Grief: What is Prolonged Grief Disorder? By: Kiara Moriarty
When experiencing grief after a loss, feelings of shock, despair, anger, guilt, loneliness, and anxiety may overwhelmingly flood our lives. According to the DSM-5, these symptoms should subside 12 months after the loss. While some believe that there is no timeline for the grieving process, it may be helpful to label prolonged grief to provide services and support where needed. When can we identify if our feelings of grief are healthy and appropriate in our healing process, or negatively impacting our life as if the loss just happened?
Prolonged grief disorder is the persistent, severe grief that extends beyond a year after a loss. This may entail identity disruption, longing for the person, disbelief or a lack of acceptance of their passing, and existential issues such as meaninglessness. While the feelings of grief may never truly subside, it is something we typically learn to carry and live with. This marks the difference between typical grief and prolonged grief. Prolonged grief is pervasive. It consumes the individual experiencing the grief, and negatively impacts their relationship with loved ones, their profession, and the world around them.
Therapy for prolonged grief disorder can be extremely helpful, such as complicated grief therapy, which uses cognitive-behavioral techniques as well as elements of attachment theory. Therapy can help the individual understand their grief, process their emotions, and accept the loss. Grief support groups are also resourceful, as members find a sense of community and gain perspective from other members.
If you or someone you know is struggling with grief, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling and Psychotherapy. Contact our Paramus, NJ, or Manhattan, NY offices respectively, at (201) – 368-3700 or (212)-722-1920 to set up an appointment. For more information, please visit https://www.counselingpsychotherapynjny.com/
After hearing the tragic news of a death, there are three possible reactions the bereaving person could have to our response: feel even sadder, become angry, or feel reassured that things will be okay. We, as the reactor who is not directly experiencing their exact loss, want nothing more than to miraculously attain Merlin’s wand, and magically make their sadness, pain, confusion, and grief disappear. We just want to make it better. But for some reason, a completely inoffensive, caring response seems like it’s a fictional, fantastical possibility.
With a response that knocks us loving, caring people to our knees, Litsa Williams, licensed clinical social worker and creator of an online grief community called What’s Your Grief, says that none of our well-thought-out poignant phrases, earnest lamentations, or solemn sorrow at the beginning of the grieving process “can’t make it even a little bit better.” To prove her point, Williams brought some examples of common, pithy sayings that people say and the counterexamples of the griever’s possible thoughts in response:
Well-meaning person: “He/she is in a better place now.” Grieving person: I couldn’t care less! I want them here with me now!
What we learn: Closely following the death, a grieving person won’t find comfort in other people telling them that their loved one is “in a better place.” At that moment, they just want them back, and think there is no “better place” than being right here on Earth with them. It can also perpetuate confusing thoughts they are having about an afterworld, and it may induce guilt because they believed their whole lives that Heaven is a good place, but right now they don’t want that loved one to be in Heaven – they want them here.
Well-meaning person: “I know how you feel.” Grieving person: No losses are the same. Stop trying to compare your pain to my current pain. You can’t possibly feel exactly what I am feeling.
What we learn: Comparing grief doesn’t get anyone anywhere. Even if you might think that it’s rational that you lost your loving mother and so did your friend, your friend isn’t in the headspace to start having that conversation. They want to be comforted – not told that their grief is comparable to yours, or anyone else’s, for that matter.
Well-meaning person: “It will get easier.” Grieving person: It’s impossible for me to forget the person I love, and will never move on from this strong, intense grief! It would be wrong to do that to them and their memory!
What we learn: Williams points out, “Remember, this list is not about things that aren’t true. It is about things that aren’t helpful to say.” Rationally, we know that most people learn to live with the grief, and the pain doesn’t feel as strong or new over time, but when that bereaved person is still processing the death and feeling the fresh, raw sting of the loss, they want nothing other than for someone to recognize, accept, and hold their hand through their current reality. Additionally, they may feel like it’s unjust or cruel to start healing and “moving on” from the one they are grieving. They probably won’t want to even imagine the possibility of letting go of that pain to some extent. Giving them the space to feel their grief at the moment is crucial so that they know that your intentions are to be there if they ever need a shoulder to cry on, a hand to squeeze, or some more tissues delivered, and not to be imposing or offering what you think to be wisdom but they think to be insulting, hurtful, or condescending.
Well-meaning person: “God has a plan,” “It was God’s will,” or “Everything happens for a reason.” Grieving person: Why would God plan or will something so painful to someone? Why would God make us suffer and feel pain like this? I don’t care if this is God’s plan or not – it sucks.
What we learn: Many do find it comforting to think that there is a greater plan that God has for them. However, the grief and intense pain they feel now might cause them to doubt, or even hate, God, religion, or even their faith and beliefs as a whole. These troubling thoughts can even occur in the minds of very religious people. Williams says that it can even cause faith-based doubts in the minds of those who do not consider themselves religious. To sum up, Williams says, “Better safe than sorry – steer clear.”
Essentially, grieving people are uninterested in comparing or doubting anything. They just want to be listened to. Williams suggests doing things to remove stress and help them feel at ease during the process, whether that be sending over meals, arranging for childcare, or helping financially by collecting funds for the funeral costs, just to name a few. Frequently, those grieving don’t remember what you said, so don’t worry about possibly hurting a grieving friend or loved one in the past. Just focus on listening, being sympathetic, and loving.
While experiencing feelings of grief, some may have difficulties such as trouble sleeping, concentrating, eating, anger, extreme sadness, difficulty socializing, drinking alcohol, smoking, or using drugs, just to name a few. Some disorders related to grief or losing a loved one include acute stress disorder, depression, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, prolonged grief disorder, and substance use disorder.
A question you don’t hear enough but should be asked more is “What is grief?” Grief is the terrible pain that accompanies loss. Since grief is a reflection of our love, it can feel suffocating. There is no time limit for healing the pain that comes along with loss. Many individuals try to suppress their pain and agony causing them to feel guilt and stagnant. Many individuals may experience grief in short passes where the feeling of distress and sadness comes and goes. Meanwhile, others may experience grief for a long period, such as months or years. It’s important to remind yourself and others that you can grieve at your own pace.
In addition, children experience grief and loss in many different ways. Children are like sponges; they take in information through observation and learned behavior. Although they are young they have deep feelings and can understand their own emotions more than it is perceived. When children grieve it can be a confusing time for them and parents. Do you tell the truth? Or do you rationalize and give simple answers such as “Grandpa is just sleeping.” Being present with them allows you to grieve as well. When children see that their parents can be vulnerable and compassionate it allows them to express themselves and be who they really are.
Here are a couple of ways to help children cope with grief:
You can tell children the truth, even though you might not include all the specific information. Mentioning to them that Grandpa is sleeping may cause them to feel afraid to go to sleep or telling them he is in heaven may make them pack their belongings and find heaven. Be clear, honest, and simple.
Allow them to ask questions. You can’t protect them from the truth but you can give them your empathetic support and love.
Attending the funeral or keeping children home. Ask your child and allow them to decide. If they say yes, have someone who will be present with them and can keep them occupied in case being around sad adults gets overwhelming. If they say no, you can offer another way to remember or honor the person such as showing pictures or lighting a candle.
Give reassurance.
If you or someone you know is struggling with their mental health, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ, or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit https://aristapsychiatrypsychotherapy.com/
Losing a loved one is inevitable and can be one of the most difficult times in life. Sadly, you cannot protect your children from the pain of the loss, but you can help them build healthy coping skills. The grieving process will look different to everyone, but it is especially different with children compared to adults. For example, preschool children will most likely view death as temporary and reversible. This is because cartoon character’s death in TV shows or movies usually will die and come back to life. While children between the ages of 5-9 will start to think of death like adults do. However, they will view death as rare and not something that will happen to them.
It is important to help the child express feelings about the death. A way to do this is by reading the child books about death, telling stories or looking at pictures of the person who died. It is also important for you to express your own sadness and make them aware that it is okay to be sad at this time. Offer your support and comfort when you can, while also encouraging them to ask any questions or talk about their feelings.
It is normal that the following weeks after the death for the child to feel immediate grief or believe that the person is still alive. However, long-term denial or avoidance of grief can be unhealthy and can lead to severe future problems.
Signs of children experiencing serious problems with grief:
Extended period of depression: a child loses interest in daily activities
Loss of appetite, inability to sleep, and prolonged fear of being alone
Excessive imitation of the person who died
Acting much younger for an extended period of time
Believing they are talking to or seeing the person who died
Withdrawal from friends
Sharp drop in school performance or refusal to attend
If these signs persist, please seek professional help; a child and adolescent mental health professional will be able to help your child accept and properly grieve the death.
If you or someone you know is seeking therapy for the loss of a loved one, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/
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