The World Health Organization, in its International Classification of Diseases, established the diagnostic criteria for “prolonged grief” and, 2 or 3 months ago, the American Psychiatric Association did the same (DSM-5 TR). Prolonged grief is defined as the constant preoccupation or intense longing for the deceased and the characteristics surrounding the death.
People suffering from prolonged grief experience clinically significant distress, which may be accompanied by impairment at work, socially and in other areas of functioning. In order to determine whether prolonged bereavement exists, these symptoms must be present every day and for most of the day.
Differences between prolonged grief and “expected” grief
The Diagnostic and Statistical Manual of Mental Disorders DSM-5 TR differentiates prolonged bereavement from normal bereavement solely on the basis of the time elapsed.
In most adults it is considered that a minimum of 12 months must pass to consider a bereavement as prolonged bereavement, and in children and adolescents this time is reduced to 6 months.
However, it is also important to take into account if there are associated symptoms, such as delusional guilt feelings or hallucinations, which would mean an extra seriousness. In these cases, the specialist in psychiatry should consider whether it is necessary to wait 12 months to speak of prolonged bereavement.
Another aspect to take into account is the sociocultural context of the patient, since there are different environments in which the “norm” establishes a longer mourning period.
Symptoms of prolonged grief
People who suffer prolonged bereavement usually present altered identity, i.e., the feeling that part of oneself has died. On the other hand, it is characterized by constant avoidance of memories associated with the death, intense emotional pain and emotional numbness, i.e., feeling that life is meaningless; and feelings of loneliness.
In addition, they may have great difficulty moving on with life, problems relating to other people, pursuing goals or planning for the future.
Are some people more likely to suffer prolonged bereavement?
Approximately 10% of bereavements turn into prolonged bereavement. In the case of children and adolescents this percentage increases to 18%.
In addition, there may be a slight predominance in women, even more so in people who have suffered the death of a close person in palliative care, HIV and especially in refugees (30%).
How can a prolonged bereavement be “cured”?
The main treatment is psychotherapy. Studies to date have shown that the most effective modality is Cognitive-Behavioral or its variants, such as Cognitive-Integrative and Metacognitive; on the other hand, and to a lesser degree, Interpersonal Therapy.
With respect to psychotropic drugs, the decision to prescribe them or not would depend on the presence of noticeable depressive and/or anxiety symptoms that interfere with the person’s usual activities. In these cases, antidepressants (the most studied are the specific serotonin reuptake inhibitors) or anxiolytics would be used.