When grief becomes the new normal: Helping patients with prolonged grief disorder
The death of a loved one is a life-changing experience. Grief is a perfectly normal reaction to such a devastating loss. However, if the feeling of loss keeps dominating your life even after a long time – as is the case in five to ten percent of the bereaved – psychologists speak of the mental health syndrome “prolonged grief disorder”. The disorder was only recently recognized as a distinct syndrome. Led by psychologists of the Catholic University of Eichstätt-Ingolstadt (KU), a special form of psychotherapy is being tested in treatment centers around Germany. The results so far are promising.
The Deutsche Forschungsgemeinschaft (DFG) has just renewed the funding of the PROGRID project. This means that persons affected by prolonged grief disorder can keep getting professional help.
“Grief is a perfectly normal reaction to a loss, which all people will experience at some time of their life. In a way, the bond with the deceased will be redefined during this phase. This is a highly individual process, that as a rule does not get treated clinically,” says Dr. Anna Vogel. She is a research associate at the Chair of Clinical and Biological Psychology (Prof. Dr. Rita Rosner) at the KU and deputy head of the KU’s psychotherapeutic outpatient department. “There is no hard and fast advice on how to deal with grief. Good is what helps you. One thing is certain: If psychotherapists intervene too early on in the grief process, this can have the opposite effect and actually prolong grieving.” Even if we usually call it a year of mourning in this part of the world – the idea being that after a year has passed, the focus of the mourner’s thoughts should no longer be on the deceased – this is not a universally applicable time frame. Even years later, grief can come to a peak on certain days, say anniversaries.
Contrary to this, a prolonged grief disorder is fundamentally different in nature. “We diagnose a disorder, if as long as six months after the event, the death of your loved one is still a dominant feature of your routine that significantly limits your style of living. Some mourners might keep secluding themselves from society, or they might still miss the deceased person with devastating intensity. They might leave their room untouched or talk about them as though they were still alive.” When treating patients with prolonged grief disorder, psychologists have also seen extreme behavior regarding the grave of the loved person. Some mourners keep visiting the loved one’s grave as many as three times a day, whereas some might avoid the cemetery altogether, because the very place seems unbearable to them.
According to Vogel, the boundaries between this disorder and a depression are blurred and require thorough diagnostics. Symptoms of the disorder that are also more commonly associated with depression is being unable to experience joy and feeling numb. Unlike depressions however, prolonged grief disorder rarely causes lack of concentration, sleeplessness or suicidal thoughts. Additionally, medication does not help with complex grief.
The fact that prolonged grief syndrome was only recently added to the statistics of the WHO on mental disorders goes to show that the issue is highly complex: “This is not about classifying grief itself as a pathology. Also, science has taken a long time to define a precise distinction between a depression, or a post traumatic stress disorder, and prolonged grief,” says Vogel. The international scientific community assumes that in particular these times of pandemic have led to an increase in the number of persons suffering from prolonged grief. “Affected patients often tell us how stressful it was for them not to be able to say goodbye to their loved one on their deathbed or to have to hold a funeral only in the smallest circle. Add the fact that many support programs had to be paused due to the restrictions in connection with the pandemic.”
Long lasting grief as a mental disorder is not limited to elderly people, which is why the researchers offer their program to all adults 18 years and older. Before the actual therapy can start, participants have several preliminary dialoging sessions that help the psychiatrist decide whether the patient is really suffering from prolonged grief disorder. The therapy then takes approximately six months and comprises 25 sessions that according to first results lead to a significant improvement of the symptoms. Points of contact for people wishing to participate in the PROGRID study are treatment centers in Ingolstadt, Munich, Frankfurt, Marburg and Leipzig.
For more information, please visit www.trauer-therapie.de.
Dr. Anna Vogel (firstname.lastname@example.org)