Complicated grief disorder (CGD)

Complicated grief disorder (CGD), also called persistent complex bereavement disorder, occurs when an individual has lost a loved one and his or her grief lasts longer and is more severe than normal. This grief becomes all-consuming, and even after a significant amount of time passes, the individual is unable to resume a normal life. Individuals with CGD may have thoughts of or attempt suicide.

With treatment from a mental health professional, most individuals with CGD can move through the stages of grief and recover. Experts do not know for certain what causes CGD although many believe it is caused by a combination of other mental health disorders and experiences such as trauma.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, CGD is not a recognized mental health disorder but is a “condition for further study.” This does not mean the condition is not real, however; it means that more research is needed before CGD can be classified as a mental health disorder. Mental health professionals still recognize CGD as a serious condition.

Background

Grief can be defined as the response to a loss. While most people associate grief with the loss of a loved one, people can also experience grief for other reasons, such as the loss of a job or the end of a relationship. Grief includes a person’s thoughts, behaviors, and emotions after the loss. If a loved has died, both the loss and the grief will remain with the bereaved for life. However, in time, the person dealing with loss and grief will adapt and resume normal activities once again.

Mental health experts believe that most individuals go through the following five stages of grief before fully accepting their loss and feeling at peace:

1. Denial.During this stage, an individual refuses to fully accept the loss. Psychologists believe that denial is a defense mechanism because the person is not yet ready to completely accept the loss. The individual may feel shock and numbness or a surge of emotion.
2. Anger. Most bereaving individuals experience anger once the reality of the loss sets in. They might direct their anger toward God or life in general. They might also be angry at their loved one for dying and leaving them alone.
3. Bargaining. In the third stage of grief, individuals often try to bargain with God or another higher power. They might offer to devote the rest of their life to service in exchange for having their loved one back. This is also a time when people ask “If only” and “What if” questions. For example, a person may ask, “If only I had sent him to the doctor, would he be alive today?”
4. Depression. Depression is common among those who are grieving. At this stage, the bereaved understand that the loss is permanent and may struggle with sadness and loneliness. They may have trouble sleeping and lose weight.
5. Acceptance. The final stage in the grieving process, acceptance does not mean that an individual is okay with the loss; it means that he or she is learning to cope with the loss and is leading a different but normal life. In time, those who have completed the grieving process may enter into new relationships.

For those with CGD, the stages of grief last much longer than normal and their symptoms seem to worsen over time. Most mental health experts believe that individuals who are suffering intense grief for six months or longer after a loss may have CGD and should seek help.

Overview

After they experience a loss, people with complicated grief disorder (CGD) enter into what appears to be a normal grieving process. The disorder is almost impossible to detect during the first two or three months after the loss when an individual’s grief is acute. However, as time passes, a person who is experiencing normal grief learns to cope with the loss and experiences peace. Those with CGD, on the other hand, continue to experience intense symptoms of grief that worsen over time. They become obsessed with the loss of their loved one and are unable to function and lead a productive, happy life.

While no one knows for certain what causes CGD, it is more common among females and the elderly. An individual is more likely to develop the disorder if the loved one was a child or if the death was unexpected or violent. Other risk factors include a past history of depression or post-traumatic stress disorder (PTSD) and traumatic childhood experiences such as abuse or abandonment.

Symptoms

• While the symptoms of CGD vary, they may include the following:
• Difficulty accepting that the loss is real
• Intense sorrow and emotional pain
• Trouble focusing on anything other than the loss of the loved one
• Bitterness and anger about the loss
• Lack of trust in others
• Trouble carrying out normal routines
• Refusing to leave the home
• Isolation and withdrawal from people and activities
• Obsession with the loved one
• Strong attachment to reminders of the loved one or avoidance of these reminders
• Pessimistic view of life in general
• Poor hygiene and lack of attention to personal appearance
• Reckless or impulsive behavior
• Thoughts and/or discussions of suicide

Diagnosis

Because CGD is not yet recognized as a mental illness, no official diagnosis standards exist. However, in one influential study in 1997 published in the Journal of American Psychiatry, a team of mental health professionals recommended that an individual be diagnosed with CGD if he or she displayed three of the following seven symptoms for any one-month period fourteen months after the loss:

• Intrusive memories or fantasies about the deceased loved one
• Strong pangs of emotion related to the lost relationship
• Powerful yearnings or wishes that the departed person was still present
• Intense feelings of loneliness or emptiness
• Avoidance of people, places, or activities that remind the grief sufferer of the
• deceased
• Recurrent sleep interference and disturbance
• Significant loss of interest in work and social activities

Treatment

Depending on the severity of CGD, individuals may be treated on an outpatient or inpatient basis. Treatment most often includes intensive individual therapy during which therapists help the individual work through his or her grief and learn to manage his or her emotions. Group therapy with others who are experiencing CGD is also often helpful. Some individuals also undergo family therapy. While no medication is yet recommended specifically for CGD, medications are often prescribed to treat co-occurring conditions such as depression.

Bibliography

“Complicated Grief.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374. Accessed 6 Oct. 2018.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Association, 2013.

Horowitz, Dr. Mardi J., et al. “Diagnostic Criteria for Complicated Grief Disorder.” Journal of American Psychiatry, July (1997): 904–901,

s3.amazonaws.com/academia.ed u.documents/44583660/Diagnostic‗Criteria‗for‗Complicated‗Grie20160409-14107-ngfm1d.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1538856483&Signature=4LpcihktXNo%2BwFIMzpIS6wF4EH8%3D&response-content-disposition=inline%3B%20filename%3DDiagnostic‗criteria‗for‗complicated‗grie.pdf. Accessed 6 Oct. 2018.

Hughes, Virginia. “Shades of Grief: When Does Mourning Become a Mental Illness?” Scientific American,1 June 2011, www.scientificamerican.com/article/shades-of-grief/

Khoshaba, Deborah. “About Complicated Grief Disorder,” 28 Sept. 2013, Psychology Today,www.psychologytoday.com/us/blog/get-hardy/201309/about-complicated-bereavement-disorder-0. Accessed 6 Oct. 2018.

Pearlman, Laurie Ann and Camille B. Wortman. Treating Traumatic Bereavement: A Practitioner’s Guide.The Guilford Press, 2014.

Rando, Theresa A. Treatment of Complicated Mourning. Research Press, 1993.

“What Are the Signs of Complicated Grief Disorder?” Bridges to Recovery,www.bridgestorecovery.com/complicated-grief/signs-complicated-grief-disorder/. Accessed 6 Oct. 2018.