When Grief overwhelms you
We understand that experiencing a loss can seem sudden and extremely painful. But when grief is unrelenting and overwhelms you for a prolonged period of time, you might be suffering ‘Persistent Complex Bereavement Disorder’.
Grief is a normal emotion usually associated with the loss or death of a loved one, but that’s not always the case. People can also grieve when adjusting to any sort of new normal; for example, in becoming an empty nester, newly single (relationship breakdown) or even newly retired. However, for the purposes of this article we will concentrate on complex grief coming about as a result of the loss or death of a loved one.
As Human Beings, we have neurologically and culturally evolved to expect the inevitable loss of a parent in the usual life cycle completed upon passing. One might say that such an expectation is normal – how often do we hear someone saying “well he had a good innings”. Accordingly, grief is an inevitable, inescapable part of life.
Thus, it is inevitable that we will all experience grief during our life-time, countered with that inevitability being understood. It sought of makes sense to us. The circle of life if you will. While extremely painful most of us will, after a few weeks, get through the immediate intensity of the grief and assume our normal lives; all-the-while remembering those lost to us.
However, where, for example, we lose a loved one, or loved ones, in unforeseen circumstances, such as in a tragic accident or by sudden illness, this will likely have a powerful effect on our brain which we are never really prepare for, and consequently find our loss difficult to accept. Nevertheless, most of us will eventually get through such a horror to resume our normal lives, though, no doubt, most will carry lingering feelings of grief and despair for an extended period; sometimes throughout one’s entire life-time. While lingering, that intensity of one’s grief will usually dissipate to a manageable level over-time, however, on some occasions, such as on birthdays, the lingering grief might return with intensify for a relatively short period. This is normal.
But, for quite a number of people who experience loss of a loved one in tragic or otherwise unexpected and rapid onset circumstances, their grief is so intense that it doesn’t organically dissipate over-time to the stage of ‘acceptance’ which is widely regarded as the final stage of the grief adjustment process. Indeed, in some circumstances the bereaving person’s grief may in fact intensify over time. This might be diagnosed as ‘Complicated Grief’ or ‘Persistent Complex Bereavement Disorder’. For the purposes of this article we will largely use the term ‘Persistent Complex Bereavement Disorder’.*
Generally speaking, there are five stages of grief:
The term ‘bereavement’ is the period of mourning after the death of a loved one. Essentially, bereavement is the period of time spent adjusting to the loss. During this time, bereaved persons will generally experience varying levels of grief that can manifest in feelings of shock, numbness, sadness and/or yearning for the person who has passed. It’s typical during the period of bereavement to experience a mix of emotions, as well as fatigue, disturbed dreams, distress, agitation and even guilt – before acceptance of the loss sets in.
For people suffering from persistent complex bereavement disorder, this final stage of adjustment – ‘acceptance’ – could take much longer to reach (if ever at all). As the term denotes, persistent complex bereavement disorder is characterised by persistent and unshakeable grief that does not follow the general pattern of the stages of improvement over time; instead, the bereaved person continues to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of their normal life functioning, and which often cause extreme distress for them.
In many cases, persons with persistent complex bereavement disorder are incapacitated by their grief and focus on the loss to the exclusion of all other interests, personal enjoyment and concerns – even their family. Moreover, there is rumination about the death and longing for reunion with the deceased, identity confusion, inability to accept the loss, anhedonia*, bitterness, difficulty trusting others and a feeling of being ‘stuck’ in the grieving process.
Persons suffering this persistent high-level of grief report loss of self-worth and sense of self, feel emotionally disconnected from others and do not wish to move on from bereavement, sometimes feeling that to do so would represent a betrayal of the deceased. Indeed, it is not uncommon for the sufferer, for no apparent reason, to blame themself for the loss. Furthermore, many sufferers of such intense prolonged grief relate that they feel that there is no closure because they didn’t get to say goodbye, as they may have had if the loss had been expected.
Some symptoms of Persistent Complex Bereavement Disorder
Somebody suffering from persistent complex bereavement disorder will display symptoms that may include the following:
- Indefinitely yearning/longing for the deceased;
- Preoccupation with the circumstances of the deceased’s death;
- Intense sorrow and/or distress that does not improve over time;
- Difficulty trusting others;
- Detachment and/or isolation;
- Difficulty pursuing interests or activities;
- A desire to join the deceased;
- Persistent feelings of loneliness or emptiness;
- Impairment in social, occupational or other areas of life.*
While these symptoms are all characteristic of grief more generally, for a diagnosis of persistent complex bereavement disorder to be made, the bereaved person will usually have suffered symptoms over a prolonged period; usually for period exceeding 6 months.
Post-Traumatic Stress Disorder -and- Grief
Sometimes these persistent symptoms of complex grief are related to Post Traumatic Stress Disorder*. (“PTSD”) In some cases the sufferer may have witnessed, or indeed survived, the tragic event, or seen the aftermath of it. Such significant and traumatic events in our lives are indelibly marked in our brain so that when certain circumstances arise which are relatable to the trauma – consciously and/or subliminally, anxiety, indeed intense anxiety might be triggered. We’ve all heard about some Vietnam veterans automatically reacting with painful agitation to the sound of military helicopters flying overhead – even 40+ years on. This example is a mere, but relatable one as to what might trigger a latent PTSD condition to manifest in the form of anxiety, even extreme anxiety.
It is thus important to ensure that a condition of PTSD is not masked by a generalised diagnosis of grieving or bereavement. This is because the affected person may be struggling to get an image out of their head or experiencing flashbacks, for example, to the moment they learned of their loved one’s death, from which drives the trauma, and which thus can keep them from working through their grief to the end stage of acceptance. Thus, a key factor to successfully helping a person suffering persistent complex bereavement disorder may well lay in treating PTSD and other related trauma driven emotions.
The Brain and Grief
There are several regions of the brain which play a role in emotion, including areas within the ‘limbic system’ and ‘pre-frontal cortex’. These involve emotional regulation, memory, multi-tasking, organization and learning. When you’re grieving, a flood of neurochemicals and hormones dance around in your head. There can be a disruption in hormones that results in specific symptoms, such as disturbed sleep, loss of appetite, fatigue and anxiety. When these symptoms converge, your brain function takes a hit. After all, if you’re overwhelmed with grief, it stands to reason that you won’t absorb your environment the same way you would when you are content.
Consider these areas of the brain and how scientists believe grief symptoms affect them:
The parasympathetic nervous system: This section of your autonomic nervous system is in the brain stem and lower part of your spinal cord. In this system, which handles rest, breathing, and digestion, you may find that your breath becomes short or shallow, appetite disappears or increases dramatically, and sleep disturbance or insomnia become an issue.
The prefrontal cortex/frontal lobe: The functions of this area include the ability to find meaning, planning, self control, and self expression. Scientific brain scans show that loss, grief, and traumas can significantly impact your emotion and physical processes. Articulation and appropriate expression of feelings or desires may become difficult or exhausting.
The limbic system: This emotion-related brain region, particularly the hippocampus portion, is in charge of personal recall, emotion and memory integration, attention, and your ability to take interest in others. During grief, it creates a sensory oriented, protective response to your loss. Perceiving loss and grief as a threat, the amygdala portions of this system instructs your body to resist grief. You may experience strong instinctual or physical responses to triggers that remind you of your losses.
As we can see, complicated grief in the form of persistent complex bereavement disorder cannot be confined to just one syndrome or disorder. In other words, there is not just a single form of complicated grief, but rather many forms of it. Indeed, the diagnostic term for complications that arise in the course of grieving has been variously defined over the past 30 or so years, with a multitude of adjectives used to describe variations from normal grief. These terms include absent, abnormal, complicated, distorted, morbid, maladaptive, atypical, intensified and prolonged, unresolved, neurotic, dysfunctional, chronic, delayed, and inhibited.
Grief Counselling – Complicated Grief Therapy
The main goal of grief counselling is to help our client integrate the reality of their loss into their life going forward, and helping them to maintain a healthy bond to the loved one they lost. In complex situations such as persistent complex bereavement disorder, we call this ‘Complicated Grief Therapy’ (CGT), which is a relatively new, and evolving, psychotherapy model designed to address symptoms of complicated grief.
Drawn from attachment theory CGT has its roots in both Interpersonal Therapy (IPT) and Cognitive-Behavioural Therapy, (CBT). Many of the CBT strategies that are used in the treatment of anxiety disorders and depression, such as graded exposure to avoided or feared situations, increasing pleasant events and challenging unhelpful thoughts, can be modified for working with people suffering persistent complex bereavement disorder. Indeed, strategies which focus on increasing the sense of control and wellbeing can help facilitate a grieving person’s adjustment to acceptance.
Of course, no two people will experience the death of a loved one in the same way. How individuals express their pain depends upon a number of factors including their personality, the circumstances surrounding the death, and the way they view the world. Indeed, how someone thinks about life and death has a significant impact on how he or she will grieve. Thus, a major part of grief counselling is for the therapist is to educate the bereaved person about what they might experience following the death of a loved one in an attempt to increase their sense of control and facilitate their adaptation in coping with their grief.
While it is never too late to seek out therapy to help you cope with grief, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you. If your symptoms are so severe that you have trouble coping with day-to-day activities, you should contact a therapist as soon as practicably possible. CBD Counselling & Psychotherapy can assist you to manage your grief so that you can lead a normal life once again.
Tips for Coping with Grief
1. Do not grieve alone
It’s vital that you stay connected with others during this time. Your support system may include your family, friends, leaders in your faith, a bereavement support group, and/or a licensed mental health professional to help you cope.
Your support system can help you:
- Make the funeral arrangements or help you with new responsibilities;;
- Find peace and comfort through your faith’s mourning rituals;
- Share your grief with others who can relate;
- Work through your difficult emotions in a safe setting.
2. Take good care of yourself
It can be easy to forget about our own needs when we are reeling from loss, but neglecting yourself won’t help you effectively deal with your grief.
- Do something creative to express your feelings (e.g., write something, paint, put together a scrapbook, or play a musical instrument);
- Eat, sleep, and exercise to avoid adding physical fatigue to your emotional fatigues;
- Be patient with yourself and allow yourself to feel whatever you feel;
- Understand what triggers your grief and prepare for those triggers (e.g., plan to take a day or two off of work, let your friends and family know you’ll need extra support, etc).
3. Seek professional grief counselling
Not everyone will need the services of a counsellor or therapist during their grieving period, but it can be very helpful for those who are really struggling. A qualified professional can help you understand the grief process and give you the tools you need to cope with your emotions.
4. Be Patient. Healing Takes Time.
Ultimately, take it easy on yourself. Healing from loss takes time, and that’s all you can do: wait and treat yourself kindly. Remember that those around you should also understand that this grieving process takes time; that way, you don’t feel needy or rushed in the stages, which can lead to unearned guilt. Allow yourself to move through all of this organically.
Never feel selfish for grieving. As mentioned, grief is your body and brain’s natural approach to healing from something incredibly painful; let them do their job for you. Then, do your job in aiding your body and brain to heal by loving yourself, getting the sleep you need, eating as well as you can, and seeking support from others around you to combat any feelings of loneliness or ruminating thoughts.
In the end, you are not alone. Everyone in the world experiences grief at some point; let us all support each other through it and let ourselves grow from it.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) – DSM 5, published in 2013, includes a condition of Persistent Complex Bereavement Disorder (PCBD) codable as a “severe and persistent grief and mourning reaction” in “Other Specified Trauma- and Stressor-Related Disorder” 309.89 (F43. 8). You can find this on page 289.
Anhedonia is the inability to feel pleasure. It’s a common symptom of depression as well as other mental health disorders.
Post traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
Author: Tim Pratten
Principal CBT Counselling & Psychotherapy
Title: When Grief Overwhelms You
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