A blogger commented on part I of this series, "One friend, after five years of grief and going to therapy is still grieving, and it is hard for me to deal with what to say to her." Is this normal?
No, according to criteria for Prolonged Grief Disorder (PGD) -- formerly, Complicated Grief -- outlined by Holly Prigerson, PhD in her discussion of why this syndrome merits inclusion in Diagnostic and Statistical Manual of Mental Disorders (DSM).
Specifically, for at least 6 months following the death of a loved one, patients with PGD exhibit severe levels of yearning plus at least five of the following:
- disbelief over the loss
- bitterness over the loss
- confusion about one’s identity
- an inability to trust others
- numbness (absence of emotion)
- feeling that life is meaningless since the loss
- difficulty accepting the loss
- difficulty moving on with life
- feeling stunned by the loss.
Importantly, Prigerson points out "individuals who meet criteria for prolonged grief disorder have been shown to be at heightened risk for present and future major depressive disorder, post-traumatic stress disorder, and generalised anxiety disorder, suicidal ideation, functional disability and diminished quality of life relative to individuals who do not meet criteria for prolonged grief disorder."
In the context of bereavement, it appears that both prolonged grief and diminished acceptance of the loss are associated with increased distress and dysfunction.
While fascinating, how do these findings help us understand the challenge of dealing with loss at the end of life?