“Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve.” -Earl A. Grollman
Grief is a universal experience, a profound response to loss that touches every aspect of our being—mind, body, and spirit. The journey through grief is deeply personal, with each individual experiencing it in their own way. Earl A. Grollman is correct that grief itself is completely natural and not a disorder or weakness. However, grief can transition into a pathological condition when it is prolonged and debilitating, causing the individual to become stuck in the grief and unable to move forward with the pursuit of happiness in their own life. This blog post will explore the natural effects of grief and provide insight into when it becomes pathological according to the DSM-5-TR.
The Natural Effects of Grief
Mind
Grief significantly impacts mental health, altering thoughts, emotions, and cognitive functions. Initially, the bereaved may experience shock and disbelief, particularly if the loss was sudden. This initial phase can give way to intense sadness, longing, and yearning for the deceased. As the reality of the loss sets in, individuals often experience a wide range of emotions, including anger, guilt, anxiety, and even relief, depending on the nature of the relationship and circumstances of the loss. Cognitively, grief can impair concentration, memory, and decision-making abilities. Individuals may find themselves preoccupied with thoughts of the deceased, replaying memories, or ruminating on the loss. This can lead to feelings of confusion and a sense of disorientation as they struggle to make sense of their new reality.
Body
The physical manifestations of grief are numerous and can be quite debilitating. Common symptoms include fatigue, sleep disturbances, and changes in appetite. Some individuals may experience headaches, stomachaches, or other somatic complaints. The body’s immune system can be compromised, making the bereaved more susceptible to illnesses. Stress-related responses are also prevalent, such as increased heart rate and blood pressure. These physical symptoms can exacerbate feelings of distress and create a cycle where physical and emotional symptoms feed into each other, prolonging the experience of grief.
Spirit
Grief profoundly affects the spirit, often challenging an individual’s beliefs, values, and sense of meaning. Spiritual responses to grief are diverse and can include a deep questioning of faith or an intensified reliance on spiritual practices. Some people may find solace in their religious or spiritual beliefs, experiencing a renewed sense of connection to something greater than themselves. Conversely, others may struggle with spiritual distress, feeling abandoned or betrayed by their faith. This can lead to a crisis of meaning, where the bereaved question the purpose of life and the nature of existence. Such spiritual turmoil can be deeply unsettling and add another layer of complexity to the grieving process.
When Grief Becomes Pathological
While grief is a natural and expected response to loss, it can sometimes develop into a more severe and chronic condition known as complicated grief or prolonged grief disorder. According to the DSM-5-TR, this pathological form of grief is characterized by intense symptoms that persist for an extended period, typically beyond six months, and significantly impair an individual’s ability to function in daily life. The list below provides an overview of the diagnostic criteria used by qualified professionals to identify when grief has become pathological.
Diagnostic Criteria for Prolonged Grief Disorder (DSM-5-TR)
1. Recent Death of a Close Other: Someone close to the individual died at least 12 months ago (or 6 months ago for children and adolescents).
2. Persistent and Pervasive Grief Response: The individual experiences intense sorrow, yearning, and preoccupation with thoughts or memories of the deceased that persists nearly every day for at least the last month. For children and adolescents, preoccupation may focus on the circumstances of the death.
3. Cognitive, Emotional, and Behavioral Symptoms: These may include persistent, near-daily difficulty accepting the death, a sense of disbelief or emotional numbness, feeling that life is meaningless without the deceased, and intense loneliness. The individual may also experience identity disruption (e.g., feeling like a part of oneself has died), difficulty re-engaging in life, and significant avoidance of reminders of the loss.
4. Impairment in Functioning: The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
5. Duration & Severity of Impairment: The symptoms clearly exceed expected social, cultural, or religious norms for the individual’s culture and context.
6. Differentiation from Other Mental Disorders: The symptoms are not better explained by another mental disorder, such as major depressive disorder or post-traumatic stress disorder.
Natural Progression vs. Pathological Grief
Natural Progression of Grief
In the natural course of grief, the intensity of symptoms typically decreases over time. While the bereaved may always carry a sense of loss, they gradually find ways to adapt and integrate the loss into their lives. They begin to re-engage with daily activities, find moments of joy, and establish a new normal. This process is non-linear and can involve periods of regression, but overall, there is a trajectory towards healing and adjustment.
Pathological Grief
In contrast, pathological grief involves persistent, intense symptoms that do not diminish over time. The individual remains stuck, unable to move forward or find a sense of peace. This type of grief can lead to severe emotional, physical, and spiritual distress, greatly affecting the person’s quality of life.
Risk Factors for Pathological Grief
Certain factors can increase the risk of developing pathological grief. The first is the nature of the relationship to the deceased, particularly one’s closeness with the decedent. The loss of a child, spouse, or someone with whom there was a particularly close bond can be especially challenging. Another consideration is the circumstances of the loss, as sudden, unexpected, or traumatic deaths can complicate the grieving process. One’s personal history also factors into how the potential to develop pathological grief, as individuals with a history of mental health issues, previous losses, or unresolved trauma may be more susceptible. A final influence on one’s risk is the level of support available during the grieving period; a weak social support system or societal stigmas surrounding the expression of grief can hinder the healing process.
Moving to the Dual Process Model of Coping
Chances are you have heard of the Kubler-Ross Grief Cycle, popularly known as the five stages of grief. These stages are denial, anger, bargaining, depression, and acceptance. Many tend to discuss this model as if individuals experiencing grief would experience all five stages in order, which has caused confusion among those who feel they do not identify with one or more stages in the specified order.
A newer model of grief called the Dual Process Model by Stroebe & Schut (1999) instead views the bereaved as oscillating between two different orientations toward coping: loss-oriented and restoration-oriented. While the individual is using loss-orientated coping, their thoughts, feelings, and behaviors are focused on grieving the loss. When using restoration-oriented coping, they are focused on reorienting given this significant change and rebuilding their life as they continue on. In the visual provided below, the jagged line that moves between each orientation represents how the individual must weather varying shifts in their coping style as they process their loss. This model reflects the flexible, ever-changing nature of the grief journey as the bereaved learn, through repeated practice over time, to pivot from looking backwards to reaching forward.
The Dual Process Model of Coping (Stroebe & Schut, 1999), Wikimedia Commons
Coping with Grief
Let’s be honest: there is no easy way to cope with the deepest, most painful parts of grief. The intensity of one’s grief can vary depending on many variables, both within the griever and their environment. Those who are finding it difficult to cope with moving through grief can experiment with the following for their mind, body, and spirit.
Mind
– Therapy and Counseling: It may sound cliche, but often talking with someone about your loss can be what is needed to feel less stuck in grief. Professional support can be invaluable in helping individuals process their emotions and develop coping strategies.
– Mindfulness and Meditation: These practices can help ground the bereaved in the present moment and reduce feelings of anxiety and depression. Use the resources that the internet can put at your fingertips, as many kind souls have uploaded helpful explanations of mindfulness practices (such as mindful walking or eating) or guided meditations to YouTube.
– Creative Expression: Writing, drawing, painting, singing, dancing, and other forms of creative expression can provide an outlet for complex emotions and facilitate healing. It may feel odd to try out these methods, but the truth is that sometimes it takes some human ingenuity to get through the hardest things that life throws at us. Your ability to creatively express is that ingenuity. Experiment as you see fit and remember that this component can be as private or as public as you desire.
Body
– Physical Activity: Exercise can help alleviate symptoms of depression and anxiety, improve sleep, and boost overall well-being. Movement releases endorphins, and Lord knows you could use more of those during periods of grief.
– Nutrition: Maintaining a healthy diet is crucial, as grief can affect appetite and eating habits. Any intense emotion can cause humans to change their eating patterns, so it is important to be intentional about getting enough water and nutrients to keep your body as healthy as possible.
– Rest: Ensuring adequate rest and sleep can help the body recover from the physical toll of grief. Many people find that they need extra rest and some can even find themselves avoiding rest until they are burnt out. Try your best to nonjudgmentally give your body the rest that it asks for; if you struggle with insomnia for an extended period of time, consider seeking professional help rather than relying solely on medications.
Spirit
– Spiritual Practices: Engaging in religious or spiritual practices that resonate with you can provide comfort and a sense of connection to something greater. If you find it difficult to pinpoint a spiritual practice that would feel healing, you can start by spending some time in nature; studies show that being in green spaces and/or under wide open skies often increases one’s sense of well-being.
– Community Support: Being part of a supportive community, whether spiritual or secular, can offer solace and a sense of belonging. It helps to be reminded that you are not alone in this very human journey through the pain of loss.
– Reflection and Meaning-Making: Finding ways to honor the deceased and create meaning from the loss can help in the healing process. This is another opportunity for creativity, as the most meaningful remembrances integrate your current values, such as beauty or even humor, and cherished memories of the deceased.
Conclusion
Grief is a multifaceted experience that affects the mind, body, and spirit in profound ways. While it is a natural response to loss, it can sometimes become pathological, leading to prolonged and debilitating symptoms. Understanding the natural effects of grief and recognizing when it becomes pathological is crucial in providing appropriate support and interventions.
For those navigating the turbulent waters of grief, it is essential to seek help when needed and to be patient with oneself. Healing is a journey, and with the right support and coping strategies, it is possible to find a path towards peace and resilience. If you are currently in the throes of grief, trust in your strength to keep on keeping on, and please reach out if you need a helping hand.
To schedule an appointment with OnePatient, contact info@onepatient.org.
