
The Australian Centre for Grief and Bereavement provides some useful information on grief for clients, including the MyGrief app. Visit www.grief.org.au.
For some people, the normal grieving and healing process can become derailed. So much so that they develop a chronic and debilitating condition. The term complicated grief will be used to refer to this condition although it is also sometimes referred to as:
For clinicians using DSM5, the diagnosis 'persistent complex bereavement disorder' has been described. With explicit criteria in conditions for further study - Section III that 'Some indications that the normal grieving process has been derailed, and that complicated grief may be present'. These include:
Complicated grief is associated with more prolonged distress and disability. As well as greater negative health outcomes and suicidality than normal grief. It is important to note that complicated grief is distinct from anxiety and depression. Although there are some common features across these disorders.
Complicated grief reactions have traditionally been diagnosed as
Substantial evidence now suggests that complicated grief is distinct from other disorders. Despite some similarities and frequent comorbidity. For example, veterans suffering any post-bereavement disorder are likely to report ongoing sadness. Those experiencing complicated grief, however, are less likely to report depressive symptoms such as low mood and feelings of hopelessness, or anxiety symptoms such as restlessness or nervousness. Instead, prominent features will include:
It is important to recognise complicated grief. As interventions only targeting anxiety, depression, or PTSD are not usually effective. Careful assessment of symptoms is therefore required. Post-bereavement anxiety, depression, or PTSD (either independent of, or comorbid with, complicated grief) can be treated using standard approaches for these disorders.
Veterans presenting with persistent and severe symptoms following the death of a close friend or relative should be assessed for the possible presence of complicated grief. In most cases, a detailed diagnostic interview is the best way to proceed although several scales are also available. For example:
Complicated grief can be a significant risk factor for suicide. As veterans may feel that life is meaningless, or express a wish to die in order to be reunited with the deceased. It is therefore important to ask grieving veterans about suicidal ideation using direct and unambiguous questions such as:
It is also important to consider and address other risk factors such as social isolation and substance abuse.
Most people find grief resolves over time with the support of their family, friends and usual coping strategies with no professional help necessary. The information below on self-management strategies may be useful for veterans who have experienced loss.
Health care providers can offer advice on basic self-management strategies that the veteran can use to assist in recovery from grief (or while undergoing any necessary psychological and/or pharmacological interventions for complicated grief). Encourage the veteran to:
Mental health practitioner delivered cognitive behavioural therapy (CBT) should be considered for veterans with complicated grief (Wittouck et al., 2011)
CBT has some general techniques applicable across a range of disorders. The specific CBT techniques for targeting complicated grief are:
Such clarifications can potentially address the intrusive images without the requirement to engage in imaginal exposure. The intervention can also include having imagined conversations with the deceased, evoking happy memories, and exploring regrets and resentment so that they are able to make goals for the future.
Complicated grief can be treated in an outpatient setting and does not usually require admission to a psychiatric hospital unit. There is not sufficient evidence to determine a recommended treatment length for complicated grief. However, as whenever using CBT, it is important to establish a clear treatment plan for each time-limited episode of care.
Veterans with milder forms of complicated grief will usually respond well to psychological interventions alone. Psychological interventions are also the treatment of choice for veterans with more severe symptoms. However, evidence suggests an adjunctive course of newer antidepressants can help veterans tolerate grief-focused CBT.
The Australian Centre for Grief and Bereavement provides some useful information on grief for clients, including the MyGrief app. Visit www.grief.org.au.