Losing a loved one is always life-changing and debilitating as we relearn how we handle the day-to-day amid devastating loss.
However, experts have now recognised a difference between a ‘normal’ level of grief and when mourning becomes a disorder that impacts on your ability to function normally in life.
In March 2022, US publication the Diagnostic and Statistical Manual of Mental Disorders (DSM) officially recognized Prolonged Grief Disorder PGD, which applies to anyone who is still unable to cope with their loss six to 12 months after being bereaved.
The inclusion in the US publication, which doctors use to diagnose disorders, will mean that those who meet the criteria can have their treatment covered by insurance companies.
Marie Curie Bereavement Services Manager, Jane Murray told FEMAIL that grief is a natural response to the loss of a loved one, is different for every individual and there is no time limit on how long it can last for.
However for some people the grief does not lessen at all with time, and for this minority, Jane says: ‘The symptoms can be severe enough to interfere with their ability to function in their everyday lives.
‘They can also experience persistent difficulties associated with their loss that exceed expected social, cultural, or religious expectations.’
Here, Jane revealed how to gague if your grieving process is following a natural pattern, or if you could be suffering from Prolonged Grief Disorder?
Prolonged Grief Disorder is a controversial term for grief that lasts for six months. In March the term was officially recognised in the Diagnostic and Statistical Manual of Mental Health Disorders in the US (stock image)
FEELING AS THOUGH PART OF YOU HAS DIED
Jane explained that some people are unable to focus on anything other than the death or how it occurred, whilst others fail to accept the fact that death is permanent. These people may also blame themselves for what happened to the person who died.
They feel as though they have lost a part of themselves and no longer feel like a whole person.
WHAT IS PROLONGED GRIEF DISORDER?
Prolonged grief disorder was recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a volume published by the American Psychiatric Association (APA) that defines and classifies mental disorders. It can happen when someone close to the bereaved person has died within at least 6 months for children and adolescents, or within at least 12 months for adults.
In prolonged grief disorder, the bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This is a tricky concept to unpack, and these people will no longer find joy in hobbies that they once enjoyed, perhaps with the deceased.
In extreme cases they may find daily life difficult and as though they are no longer fully experiencing day-to-day sensations and will carry around a deep emptiness.
A SENSE OF DISBELIEF ABOUT THE DEATH
Disbelief is the refusal to accept that something is real or true. It is an emotion often associated with shock.
The disbelief that can follow the death of a loved one is described as an adaptive and temporary response.
Jane said that people may react like this if the death of a loved one comes out of the blue and is unexpected
Healthcare professionals explain that this response is one that protects a person from the pain of loss and allows them, the survivor, to manage all of the details that follow a death.
Embracing the painful reality does not happen quickly or easily, and it can be an exhausting process.
However, acceptance of reality should come with time and if it doesn’t this is a sign that the bereaved person needs additional help.
AVOIDANCE OF REMINDERS THAT THE PERSON IS DEAD
When a loved one passes, the ones left behind face traumatic memories, painful emotions, logistical issues, secondary losses, and so on.
This can be incredibly overwhelming and all-consuming and so to not feel this bombardment of painful memories they may avoid triggers.
Jane recalls an older woman who, with her husband had led a very happy life together, but two years following his death she felt her emotions were as raw as the day he died.
Jane explains: ‘She had become withdrawn and socially isolated, afraid to experience hobbies she used to enjoy.’
This avoidance of triggers was her way of keeping her emotions at bay.
STRONG EMOTIONAL PAIN RELATED TO THE DEATH (ANGER, BITTERNESS, OR SORROW)
Grief can hit people immediately and with full force, potentially causing them to cry a lot or feel like they are not coping.
People can worry that their feelings are so overwhelming that they don’t know how they can live with them.
These feelings are so overwhelming that they can manifest through strong emotions, in particular anger.
While your rational brain knows the object of your anger isn’t to blame, your feelings in that moment are too intense to act according to that.
As this subsides your brain will let other emotions in that you have been masking with anger.
DIFFICULTY MOVING ON WITH YOUR LIFE
Some people may find it hard to continue with life and get enjoyment out of things that they used to enjoy.
They may distance themselves from social situations, family and friends – becoming increasingly more isolated.
If they do continue with life they may feel guilty for moving on without their loved one and fear that they will forget them, which never happens.
In another case of Prolonged Greif, Jane remembers a middle-aged gentleman whose wife had passed away 18 months previously.
Jane said: ‘As he told his story of them together and brought photos in and remembered – often with tears- happier times, he slowly began to believe that living his life without her physically in it did not mean he did not love her anymore.’
Emotional numbness is a state of being in which you are not feeling or expressing emotions.
Often this feeling is temporary and yet, for some, emotional numbness becomes a strategy to protect themselves from further emotional or physical pain.
While it may provide temporary relief, learning to cope with difficult feelings, which can lead to denial and avoidance behaviours.
Emotional numbness manifests itself in an inability to fully participate in life, feeling detached from others, feeling flat both physically and emotionally, and having difficulty with experiencing positive feelings such as happiness.
The main characteristic of emotional numbness is that the person will prefer isolation and increasingly withdraw themselves.
FEELING THAT LIFE IS MEANINGLESS
Death can bring a multitude of emotions and questions to mind including what the point of life is and what happens after death.
Life can appear fleeting and the pain experienced makes people question why.
When someone is grieving and experiencing a mix of strong and debilitating emotions these questions can conjure up severe and brash answers.
Not being able to answer existential questions such as the point of life, these people can lean toward to the terminal answer that life is meaningless and believe that there is no point.
This type of loneliness occurs when feelings of loneliness and uncomfortable social isolation go on for a long period of time.
It is characterised by constant and unrelenting feelings of being alone, separated or divided from others, and an inability to connect on a deeper level.
It can be accompanied by deep-rooted feelings of self-doubt, low self-esteem, or social anxiety.
This can be extremely debilitating and impact all areas of a person’s life.
Even if they do try to socialise, they may feel social burnout very quickly and become increasingly drained.
In severe cases it can also lead to sleep issues, weakened immune system, poor diet and more.
How to cope if you or a loved one is experiencing prolonged grief?
- Identify supportive people in their life and stay involved with them: this will help to manage the sense of loneliness or isolation that can follow the loss of a loved one.
- Set clear boundaries: this includes acceptance that you may not feel up to all of your usual commitments, whether in work or social life. It is important to be kind to yourself and make your own emotional well-being a priority when coping with prolonged grief.
- Consider pursuing a new hobby or interest: it might be difficult to maintain the activities you once enjoyed without the company of your loved one. It can be helpful to start a new hobby or activity for your enjoyment, whether it’s done as an individual or as part of a group.
- Be mindful of any wishful thinking about the deceased: it is natural to miss a loved one, but it isn’t helpful to dwell on what it might be like if they were still with you.
- Honour the deceased at particular times of the year, such as their birthday and anniversary of the death: establishing grief rituals e.g. letting balloons off/ lighting a candle/ cooking their favourite meal/ hanging a special ornament on the Christmas tree… can be a way to keep them in your memory and continuing the emotional bond with them at especially important times while moving on with your life more generally.
- Accept your loss and the natural sadness that follows: give yourself safe times and places to grieve deeply- acknowledging your feelings and expressing your emotions, rather than trying to avoid them or holding in the tears. Letting yourself have these feelings will eventually allow them to lift and become less heavy.