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Bereavement, Complicated Grief, and DSM, Part 2: Complicated Grief

Year: 2010

Type: article

Abstract: The Case of Ms B Ms B is a 65-year-old woman who comes for an evaluation because she isn’t getting past her intense grief over her deceased husband, who died of a myocardial infarction 4 years ago. Ms B is tearful, recalling how wonderful her husband was, that he was her soulmate, and that he loved her in a way no one else ever did. Although she thinks about her husband daily, she avoids looking at pictures, visiting the gravesite, or even going to places they used to enjoy together to try to ward off the intense bouts of misery these reminders provoke. At times, she seems angry, stating emphatically that he shouldn’t have died. She is plagued by thoughts about the doctors who did not diagnose the impending heart attack. Even though she knows that it is irrational, she can’t get the idea out of her mind that his doctor should have suspected that he had blocked arteries during a routine visit 1 week prior to his death and done something to save him. She often neglects to take her hypertension medication, knowing that this could be dangerous, and agrees that she is leaving life and death to chance. Religion used to be a source of comfort, but she no longer attends church regularly or finds companionship or support from the church community. Ms B maintains that no one can help her because no one can bring her husband back. Many clinicians don’t know quite what to make of Ms B’s continued suffering. Her symptoms clearly reflect grief, yet the excessive avoidance and preoccupation with thoughts that her husband need not have died and the persistence of intense acute grief symptoms over a 4-year period seem atypical. She has some mood symptoms, but does not meet criteria for major depressive disorder (MDD). Her avoidance behaviors and preoccupation with her husband’s death resemble the symptoms of PTSD, but the focus of her thoughts is related to her loss rather than reexperiencing a dangerous event, and she feels sadness rather than fear. She does not meet criteria for posttraumatic stress disorder (PTSD). Her grief symptoms have not changed much since her husband died 4 years ago. She and her family feel she is stuck in her grief. Does she have a definable, serious, treatable disorder? Not according to the DSM-IV-TR.1 The rest of this review will describe the syndrome of complicated grief, a condition that describes Ms B’s state and that also requires a specific, targeted treatment.

Source: The Journal of Clinical Psychiatry

DOI: 10.4088/jcp.10ac06391blu