Bereavement

The overarching experience of coping with loss and change. It is the emotional and psychological condition experienced after a loss, typically due to death, but it can also apply to non-death-related losses. Bereavement often encompasses both inward and outward expressions of grief and the cultural, social, and personal practices that help individuals process and adjust to the loss, often through rituals and support from loved ones. It usually involves a period of grieving.

Grief

The emotional, mental, and/or physical response to a loss, often due to death but also encompassing other life changes, such as the end of relationships, loss of identity, or illness. Sometimes people experience periods of grief in anticipation of a loss. Grief is deeply personal and can occur differently in everyone, shaped by the nature of the relationship, the degrees of support, circumstances of the loss, cultural influences, and individual coping mechanisms as well as other considerations. While it can be an intense experience, it is considered a natural human reaction to loss that generally subsides over time for most people.

Prolonged Grief Disorder (PGD)

Although most people experience periods of grief and bereavement after the death of an individual without long-term mental health concerns, some may experience symptoms that could benefit from additional help. In 2022, the American Psychiatric Association added Prolonged Grief Disorder (PGD) to the DSM-5-TR after clearly distinguishing PGD as its own distinct diagnosis.

Major features of the criteria for PGD include, but are not limited to:

• Intense yearning or thoughts about the deceased

• Significant and persistent degree of distress

• Significant decrease in functioning

• Symptoms that last more than one year in

The DSM-5-TR criteria for PGD require that distressing symptoms of grief continue for at least 12 months following the loss of a close attachment and that the grief response is characterized by intense longing/yearning for the deceased person and/or preoccupation with thoughts and memories of the lost person to a clinically significant (i.e., impairing) degree, nearly every day for at least the past month. Furthermore, as a result of the death, at least 3 of the following 8 symptoms have been experienced to a clinically significant degree:

• (1) feeling as though a part of oneself has died

• (2) a marked sense of disbelief about the death

• (3) avoidance of reminders that the person has died (often coupled with intense searching for things reminiscent of the deceased person and/or evidence that they are still alive, such as mistaking others for the person who died

• (4) intense emotional pain (anger, bitterness, sorrow) related to the death

• (5) difficulty with reintegration into life after the death

• (6) emotional numbness (particularly with respect to an emotional connection to others)

• (7) feeling that life is meaningless as a result of the death

• (8) intense loneliness as a result of the death.

The burden of these symptoms causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The duration and severity of the bereavement reaction clearly exceeds social, cultural, or religious norms for the individual’s culture and context. Additionally, the symptoms are not better explained by major depressive disorder, posttraumatic stress disorder, or attributable to the physiological effects of a substance (e.g., medication or alcohol) or to another medical condition.

Examples of how grief can be expressed:

• Sadness

• Anger

• Guilt

• Confusion

• Relief

• Anxiety

• Numbness

• Helplessness

• Fatigue

• Loss of appetite

• Sleep disturbances

• And many more…

Strategies for coping with grief and loss:

• Support from friends, family, and/or other known community members

• Cultural, social, religious, faith, or other beliefs or rituals

• Local or virtual grief support groups

• Community-based or virtual grief counseling services

• Grief peer support services

• Artistic expression

• Physical movement and exercise

• Outreach to a mental health professional, like Andrea

When supporting someone grieving, avoid minimizing their feelings or offering unsolicited advice; instead, focus on active listening and offering practical support. 

Here are some things to avoid saying to someone who is grieving:

• "I know how you feel" or "I've been there": Everyone's grief is unique, and your experiences don't necessarily validate theirs. 

• "They're in a better place" or "At least they're not suffering anymore": These statements can be dismissive and can make the grieving person feel like their loss is being trivialized. 

• "You should be over it by now" or "It's been a while, aren't you over it yet?": Grief is a process, and there's no set timeline for healing. 

• "You'll be okay after a while" or "Things will get better": While these are well-meaning, they can feel like empty promises and can be unhelpful in the moment. 

• "Stop crying" or "You shouldn't feel that way": Allow the grieving person to express their emotions without judgment. 

• "They brought this on themselves" or "It was their fault": Avoid assigning blame or making assumptions about the situation. 

• "At least they lived a long life" or "At least they didn't die young": These statements can be insensitive and can make the grieving person feel like their loss is being minimized. 

• "God has a plan" or "Everything happens for a reason": These statements can be seen as religious or philosophical and can be unhelpful to someone who is grieving. 

• "You can remarry/have another child": These statements can be insensitive and can make the grieving person feel like their loss is being minimized

Prolonged grief disorder is only one form of grief that can cause extraordinary challenges for individuals. People can also experience other difficult grief reactions. People who are, or think they are, experiencing PGD or are having an especially hard time processing their grief, may seek clinical care, such as individual or group psychotherapy to support them through their loss. Many may also find other support, such as grief peer support, helpful with this experience. 

Sometimes medication may be warranted to treat co-occurring anxiety, depression, or sleep issues.  Talk with Andrea about options and resources.   Don’t let others minimize your feelings or give you unwarranted timeline advice as to when you “should be over it”.