of those who lost a loved one after they were inflicted with such traumas right before death – before any chance of comfort from loved ones? Could the resulting guilt play a role when a loved one imagines themselves risking their own life by forcing their way in to the hospital to say good-bye, which is kind of like a fantasy remake of their tragic end to the relationship?
Could the anger in PGD be misdiagnosed and also seen as political extremism?
Could politics also play a role in diagnoses?
These are just the few of many questions I have concerning the situational etiology of prolonged grief disorder. Included in my questions are many covariants, including mediators and moderators that can best explain those situations, such as betrayal trauma perception.
Additionally, will neuroscientists also look into predispositional factors, or even post-situational factors that might change the brain’s functioning, such as when the hippocampus shrinks after trauma is experienced? Could the limbic system play a role in PGD?
Etiology might not be important to some behavioral scientists, but it is important for those who believe in prevention and certain treatment modalities. And speaking of which, what are the treatment modalities for complex, complicated, prolonged grief?
Given that we haven’t seen the final published copy of this addition to the psychiatric guide to diagnosis, it’s hard to answer some of your questions. The preliminary language seems to deal with grief over the loss of someone to death, as opposed to, for example, a heartbreaking breakup with a good friend or love. I don’t doubt, however, that the conditions of bereavement can be exacerbated by many factors including some of those you mentioned. I hope therapists are on solid enough ground that politics does not contribute to misdiagnosis, but I can’t rule it out in the case of ill-prepared or judgmental therapists. I suspect that since the diagnostic category of PGD will be new, we are only at the beginning of research on the best treatments — that is, those that can be validated by well-crafted research. Thanks for your provocative comment, Dragonfly.
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I am also concerned about climate change, potential for civil unrest and/or wars, increased traumatic inequalities and resulting discrimination and hate, people needing to fend for themselves, people in the helping fields quitting in great numbers, etc. Without good leadership for global and local problems, the toll on losses increase, and perhaps so does prolonged grief disorder among the masses.
Well said, Dragonfly.
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