Dear Doctors: My mother and stepfather were married for 42 years when he passed away suddenly. That was a year ago, and she's still struggling. I talked to my doctor about it, and he said it sounds like “complicated grief.” I've never heard of that. What can we do to help her?
Dear Reader: Grief is a response to loss that is so profound, it can temporarily disrupt our most basic connections to daily life. Someone who is grieving may find it difficult to perform routine tasks, have trouble sleeping or eating, and may be unable to feel interested or involved in the lives and actions of others. Sorrow can prevent them from feeling other emotions, such as contentment, happiness, curiosity or joy. Anger may also make a baffling, and unwelcome, appearance in their lives. The rigors of grieving can give way to depression, lead to health problems and even cause changes to cognition.
For most people, the intensity of grief eases. They begin to cope with their loss, resume their lives and even become able to forge new relationships. This typically occurs gradually over a period of time. And unlike in theories about specific stages of grief, recovery is typically fragmented, uneven and perhaps a bit chaotic.
For some people, though, the emotional distress of grief fails to lessen. And as it persists, it puts the individual at risk of both physical and mental health issues, suicidal thoughts and even premature death. This has led to the term that your doctor used: complicated grief. Sometimes also referred to as prolonged grief disorder, it was first identified in the early 1990s. It is estimated that up to 10% of people who suffer a loss experience complicated grief. Older adults, like your mother, have been found to have an increased risk of developing this disorder.
Treatment often involves a multidisciplinary approach. For some, it includes medications to manage depression and anxiety. These can help ease the emotional burden that makes it difficult for the individual to feel a sense of the future. Complicated grief shares some aspects of post-traumatic stress disorder. This has led to the development of a targeted type of psychotherapy for this disorder. It includes an educational aspect, in which people learn about the signs and symptoms of complicated grief. This helps them to understand what they are experiencing. The therapy also helps people explore the unexpected ways in which grief has manifested in their lives, focuses on coping skills and gives them a safe space in which to express and explore their feelings. In addition to loss, these often include despair, guilt and hopelessness.
Behavioral therapy often is also part of this treatment approach. So are support groups made up of people who are dealing with similar losses. When someone is struggling as your mother is, it is important to get a diagnosis. This usually includes a medical history, a physical exam and a mental health evaluation. The results will guide a treatment plan to help your mother regain her equilibrium and move forward with her life.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
