Complicated grief

from Wikipedia, the free encyclopedia

The complicated grief is also referred to as "persistent grief disorder" or "pathological grief" and is a complication of "normal" sadness . This term describes a course of grief in which, even after months (at least six months) or years, the bereaved are unable to accept the death of a person and to integrate the grief into their lives. When complex grief develops, there is always a specific trigger - the death of a loved one.

Symptoms

Since grief is never linear and schematic and shows different characteristics in its course, and also because of the emotional instability of those affected, the following criteria of complicated grief can only lead to a diagnosis after prolonged observation.

The course of mourning is unusually intense and clearly prolonged. Although a lot of time has passed since the death of a loved one, there remains a great longing and an overwhelming pain, a great deal of suffering that leads to loss of identity, hopelessness and senselessness. A great loneliness and a feeling of surreality arise. Trust in life no longer exists, the future no longer takes place. Life has become empty and meaningless. People withdraw, are weak; in extreme cases, social contacts are avoided or even broken off. The mourners are deeply distressed and emotionally isolated. The circumstances of death are thought through over and over again in an endless loop. This can lead to feelings of guilt and anger about the loss. Either the mourners become intensely preoccupied with the deceased person, or remembering is avoided, as the loss of control leads to sadness, crying and dejection again. In order to counteract the loss of control, the mourners try to distract themselves, which in extreme cases leads to hyperactivity and total physical exhaustion.

The grief is always reactivated by internal or external triggers. These triggers are mostly memories, places, objects, smells or situations that are associated with the deceased person. These can be positive as well as negative things or memories. Calendar dates such as the day of death, birthday, public holidays or the wedding day are also grief triggers.

In addition to the psychological stress, there are also various physical symptoms such as total exhaustion, cardiovascular complaints ("Broken Heart Syndrome"), constant tiredness, concentration problems, loss of appetite or binge eating, body aches, headaches, nerve pain, dizziness, sleep disorders, freezing, etc. Mortality and Suicide rates are significantly higher among survivors who have a complicated course of grief.

According to the Federal Statistical Office , 933,000 people died in Germany in 2017; an average of three people mourn one person. Approx. 4% of all mourners develop a complicated grief, that is about 110,000 people per year in the Federal Republic of Germany. Unrecognized, untreated, complicated grief can lead to alcoholism, neglect, and drug or drug abuse and further psychological complications, e.g. B. cause anxiety disorders or depression.

research

Rita Rosner, Birgit Wagner, Hansjörg Znoi, Gabriele Pfoh, Willi Butollo, Paul A. Boelen and other scientists have found in several empirical studies that, in addition to the natural course of the mourning process, there is also a group of people for whom the grief also persists does not decrease for a long time.

Various factors are of significant importance:

  • Relationship intensity and degree of kinship
  • Longing and longing for the deceased person
  • Emotional bond with the deceased
  • Attachment to the deceased person
  • In the event of the death of a child - no further siblings
  • Existing mental illnesses
  • Separation anxiety
  • Circumstances of death
  • Resilience of the bereaved
  • Previous or subsequent deaths
  • Lack of social support
Secondary criteria
  • Financial problems
  • Job problems
  • Religious Norms
  • Values ​​about life

For some time now, various examinations on complicated grief have been trying to change the ICD 11 so that these people receive professional support and are no longer treated in the same way as other mental illnesses such as depression or post-traumatic stress disorders.

Complicated grief differs significantly from the clinical pictures described above and therefore belongs in the hands of an expert therapist. The aim of the therapeutic intervention should not be the “healing” of the patient, but the acceptance and integration of death, loss and grief into the life of the mourner. This requires an adjustment to the new situation so that life becomes worth living again. But this is never the dissolution of the relationship with the deceased person. The promotion of self-acceptance and personal responsibility is just as helpful as dealing with one's own grief experience. This also includes the acceptance of the loss of control. Regaining joy in life and hope in a future without the deceased should also be the main goal here. Support and external acceptance by the social environment is certainly helpful. Therefore, family, friends and other treating physicians should also be informed about these topics. Of course, this is difficult for patients and their relatives to accept at first if there are no drugs or therapies that promise a cure. Respect for the deceased and those who mourn can only be guaranteed by rethinking and dealing with grieving people in a new way.

This requires clarification and information, which should not only take place when the bereavement has occurred, but a fundamental review of how these issues are dealt with in society. It is necessary to remove the taboo from the topics of death and mourning and to introduce future generations to this topic so that they become just as natural as the birth of a person. Death and grief are still stigmatized; This also makes the mourners isolated and lonely. Unfortunately, there are so far very few therapists who have received training or advanced training in the field of complicated grief. Drug therapy has been ineffective in treating complicated grief and should only be used as support. The mostly voluntary grief counselors who help various charitable organizations are often more specialized and scientifically up-to-date and can be helpful first for people who do not experience understanding in their social environment and who often have to wait months for a suitable therapy place.

literature

  • Birgit Wagner  : Complicated grief. Basics, diagnostics and therapy . Springer, Berlin Heidelberg 2013, ISBN 978-3-642-37358-9 .
  • Willi Butollo and Gabriele Pfoh: When time alone does not heal . ISBN 978-3-8436-0386-7 .
  • Gabriele Pfoh: Presentation at the AHG Tönisstein symposium Complicated grief was yesterday .
  • Helga Bartl: Catamnesis of a psychotherapy study for the treatment of complicated grief with integrative cognitive behavioral therapy . Dissertation, Munich, 2015
  • Paul A. Boelen: Self-Identity After Bereavement. Reduced Self-Carity and Loss-Centality in Emotional Problems after the Death of a Loved One.
  • Gabriele Pfoh, M. Kotoucova and R. Rosner (2012): DGVT Further Education Complicated Grief, outpatient individual therapy for adults .
  • Birgit Wagner: diagnosis of complicated grief . Springer, Heidelberg 2014

Individual evidence

  1. ↑ More deaths and fewer births in 2017. In: Press release. Federal Statistical Office (Destatis), July 13, 2018, accessed on June 16, 2019 .
  2. ↑ Gabriele Pfoh, Michaela Kotoučová, Rita Rosner: DGVT education and training: Complicated Grief: Outpatient treatment of single adults. In: DGVT-FW> Interactive training> Archive of specialist articles. German Society for Behavioral Therapy V. DGVT, Further Education, 2012, accessed on June 16, 2019 .
  3. ↑ Anette Kersting, Elmar Brähler, Heide Glaesmer, Birgit Wagner: Prevalence of complicated grief in a representative population-based sample . In: Journal of Affective Disorders . tape 131 , no. 1-3 , June 2011, pp. 339–343 , doi : 10.1016 / j.jad.2010.11.032 ( elsevier.com ).
  4. ↑ Andreas Maercker, Hansjörg Znoj: The younger sibling of PTSD: similarities and differences between complicated grief and posttraumatic stress disorder . In: European Journal of Psychotraumatology . tape 1 , no. 1 , January 2010, ISSN  2000-8198 , p. 5558 , doi : 10.3402 / ejpt.v1i0.5558 , PMID 22893801 , PMC 3402016 (free full text) - ( tandfonline.com ).
  5. ^ Paul A. Boelen, Jos de Keijser, Marcel A. van den Hout, Jan van den Bout: Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. In: Journal of Consulting and Clinical Psychology . tape 75 , no. 2 , 2007, ISSN  1939-2117 , p. 277-284 , doi : 10.1037 / 0022-006X.75.2.277 ( apa.org ).