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Pathologic grief and the activation of latent self-images
Abstract
The authors studied the case material for patients treated with either psychoanalysis or brief therapy to examine the basis for the various states of pathological grief after berevavement. They view these states as intensifications or unusual prolongations of states found in normal grief and describe them in terms of the reemergence of self-images and role relationship models that had been held in check by the existence ofthe deceased person. This conclusion concerning preexisting mental schemata leads to an elaboration and partial revision of theories of regression, ambivalence, and introjection as causes of pathological grief.
... Überdies werden die Wahrnehmung des eigenen Selbstwertes, konstruktive Selbstwirksamkeits-und Kompetenzerwartungen benannt. Bei negativen oder pre-mortem in Teilen durch die verstorbene Bezugsperson kompensierten Selbstbildern könne der Verlust zu einer Reaktivierung latenter negativer Selbstbilder führen (Horowitz et al., 1980). Als Stress-Mediatoren fungieren außerdem individuelle Überzeugungen und Wertvorstellungen, mitunter auch auf spiritueller Ebene (Park, 2010;Wortman & Silver, 1989), sowie soziale Variablen. ...
... Rekurrierend auf Pisarskis Modell der Beziehungsfäden (Abschnitt 2. Horowitz et al. (1980) benannte Risiko, dass der Verlust einer nahestehenden Person, durch die zumindest in Teilen Aspekte des eigenen Selbstbildes kompensiert oder aufrechterhalten werden, zu einer Reaktivierung latenter negativ konnotierter Selbstbilder führen könne. Inwiefern sich dieses Phänomen de facto in Maries Trauererleben widerspiegelt, kann nicht abschließend rekonstruiert werden. ...
Die vorliegende Masterarbeit befasst sich mit dem Trauererleben weiblicher Adoleszenter im Zuge der Covid-19-Pandemie. Seit nunmehr zwei Jahren beeinflusst das pandemische Geschehen den Lebensalltag zahlreicher Menschen und somit unweigerlich auch die Trauer nach dem Verlust einer nahestehenden Person. Unter der Berücksichtigung der Spezifika der Adoleszenz, die per se eine von Umbrüchen und Neuorientierungen geprägte Lebensphase darstellt, wird der Frage nachgegangen, wie Menschen im Alter von 17 bis 22 Jahren ihren Trauerprozess retrospektiv beschreiben. Rekurrierend auf Bezugstheorien der
Trauer- und Stressforschung sowie auf gegenwärtige Untersuchungen zu den psychosozialen Folgen der Corona-Krise werden insbesondere personale Belastungen und Ressourcen in den Blick genommen. Zu diesem Zweck wurden leitfadengestützte Interviews geführt, die mit der dokumentarischen Methode nach Bohnsack und Nohl sowie der systematischen Metaphernanalyse nach Schmitt ausgewertet wurden. Die komparative Analyse der drei ausgewählten Interviews zeigt auf, dass sich Maßnahmen der physischen Distanzierung sowie die mit den Restriktionen einhergehenden eingeschränkten Trauer- und Freizeitgestaltungsräume als zentrale Belastungsfaktoren erwiesen. Zudem wurde die bisweilen fehlende Alltagsstruktur hervorgehoben, die eine Ablenkung von verlustfokussierten Gedanken erschwere. Es zeigte sich ein doppeltes Verlusterleben, das sich zum einen auf den Personenverlust sowie zum anderen auf den ex abrupto veränderten Lebensalltag bezieht. Zugleich richteten die Befragten den Blick auf neue Copingstrategien: Exemplarisch ist auf den Einsatz digitaler Medien zur Aufrechterhaltung und Initiierung von Kontakten, die mitunter kreativ gestaltete und der Introspektion dienliche verlängerte Zeitspanne zwischen Tod und Bestattung sowie auf Momente intensivierter Erinnerungsarbeit zu verweisen. Im Gesamtbild zeigt sich eine heterogene Wahrnehmung kumulativer Belastungsfaktoren. Die Corona-Krise tangierte das Trauererleben aller Befragten, worauf sowohl mit einer Vielzahl adaptiver als auch mit maladaptiven Bewältigungsstrategien reagiert wurde. Deutlich wird überdies der Wunsch nach gesteigerten politischen Partizipationsmöglichkeiten und einem verbesserten Zugang zu trauerbezogenen Unterstützungsangeboten. Dies stellt einen ersten Anknüpfungs-punkt für gesellschaftspolitische und strukturelle Veränderungen im Sinne einer adäquaten Berücksichtigung der Belange junger Menschen dar.
Abzuwarten bleibt darüber hinaus, ob durch die gegenwärtige Krisenerfahrung Enttabuisierungs- und Destigmatisierungsprozesse im Hinblick auf thanatale Themen weiter vorangetrieben werden können und inwieweit auf institutioneller Ebene auf die antizipierte gesteigerte Zahl prolongierter Trauerprozesse reagiert wird.
Schlagwörter: Trauer · Covid-19-Pandemie · Corona-Krise · Coronapandemie · Adoleszenz · Trauerprozess · prolongierte Trauer · Coping · Resilienz · Stressoren · Partizipation · Tod · Verlust
... Es preciso que exista una oscilación equilibrada entre la confrontación y la restauración, pero la resolución del duelo sólo podrá tener lugar mediante la transición gradual a mecanismos de restauración (Stroebe & Schut, 2001). Esta oscilación bimodal entre reacciones de evitación y de confrontación ha sido descrito como una respuesta normal a una experiencia anormal (Lindemann, 1944;Horowitz et, al, 1980;Van der Kolk, 1996). ...
... Los estudios de investigación destacan también el incremento de suicidios, conductas de riesgo para la salud, aumento de problemas cardiovasculares y la aparición de cáncer, durante los duelos traumáticos(Boelen et al. 2010). La presencia de estos problemas derivados de la falta de elaboración del duelo, podrían dar lugar al llamado duelo patológico, este se define como aquel cuya intensificación provoca que "la persona esté desbordada y recurra a conductas desadaptativas, o permanezca inacabablemente en este estado, sin avanzar en el proceso de duelo hacia su resolución"(Horowitz, et al., 1980). Los datos aportados, evidencian la importancia de una buena elaboración del duelo a la hora de preservar una buena salud tanto mental como física, después de vivir una pérdida significativa. ...
Esta obra describe el Servicio de Primera Ayuda Psicológica Telefónica (SPAP), desarrollado en 2020 en España durante la pandemia acontecida por la COVID-19. Se detallan algunos de los numerosos casos atendidos, siendo su finalidad servir de modelo y precedente de cara a futuras situaciones de crisis. En el Capítulo 3, se detalla el caso de "Valentía", una menor española de seis años que presenta sintomatología ansiosa durante el confinamiento por la COVID-19. A lo largo del capítulo, se presenta el caso clínico, en el que se empleó un enfoque cognitivo-conductual y cuya intervención se llevó a cabo de manera telefónica en tres llamadas de una duración aproximada de 50 minutos.
... 16 Además, el duelo supone una regresión intensa, donde las personas se perciben como inútiles, inadecuadas e incapaces. 17 Otro aspecto importante es que la muerte del niño cuestiona los valores fundamentales de la vida, de cada padre y sus creencias filosóficas, e impide que se adapten a la pérdida. Esto genera una lucha contra sí mismos, fomenta la impotencia, el no desarrollo de las capacidades de confrontamiento necesarias o aislamiento del mundo y evación de las exigencias del medio; por lo tanto, es necesario el aprendizaje y ensayo de nuevos roles. ...
... Los estudios demuestran aceptación de la pérdida cuando ambos padres tienen estilos de afrontamiento similares y comunicación más abierta. 17 El análisis de las circunstancias que rodean al fallecimiento, la expresión, clarificación y aceptación de los sentimientos generados por el embarazo, nacimiento y muerte; la ayuda en la construcción de redes de apoyo eficaces, y la resignificación de algunos eventos de vida importantes para las parejas, son aspectos relevantes en los que debe centrarse la intervención psicológica. ...
Impacto emocional en las parejas a quienes se informa que su feto tiene defectos congénitos Artículo de revisión RESUMEN Los embarazos con defecto congénito desencadenan una reacción de duelo en los futuros padres, que puede complicarse y evolucionar a estados emocionales patológicos, por lo que es importante la valoración e intervención psicológica en el proceso de duelo durante el diagnóstico prenatal, el transcurso del embarazo y la finalización del mismo. Este artículo revisa las manifestaciones emocionales de las parejas que viven un embarazo con diagnóstico de defecto congénito y muestra que las pérdidas perinatales y neonatales generan una respuesta emocional con todas las características y síntomas del duelo; sin embargo, factores personales, internos y externos, pueden facilitarlo o complicarlo y evolucionar a duelo patológico, este último exige un proceso psicoterapéutico que evite repercusiones clínica-mente significativas en la salud psicológica. La propuesta de manejo del duelo para los padres consiste en el trabajo psicológico desde el diagnóstico prenatal hasta la finalización del embarazo. ABSTRACT Pregnancies with congenital defects cause a grief reaction in future parents, that in many cases can get complicated and to progress to pathological emotional conditions. Due to this grief process psychological evaluation and intervention is important during prenatal diagnose, pregnancy course, and pregnancy end. This article reviews emotional manifestations in couples who undergo a pregnancy diagnosed with congenital malformation, and shows that perinatal and neonatal losses produces an emotional response with all characteristics and symptoms of grief. However, personal factors (both internal and external) can facilitate or complicate it, and evolve to a pathological grief. This pathological grief requires a psychotherapeutic process to avoid clinically meaningful psychological health impacts. The proposal to parents' cope with grief consists in psychological work since prenatal diagnosis until pregnancy end. RÉSUMÉ Les grossesses avec défaut congénital provoquent une réaction de deuil chez les futurs parents, qui peut se compliquer et évoluer à des états émotionnels pathologiques, pour cela il est importante la valorisation et intervention psychologique dans le processus de deuil pendant le diagnostic prénatal, l'évolution de la grossesse et sa finalisation. Cet article fait la révision des manifestations émotionnelles des couples vivant une grossesse diagnostiquée avec défaut congénital et montre que les pertes périnatales et néonatales génèrent une réponse émotionnelle avec toutes les caractéristiques et symptômes de deuil ; pourtant, des facteurs personnels, internes et externes, peuvent le rendre facile ou compliqué et le faire évoluer vers un deuil pathologique, ce dernier exige un processus psychothérapeutique qui évite des répercussions cliniquement significatives sur la santé psychologique. La proposition de la conduite du deuil pour les parents consiste dans le traitement psychologique à partir du diagnostic prénatal jusqu'à la fin de la grossesse. Most-clés: deuil, intervention psychologique, défaut congénital, réactions émotionnelles. RESUMO As gestações que têm defeitos congênitos ocasionam uma reação de dor para os futuros pais, que pode complicar e evolucionar o estado emocional patológico, pelo qual é importante a valoração e intervenção psicológica no processo de dor, durante o diagnóstico pré-natal, no transcurso da gravidez e na finalização do mesmo. Este artigo revisa as manifestações emocionais dos casais que vivem uma ges-tação com diagnóstico com defeito congênito e mostra que as perdas perinatais e neonatais geram uma resposta emocional com todas as características e sintomas de dor, no entanto, fatores pessoais, internos e externos, podem facilitar ou complicar e evolucionar a dor patológica, este último exige um processo psicoterapêutico que evite repercussões clinicamente significativas na saúde psicológica, desde o diagnóstico pré-natal até o final da gravidez. Palavras-chave: Dor, intervenção psicológica, defeito congênito, reações emocionais.
... In the most recent volume of the Diagnostic and Statistical Manual (DSM III-R) (1987), pathological grief reactions have been designated as "complicated bereavement." According to Horowitz (1980), pathological grief is: the intensification of grief to the level where the person is overwhelmed, resorts to maladaptive behavior, or remains interminably in the state of grief without progression of the mourning process towards completion ... [It] involves processes that do not move progressively toward assimilation or accommodation, but, instead, lead to stereotyped repetitions or extensive interruptions of healing. ...
... This lack of ability to make decisions and function in the same manner as before the loss, exacerbates the anxiety and despondency of the situation. Sometimes, the griever feels inadequate and helpless, and will regress to latent negative self-images (Horowitz, 1980). Depression may also manifest itselfin the form oflack of concern for self, desire to die, and suicidal thoughts. ...
... In a normal process of overcoming grief, the person goes through several stages as he/she processes what has happened and overcomes the negative consequences generated on a subjective level. However, grief can become complicated and even pathological when the severity of the events overwhelms the person who does not have sufficient personological resources to cope (Horowitz et al., 1980;Zhai & Du, 2020;Hilberdink et al., 2023). ...
In the context of the Colombian armed conflict, women have been the most affected, with the grief process being the most deficient due to the lack of psychosocial support. The objective of this study was to describe resilience and coping strategies in a sample of women victims of the armed conflict and their relationship with the stages of grief experienced. The methodology used was a quantitative, descriptive, non-experimental, ex post facto approach. Twenty women victims of the armed conflict who were in different stages of grief due to the loss of their loved ones as a result of the armed conflict participated in the study. The Resilience Scale SV-RES for youth and adults by Saavedra and Villalta (2008), the Coping Strategies Inventory adapted by Cano, Rodríguez, and García (2006), and the Grief Phases Scale by Miaja and Moral (2013) were used. Results: Deficiencies in the use of coping strategies were identified in the study sample, with a higher frequency of use of non-functional strategies. Women who were in more advanced stages of grief showed the use of more functional coping strategies. No correlation between stages of grief and time since loss was identified. Conclusions: The results suggest that the process of coping and grief elaboration in the sample of women victims of the armed conflict is not related to the time elapsed since their loss, but rather to the use of personological resources.
... Complicated grief can be understood as those manifestations that cause 'the person to become overwhelmed, to resort to maladaptive behaviours or to remain endlessly in this state without progressing in the grieving process towards resolution'. 12 Despite this, family members can experience the organ donation request positively, regardless of what their final decision was. 13 The decision to donate and bereavement The claim is often made that organ donation may positively impact families' grieving process. ...
Introduction
There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors’ relatives.
Methods and analysis
A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient’s death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives’ grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software.
Ethics and dissemination
This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.
... The complicated mourn is defined as the lack of satisfaction of lived experiences, such that the person is overwhelmed and appeals to maladaptive coping behaviors[14] [18].[ ] I know I am sick; no need to repeat me that all the time, but I can do better things without bothering me. ...
... Böyle bir dönemden geçen kişi kaybını kabullenmek için zamana, içsel motivasyona ve sosyal desteğe ihtiyaç duyar. Kişinin yas süreci bir sebepten ötürü sekteye uğrar, yaşanması olağan yas evrelerinin birinde takılıp kalır yani ruhsal açıdan sağlıklı bir şekilde yasını tutamazsa; yas süreci uzar, hissedilen acı derinleşir ve beklenmedik, abartılmış, uzamış bazı patolojik tepkiler veya tepkisizlik hali gelişebilir [9][10][11]. Bu durum patolojik, maskelenmiş, çözümlenmemiş, kronik, gecikmiş ya da komplike yas olarak adlandırılır [10,12,13]. ...
... Al principio del duelo es normal una dificultad para gestionar el dolor, pero mantenido en el tiempo, más allá de un año o dos, podría convertir el duelo en patológico o complicado. En este sentido, podríamos entender este tipo de duelo por infidelidad como una intensificación del dolor, de manera que la persona está y se siente psicológicamente desbordada, por lo que recurre a conductas -tildadas dedesadaptativas que, de alguna manera, la mantienen en un bloqueo en el proceso de duelo, sin poder resolverlo (Horowitz, 1980). De ahí que la complicación del duelo en la infidelidad, hace que se hable casi indistintamente de duelo complicado (no resuelto), duelo patológico o duelo traumático. ...
RESUMEN La infidelidad suele desencadenar una inestabilidad en la relación amorosa que frecuentemente desemboca en separación y divorcio. Tiene graves consecuencias tanto a nivel individual como familiar, social y económico. A pesar de la profunda conmoción, muchas parejas deciden seguir en relación, lo que implica habitualmente atravesar por un proceso de cura. Tanto si se separan como si siguen juntas, la labor terapéutica se ve impelida a trabajar el duelo, debido a las numerosas pérdidas que conlleva. Un duelo por lo general complicado por su intensidad y duración, así como por lo traumático de la experiencia. SUMMARY Infidelity often triggers instability in the love relationship that often leads to separation and divorce. It has serious consequences both at the individual, family and social level. Despite the deep shock, many couples decide to stay in relationship, which usually involves going through a healing process. Whether they are separated or if they remain together, the therapeutic work is impelled
... Sometimes the intensity or the course of the grieving process is altered. In this case we speak of complicated grief (Horowitz, Wilner, Marmar, & Krupnick, 1980;Simon et al., 2011;Vargas, 2003). ...
... Cuando el afrontamiento es deficitario y se ven alterados el curso o la intensidad del proceso de duelo, entonces se habla de duelo complicado (DC) (Horowitz, Wilner, Marmar y Krupnick, 1980;Vargas, 2003;Simon et al., 2011). ...
Objective: to describe the type of coping which develops (focused on emotions, focused on the problem and search for transcendence) a sample of people in complicated grief (CG), its level of resiliency and to study the possible correlation between coping and resiliency. Method: Descriptive correlational study on a sample of 130 people in situation of complicated mourning with data collected through self-report in a mourning listening or accompaniment center. Results: average age 56 years, 76% women, 24 % men. Average of complicated mourning 41.28 on 76. Medium all about 4 total coping 2.66 (coping focused in problems 2.56; emotions 2.22 and search for transcendence 3.21). Resiliency average 4.49 of 7. Significant correlations (alpha=0.01) were found: the three factors of the scale with the coping total score: with coping focused on emotions Pearson: 0.591; problems Pearson: 0.703 and search of trascendence Pearson: 0.711. Among factors coping focused on problems and search for transcendence Pearson: 0.287. Conclusion: Resilience appears to be natural and common to the CG. It is associated with focused on problems coping and search for transcendence, while the CG is associated with emotion-based coping. INTRODUCCIÓN La pérdida de un ser querido implica siempre una etapa posterior de adapta-ción. Esta etapa se denomina duelo y se trata de un proceso normal y necesario (Bermejo, 2005; Howarth, 2011). Cuando el afrontamiento es deficitario y se ven alterados el curso o la intensidad del proceso de duelo, entonces se habla de duelo complicado (DC) (Horowitz, Wilner, Marmar y Krupnick, 1980; Vargas, 2003; Simon et al., 2011). Desde los años 80 se viene hablando del modo en que la gente enfrenta los sucesos vitales estresantes, como por ejemplo la muerte, empleando el término (Págs. 85-95)
... Self-hate has been operationalised within the self-criticism literature as a response to failure or setbacks (i.e., Forms of Self-criticism/ Self-reassurance Scale); however, self-hate items were derived from clinical impressions rather than an established theory, and the authors questioned the content validity of this scale in regards to how much 'hate-based emotion' was assessed (Gilbert et al., 2004). Alternatively, the Self-Disgust Scale (SDS; Overton et al., 2008) has recently been developed to measure the closely related construct of self-disgust, a form of negative self-view that results from a change in one's sense of self from feeling loveable to feelings of inferiority and worthlessness (Chu et al., 2013;Horowitz et al., 1980). However, the SDS was originally designed for use within eating disorders, with a focus on body image, is not unidimensional (consists of between two and three subscales), and has demonstrated an inconsistent factor structure across studies, with multiple items cross loading on factors, thereby making this scale unsuitable for the assessment of self-hatred. ...
Background: The “self” has been implicated in the development of a range of psychological disorders. While a growing body of literature has emerged exploring the Interpersonal Psychological Theory of Suicide (IPTS), little research has been conducted on the construct of self-hate and its relationship with suicidal ideation. The aims of this study were to: 1) develop and validate a brief self-report instrument of self-hate; and, 2) explore the relationship between self-hate, suicidal ideation, and the two main factors of the IPTS, perceived burdensomeness and thwarted belongingness. Methods: Initial development of the item pool involved an expert panel and the development of the Self-Hate Scale included exploratory and confirmatory factor analyses using a large community sample. Results: A 7-item Self-Hate Scale was developed, which exhibited a reliable unidimensional factor structure. High self-hate was found to predict suicidal ideation, while the relationship between low/moderate self-hate and suicidal ideation was partially moderated by the level of thwarted belongingness. The study provided limited evidence for the IPTS’ main predictions. Limitations: While the current study provided support for the psychometric properties of the Self-Hate Scale, the scale will need to be replicated and validated using clinical populations. Conclusions: The Self-Hate Scale is a brief, psychometrically valid measure of self-hate that has the potential to be useful in suicide risk assessment.
... Although pathological variants of bereavement have long been recognized in the psychiatric literature (3)(4)(5)(6)(7)(8), there exists considerable confusion over the precise nature of symptoms that constitute a pathological grief reaction. Many formulations of complicated bereavement reactions, such as that found in DSM-IV, focus almost exclusively on symptoms of depression (e.g., sad mood, psychomotor retardation, poor appetite). ...
... In addition to the mental health and mortality consequences of bereavement described above, some characterize complications of bereavement as ''pathological'' with subtypes of inhibited, delayed, and prolonged (Bowlby, 1980(Bowlby, /1981Horowitz, Wilner, Marmar, & Krupnick, 1980;Middleton, Raphael, Martinek, & Misso, 1993;Parkes, 1965;Worden, 1991). Recent attention has focused on a variant of prolonged grief now termed complicated grief (CG). ...
The purpose of this cohort sequential study was to determine whether the presence of complicated grief (CG) measured at various points in the spousal bereavement process is associated with an increase in mental and physical health problems 18 months later. One hundred twelve participants provided data at four points in time. CG was measured with the Inventory of Complicated Grief (ICG), and mental health was measured with the Integra Outpatient Tracking Assessment, Mental Health Index (MHI), and illnesses by self-report. Twenty-nine participants were identified as experiencing CG. Beginning at 6 months after the death, MHI scores were significantly lower for the CG group and those results were persistent. The CG group experienced more additional life stressors, perceived less social support, and achieved less clinically significant change in MHI than the NCG group. Identification of CG at any point at 6 months or later in bereavement indicates a need for professional intervention. Implications for establishing CG as a DSM diagnosis are discussed.
... Horowitz, patolojik yas› belli baz› davran›fllar›n varl›¤›na de¤il, yas tepkisinin süresi ya da yo¤unlu¤undaki art›flla iliflkilendirmektedir (Horowitz 1980;akt. Worden 1991). ...
... Research has suggested that feelings of disgust with the self may be understood as a form of negative self-views, such as self-criticism, hatred, and attacking (Chen, Wu, & Bond, 2009;Gilbert, Clarke, Hempel, Miles, & Irons, 2004). For instance, Horowitz, Wilner, Marmar, and Krupnick (1980), suggested that the state of self-disgust, which is related to thoughts and feelings of self-hate, is the result of an alteration in the sense of self from lovable to unworthy or inferior. Self-hate is also among the defining concepts of perceived burdensomeness (Van Orden et al., 2010). ...
Although predominantly studied within the context of taste aversion, the definition of disgusting stimuli has been continually broadened and refined. Recent evidence has indicated that disgust may play a crucial role in the development and maintenance of various psychopathologies (McNally, 2002). Yet, research examining the role of disgust in suicidal ideation and behavior has been limited. In this paper, we highlight the potential role of disgust with life in the development and maintenance of severe suicidal ideation and behavior and suggest future directions for study.
... However, a portion continue to grieve for an extended period of time and begin to exhibit symptoms of a state known as prolonged grief disorder (PGD) Morina et al., 2010), which is a disorder defined by Prigerson et al. (2009) who have developed and empirically tested consensus and diagnostic criteria for PGD. These symptoms were also variously labeled pathological grief (Horowitz et al., 1980), traumatic grief (TG) (Prigerson et al., 1999), and complicated grief (CG) (Kersting and Wagner, 2012). PGD results in substantial distress and impairment, worsens one's quality of life, and has been linked to excess medical morbidity and suicide rates (Stroebe et al., 2007). ...
Few epidemiological studies have investigated prolonged grief disorder (PGD) in the general population of Asian countries, including China. The aim of this study was to explore the rates and risks of PGD, and the association between PGD, post-traumatic stress disorder (PTSD), depression and anxiety in bereaved Chinese adults. The PG-13, PTSD Checklist-Civilian Version (PCL-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) were administered to 445 subjects. Prevalence within the general population of China was 1.8% (i.e., 8/445). Among the eight subjects who met the PGD diagnosis, 75%, 87.5% and 75% scored above the cut-off point on the PCL-C, SDS and SAS, respectively, although a portion remained free from comorbidity. ANOVA, correlation analysis and stepwise multiple regression analysis demonstrated that kinship to deceased, age of the deceased, religion belief and cause of death were predictive of prolonged grief. A small proportion of bereaved persons may exhibit PGD. There is a substantial but far from complete overlap between PGD and the other three diagnoses. Bereaved parents and the widowed have high risk of PGD. These findings highlight the need for prevention, diagnosis and treatment for PGD patients.
... Cuando las reacciones emocionales son muy intensas e impiden el funcionamiento en la vida diaria, la duración de la reacción es anormalmente larga (dura más allá de un año) y aparecen síntomas inhabituales (por ejemplo, alucinaciones, referidas a visiones o voces del fallecido, ideas delirantes o pensamientos suicidas recurrentes), se puede hablar de duelo patológico (Fernández-Montalvo y Parkes, 1972;Worden, 1998). La pena mórbida es la intensificación del duelo hasta un punto en que la persona niega la pérdida, se siente desbordada, recurre a conductas desadaptativas o permanece inacabablemente en este estado, sin mostrar avances en el proceso de resolución del duelo (Horowitz, Wilner, Marmar y Krupnick, 1980) ...
RESUMEN El pesar por la muerte de un ser querido es una experiencia que todos los seres humanos sienten. Sin embargo, no todos experimentan las mismas necesidades psicológicas ni tienen los mismos recursos personales y sociales disponibles. La muerte de una persona allegada es un factor muy estresante, pero muchas personas se muestran resistentes emocionalmente para superar este trance. La pena mórbida se produce cuando la persona experimenta durante el proceso del duelo emociones negativas (tristeza, ira, culpa, confusión) muy intensas y duraderas que interfieren negativamente en su vida cotidiana. Entre el 10 Y el 20% de las personas afectadas por una pérdida pueden necesitar ayuda profesional. En estos casos el tratamiento debe darse de forma temprana para evitar la cronificación de los sintomas. La lamentación dirigida, la exposición y la entrenamiento en competencias contribuyen a aliviar los sfntomas depresivos y a reconstruir la autoestima y las creencias sobre las habilidades personales. Los grupos de autoayuda pueden ser una ayuda complementaria, sobre todo Correspondencia: Facultad de Psicología. Universidad del País Vasco. Avda. de Tolosa. 70 20018 San Sebastián (Spain).
... Sometimes the intensity or the course of the grieving process is altered. In this case we speak of complicated grief (Horowitz, Wilner, Marmar, & Krupnick, 1980;Simon et al., 2011;Vargas, 2003). ...
Objective: To analyze variations in complicated grief (CG) across sociodemographic variables and variables of optimal functioning: psychological well-being (PWB), available social support (ASS) and satisfaction with available social support (SASS). Method: A cross-sectional study was done with N = 110 people going to a free bereavement listening center (LC). They were given a questionnaire that included sociodemographic aspects. The Inventog of Complicated Grief by Prigerson (ICG), a Spanish language adaptation of Ryff's Psychological Well-Being Questionnaire and the abbreviated version of Sarason's Social Support Questionnaire (SSQSR) were used. A descriptive and correlational (Pearson) analysis was carried out. Multiple linear regression was done by using a method of a step-by-step backwards elimination. Results: The average CG 40.91 (SD = 11.89), PWB 119.23 (SD = 18.75), ASS 10.56 (SD = 6.31) people and SASS 13.48 (SD = 4.17). The predictive variables of CG level were: PWB, ASS, SASS, months since loss, receiving pharmacological assistance and parental relationship. The adjusted R-squared was 42.4%. Conclusions: We can consider PWB and SASS predictors of CG. It would be appropriate to clarify the effect of depressive symptoms on the perception of ASS. This study contributes to increasing efficiency of resources, to be able to partially predict CG through variables that do not involve the worsening of a mourning relative's state.
Conceptualisations of grief have transformed significantly in recent decades, from an experience accepted and expressed in community spaces to a diagnosable clinical phenomenon. Narratives of this transformation tend to focus on grief’s relationship to major depression, or on recent nosological changes. This paper examines the possibility of a new narrative for medicalisation by grounding in the networks of language and power created around ‘grief’ through a critical discourse analysis of psy‐discipline articles ( n = 70) published between 1975 and 1995. Focusing on shifts in definitions of, methods used to approach, and rationales motivating study of the experience, it posits that the psy‐disciplines exerted exclusive expertise over grief decades before its creation as a diagnosis. By reconceptualising grief in the terms of psy‐specific symptoms and functional performance and by approaching it with the decontextualising and interventionist methods of an increasingly scientific psy‐discipline, the psy‐community medicalised grief between 1975 and 1995. Identifying neoliberal and other cultural influences shaping this process of medical construction and reconsidering narratives of grief’s history mindful of the powers exerted in medicalisation, this paper establishes that these moments played a critical role in the development of the present’s grief.
At 1.5 years post-Spitak-earthquake, elderly survivors had significantly less intrusive and more hyperarousal symptoms (e.g., startle, hypervigilance, irritability, insomnia) than younger adults, indicating that treatment for the elderly requires more focus on hyperarousal symptoms (e.g., use of anxiety management techniques).
At 1.5- and 4.5-years post-earthquake, two groups of adults, exposed to severe trauma (earthquake and political violence), experienced comparably high levels of PTSD and depressive symptoms. The results dispelled the prior notion that natural disasters result in less severe reactions and underscore the importance of using objective and subjective measurements to determine exposure severity. They also showed that previous exposure to political violence had an additive effect on subsequent earthquake exposure-related PTSD severity.
The twenty-three-year prospective study among adult survivors of the earthquake showed that a substantial portion of the population (11.6%) still had PTSD related to the earthquake, and another 9.9% had PTSD related to post-earthquake traumas (e.g., fights, accidents, etc.). Risk factors for PTSD at twenty-three-year follow-up included baseline depression, job loss, post-earthquake traumas, and chronic medical illnesses. The chapter also presents important findings from other disaster studies, including the effect of cumulative trauma, delayed onset PTSD, increased mortality associated with PTSD and depression, and comparisons of recommended treatments for PTSD and depression and their limitations.
This study examined the psychosocial experiences of infant mortality by mothers in Nigeria. Mothers (n = 2 400) from the six geo-political zones in Nigeria participated in the study (age range = 18 to 40 years and above; African Traditional Religion (ATR) = 3%, Christian = 62%, Islam = 35%). The mothers self-reported their demographic data and completed the Psychosocial Experiences of Infant Mortality scale. Logistic regression analysis indicated that locality and marital status predicted mothers’ disposition toward psychosocial experiences of infant mortality.educational qualification of mothers also significantly predicted their psychosocial experiences. The findings suggest that psychosocial management practices could be helpful in counselling mothers who experienced infant mortality.
Bereavement services are often provided as components of hospice and palliative care plans, including emotional, psychosocial, and spiritual support provided to individuals and families to assist with grief, loss, and adjustment after the death of a loved one. Patient- and family-centered care is a hallmark of palliative care. Moreover, bereavement counseling is offered as a hospice care benefit that is covered by Medicare and various private insurance plans. However, not all hospital-based palliative care programs offer bereavement support. Many bereaved persons whose loved one dies in the hospital while receiving palliative care services may not have access to a bereavement support program. This practice concept article describes an innovative bereavement program designed to offer support to individuals whose loved one died in the hospital while receiving palliative care. The bereavement team, including clinical professionals from the inpatient palliative care team and two community hospices, developed the University of Florida (UF) Health Bereavement Program. The interprofessional team includes social workers, volunteers, chaplains, nurses, nurse practitioners, and physicians. The Bereavement Program incorporates grief support workshops, follow-up with participants, via postal mail at timed intervals, website access to grief resources, staff education, and an annual evening of remembrance program. Finally, interagency collaboration has extended the reach of bereavement services beyond UF Health into our community at large.
The present paper offers a selective review of the relevant empirical literature that has attempted to outline the reaction of a person to the death of a spouse, and the manner in which this reaction differs from a clinically significant depressive disorder. This review indicates that although grief and depression may be similar in some ways (e.g., affective and behavioural disruption), they rarely are similar in terms of level of pathology in cognitive functioning. In light of this, it is recommended that caregivers working with the bereaved go beyond assessment of depressive symptomatology, and explore the personal meaning of the death for the grieving spouse.
Impacto emocional en las parejas a quienes se informa que su feto tiene defectos congénitos Artículo de revisión RESUMEN Los embarazos con defecto congénito desencadenan una reacción de duelo en los futuros padres, que puede complicarse y evolucionar a estados emocionales patológicos, por lo que es importante la valoración e intervención psicológica en el proceso de duelo durante el diagnóstico prenatal, el transcurso del embarazo y la finalización del mismo. Este artículo revisa las manifestaciones emocionales de las parejas que viven un embarazo con diagnóstico de defecto congénito y muestra que las pérdidas perinatales y neonatales generan una respuesta emocional con todas las características y síntomas del duelo; sin embargo, factores personales, internos y externos, pueden facilitarlo o complicarlo y evolucionar a duelo patológico, este último exige un proceso psicoterapéutico que evite repercusiones clínica-mente significativas en la salud psicológica. La propuesta de manejo del duelo para los padres consiste en el trabajo psicológico desde el diagnóstico prenatal hasta la finalización del embarazo. ABSTRACT Pregnancies with congenital defects cause a grief reaction in future parents, that in many cases can get complicated and to progress to pathological emotional conditions. Due to this grief process psychological evaluation and intervention is important during prenatal diagnose, pregnancy course, and pregnancy end. This article reviews emotional manifestations in couples who undergo a pregnancy diagnosed with congenital malformation, and shows that perinatal and neonatal losses produces an emotional response with all characteristics and symptoms of grief. However, personal factors (both internal and external) can facilitate or complicate it, and evolve to a pathological grief. This pathological grief requires a psychotherapeutic process to avoid clinically meaningful psychological health impacts. The proposal to parents' cope with grief consists in psychological work since prenatal diagnosis until pregnancy end. RÉSUMÉ Les grossesses avec défaut congénital provoquent une réaction de deuil chez les futurs parents, qui peut se compliquer et évoluer à des états émotionnels pathologiques, pour cela il est importante la valorisation et intervention psychologique dans le processus de deuil pendant le diagnostic prénatal, l'évolution de la grossesse et sa finalisation. Cet article fait la révision des manifestations émotionnelles des couples vivant une grossesse diagnostiquée avec défaut congénital et montre que les pertes périnatales et néonatales génèrent une réponse émotionnelle avec toutes les caractéristiques et symptômes de deuil ; pourtant, des facteurs personnels, internes et externes, peuvent le rendre facile ou compliqué et le faire évoluer vers un deuil pathologique, ce dernier exige un processus psychothérapeutique qui évite des répercussions cliniquement significatives sur la santé psychologique. La proposition de la conduite du deuil pour les parents consiste dans le traitement psychologique à partir du diagnostic prénatal jusqu'à la fin de la grossesse. Most-clés: deuil, intervention psychologique, défaut congénital, réactions émotionnelles. RESUMO As gestações que têm defeitos congênitos ocasionam uma reação de dor para os futuros pais, que pode complicar e evolucionar o estado emocional patológico, pelo qual é importante a valoração e intervenção psicológica no processo de dor, durante o diagnóstico pré-natal, no transcurso da gravidez e na finalização do mesmo. Este artigo revisa as manifestações emocionais dos casais que vivem uma ges-tação com diagnóstico com defeito congênito e mostra que as perdas perinatais e neonatais geram uma resposta emocional com todas as características e sintomas de dor, no entanto, fatores pessoais, internos e externos, podem facilitar ou complicar e evolucionar a dor patológica, este último exige um processo psicoterapêutico que evite repercussões clinicamente significativas na saúde psicológica, desde o diagnóstico pré-natal até o final da gravidez. Palavras-chave: Dor, intervenção psicológica, defeito congênito, reações emocionais.
This article discusses applications of attachment theory and theories of bereavement to the treatment of trauma with loss of the mother in young children. The article suggests guidelines that may be useful in clinical work with these difficult cases. Clinical application of the guidelines is illustrated by discussion of the therapeutic work with a 3-year-old boy who at the age of 2?/2years survived an automobile accident in which his mother died.
According to psychosomatic theories physical illness can have different meanings or subjective significances for patients. Five major categories of meanings have been distinguished: “threat,” “loss,” “gain or relief,” “challenge,” and “insignificance.” Each meaning has its determinants and emotional response. A variety of these determinants are described: intrapersonal, interpersonal, pathology-related, and sociocultural factors can all determine the way in which patients view their illness (Fig. 1 gives a survey of this theory).
Much has been written about the peculiarities of the lost, excruciating American war in Southeast Asia (Bourne, 1970; Lifton, 1973; Haley, 1974; Goodwin, 1980; Blank, 1981), about the psychological sequelae of combat (Swank, 1949; Futterman and Pumpian-Mindlin, 1951; Archibald and Tuddenham, 1965; Horowitz, 1975; Howard, 1975; Defazio, 1978; Kormos, 1978; Shatan, 1978, Wilson, 1980) and of other, nonmilitary trauma (Visotsky, Hamburg et al, 1961; Eitinger, 1964; Des Pres, 1976; Niederland, 1968, 1981). There are clear accounts of crisis-intervention techniques behind the battle lines (Grinker and Spiegel, 1945; Glass, 1947, 1954; Pettera, Johnson and Zimmer, 1969; Colbach and Parrish, 1970; Jones and Johnson, 1975). And there is now an established literature on brief psychotherapy. This chapter, while not an exhaustive review of all these issues, brings together relevant aspects of the literature and adds clinical case material with the aim of making coherent sense of a brief therapeutic approach to selected symptomatic combat veterans.
Violence is an all too common feature of modern life. Media presentations are filled with images of people hurting one another, and although much attention is given to scenes depicting violence and even to perpetrators of violence, little is given to victims (Bard & Sangrey, 1979). Violence involves physical force with the intent to harm another, and from an observer’s perspective, victims’ injuries seem best measured in terms of physical harm. The plight of the victim, in other words, is generally understood in terms of physical violation. Yet injury to victims of violence involves not only physical violation but psychological violation as well. The aftermath of violence for victims must be understood by considering threats not only to their bodily integrity but to their psychological integrity. Victims are forced to confront directly the possible loss of physical functioning and even death. They are also forced to confront directly the possible breakdown of the cognitive structures that had been so instrumental in providing psychological stability.
The collective aim of all psychotherapies is the amelioration of an individual’s problems of living. The process by which this goal is achieved, however, will vary according to the particular orientation of the psychotherapeutic approach in question. The case illustrations presented in this chapter demonstrate the contribution of contemporary behaviour therapy to the resolution of three such problems of living, namely, auditory hallucinations, insomnia and grief. Fictitious names have been given to the clients, and the details of each case have been altered to maintain confidentiality. While aspects of assessment, intervention and evaluation will be described, it must be emphasized that the strategies employed throughout the therapeutic process were designed to meet an individual’s requirements and circumstances; each intervention package has therefore been tailor-made to meet the needs of one particular person.
This chapter deals with the scales and syndromes of axis 1 disabilities. As conceptualized in DSM-III-R, a mental disorder is a clinically significant behavioural or psychological syndrome or pattern that is associated with current distress (a painful symptom) or disability (disturbance in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable response to a particular event Whatever its original cause, it must currently be considered a manifestation of a behavioural, psychological or biological dysfunction in the patient- As discussed by Spitzer and Williams (1988), clinically significant means some pathological disturbance and behavioural or psychological syndrome or pattern that refers to the core symptoms. These symptoms are associated with either distress or disability.
Cognitive psychotherapy, as originally conceived and developed by Beck and his followers (Beck 1963, 1964, 1976, 1985), is a now well-estabished method of treatment in many countries, where active training and research centres contribute to its further refinement and diffusion. National societies of cognitive psychotherapy have been established, meetings and symposia occur frequently, and a number of specialized journals are regularly issued. During recent decades substantial evidence has been accumulating that lends support both to the theoretical basis of cognitive psychotherapy and to its therapeutic effectiveness in the treatment of various kinds of psychopathological disorders. Its place among the powerful methods of treatment is properly acknowledged in modern psychiatric textbooks.
Compared to the general population, older adults often experience greater excess disability due to a variety of emotional disturbances and formal psychiatric disorders. There is increasing evidence that much of this unnecessary suffering can be ameliorated by a variety of psychotherapeutic interventions (Teri & McCurry, 1994). However, there are factors unique to older adults that affect the recognition of emotional disorders in late life as well as the availability, delivery, and effectiveness of mental health services. This chapter begins with an overview of key issues relevant to psychotherapy with older adults, beginning with accessibility and utilization of mental health services in this population. This is followed by a selective review of relevant clinical, empirical, and theoretical issues in the diagnostic categories of late-life depression, anxiety, and substance abuse. The chapter concludes with a discussion of suggested guidelines for therapeutic interventions with older adults, with particular attention to psychiatric disability in individuals with neurological disorders.
We present in this study a description of traumatic grief counseling in group in the Center of Mental Health of Puente de Vallecas carried out after the terrorist attack occurred in Madrid on March 11, 2004. We address in this work social demographic issues, data concerning the circumstances of the death, a subjective valuation of the members of the group regarding the treatment applied and strategies of coping according to the Coping Depression Inventory (CID). The therapy applied during 9 months helped to accept the loss suffered facilitating the control of the own emotions and the adaptation to the new reality. We have found that counseling in group is an appropriate treatment and that the most effective strategies of coping are the group activities and the emotional self-expression.
Most serious life events involve actual or potential losses: of a loved one, of material possessions, of health, or of hopes for the future. The ideal adjustment to loss is to accept it, replace that which is lost, and go on living. Between the first pangs of recognition of loss and adaptation to circumstances as they must be, there is an important, painful interval characterized by states of both intrusion and denial.
Objective: To test the psychometrics properties of the Grief Cognitions Questionnaire(GCQ) in Chinese bereaved sample. Methods: 450 bereaved individuals were tested with a measuring battery including GCQ, Prolonged Grief-13(PG-13), Posttraumatic Stress Checklist-Civil Version(PCL-C), Zung Self-Rating Depression Scale(SDS) and Zung Self-Rating Anxiety Scale(SAS). Results: Confirmatory factor analysis suggested that the current bereaved sample support the nine-factor model. Internal consistency coefficient was 0.97; retest reliability coefficient was 0.76; convergent validity(0.45-0.73) were good and discriminate validity(0.28-0.53) was acceptable. After controling for basic informations, GCQ score in PG-group was still significantly higher than the control group[F(1,435)=129.40, P=0.000]. Conclusion: Chinese version GCQ shows good psychometrics properties in Chinese bereaved sample. Thus, GCQ can be used in Chinese culture.
IntroductionClassification and Unipolar DepressionSymptoms and SyndromesCompeting ClassificationsThe Limits of ClassificationLeaky Classes and ComorbidityDepression and the Threshold ProblemCase Identification in ResearchQuestionnaires and InterviewsBottom-up and Top-Down Case IdentificationThe Frequency of Depressive DisorderDepression and SexDepression and AgeOther Sociodemographic Variables That Influence Rates of DepressionBIological Explanations for the Sex Ratio In DepressionLife Stress and DepressionThe Childhood Antecedents of Later DepressionThe Epidemiology of Treatment for DepressionThe Genetic Epidemiology of Major DepressionConclusions
References
Reasons why people with learning disabilities do not receive the support they require following a bereavement are explored in the context of a social model of disability. Grief and bereavement issues are also seen as a health promotion issue.
A variety of interventions are identified which could meet the needs of people with learning disabilities at this sensitive time in their lives. The outcomes of health promotion interventions are highlighted, and a facilitation model of grief is outlined (based on Heron 1989). This model is designed to help people who have experienced uncomplicated grief reactions and consists of six dimensions of facilitation which are detailed. Finally, ways of moving forward in this sensitive area are suggested.
Although survivors of homicide victims are recognized as a distinct bereaved population, little attention has been given to concepts of posthomicide wellness and the conditions that advance survivors' healing. This article examines the well-being of survivors through interviews and focus groups with survivors and victim assistance providers. Data were analyzed using a combination of template analysis and grounded theory, qualitative approaches that serve to broaden existing theory and prior research about homicide bereavement so that survivors' functioning can be assessed outside of theory built principally on death due to natural causes or through the lens of complicated bereavement. Findings include eight dimensions of well-being: (a) movement/intentionality, (b) stagnation, (c) reckonings, (d) injustice, (e) factors in the criminal justice system that help or hinder, (f) the role of time, (g) faith, and (h) family and friends. Findings suggest that posthomicide well-being is associated with cognitive and emotional movement in a forward direction. Discussion centers on the prevention of or reduction in barriers that block survivors' movement.
Objective: The present study sought to explore the association of negative cognitions with emotional problems after bereavement, such as symptoms of prolonged grief, depression and anxiety. Methods: Totally488 bereaved adults were asked to complete a battery of structured questionnaires, including Prolonged grief Questionnaire (PG-13), Grief Cognitions Questionnaire( GCQ), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). Results: Hierarchy regression analyses were conducted，each of these cognitive variables was significantly related to the severity of symptoms of prolonged grief, depression and anxiety, even when demographic background and loss-related characteristic which were initially found to influence symptom severity, were statistically controlled. When using stepwise regression method, it was found that global negative belief about self, self-blame, global negative belief about life and future each explained a unique proportion of variance in prolonged grief symptom. global negative belief about future, threatening interpretations of grief, global negative belief about world each explained a unique proportion of variance in depression symptom. Threatening interpretations of grief and global negative belief about future each explained a unique proportion of variance in prolonged grief symptom. Conclusion: To some extent, the findings are in support of Cognitive- Behavioral Conceptualization of grief, and offer some empirical evidence for the cognitive intervention of prolonged grief disorder.
This article, a qualitative exploration of the experiences of subsequent children, endeavors to clarify common issues and experiences of this population. Subsequent children, also known as subsequent siblings, are children born after the death of a brother or sister. For this study, 25 adult subsequent siblings participated in semi-structured interviews. Few researchers have written about this population, and much of what has been documented was researched from single case studies, or from very small samples. This study aims to explore the commonalities of the unique experience of being a subsequent child. Themes which emerged include various replacement child dynamics, impaired bonding with parents or altered parenting as a result of the loss, family grief and its repercussions, meaning making and spiritual questioning, fantasies about the lost sibling, disenfranchised and unresolved grief, taking on a caregiver role, and survivor guilt. The implications for clinical practice are presented.
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