PATHOLOGICAL GRIEF REACTION
Dennis B. Kottler, MD
Westlake Village, CA
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See also: Depression and Bipolar Disorders
See also: Bereavement
When does a "normal" grief reaction (bereavement) become "pathological?"
While there is no definitive answer to this question, most grief reactions last in the neighborhood of 6 to 12 months, although there is significant variation, both individually and culturally. If a grief reaction does not shows signs of resolving in this approximate time frame and especially if there are signs of a Depressive Disorder (See Bereavement), the possibility of a "Pathological Grief Reaction" should be considered.
Other forms of "pathological grief" occur when the original grief is not felt; when it is suppressed or delayed. Individuals with this problem may present with somatic or behavioral problems. In this case the emotions associated with the loss find expression through inappropriate channels. An example would be someone who seems unaffected by a loss but then develops a "lump in the throat" or some other symptoms for which no physical cause can be found.
What causes a "Pathological Grief Reaction?"
Again, there is no single, simple answer. However, a history of a prior mood disorder is a predisposing factor.
There are also various patterns of psychological conflict which may be involved in the development of a "Pathological Grief Reaction?" For example, there may have been feelings of ambivalence towards the deceased, especially feelings of anger and, perhaps, the unconscious wish that the deceased would die. This engenders guilt when the death actually occurs.
Another pattern of psychological conflict involves a feeling that the loss is a punishment. The grieving individual may feel that he has committed some terrible behavior for which he is being punished.
What are the consequences of a "Pathological Grief Reaction?"
An untreated "Pathological Grief Reaction" can have long-term consequences. The grieving individual may be stuck in depression which can sometimes last many months or even years. There may be substance abuse or other self-destructive behavior. At its worst, the "Pathological Grief Reaction" can result in suicidal behavior. In other cases, anger can be displaced onto significant others.
Treatment of a "Pathological Grief Reaction"
While each situation is different, treatment often involves medication (especially when symptoms of a Depressive Disorder are present) as well as psychodynamic psychotherapy. It is usually helpful for the individual to gain insight into the psychological roots of the unresolved grief.
The individual should also be encouraged to have an emotional support system in place, such as a network of good friends and/or a caring significant other. Exercise and diet as well as good sleep hygiene are also important.
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