4

significant loss causes injury to attachment system -> poses threat to sense of security and safety

in initial aftermath, system doesnt recognize loss as permanent, leading the bereaed to engange in efforts to re-establish real or symbolic proximity

loss can trigger separation anxiety into adulthood

form of learning - neural basis of attachment supports the knowledge that a loved one persists, even when they are absent —> conflict when person dies

—> gone but also everlasting theory (Tiem and feedback in the form of real-world experience are needed to overcome this dissonance, new neural connections must be formed)

activtion in common areas:

• ACC, PCC, PFC, Insula & Amygdala

Physiological

• neuroendocrine (alterations in cortisol), immunological (impaired immune function over time)

• somatic changes (increased risk of cardiovascular disease, premature death)

Psychological

• increased risk of anxiety, depressive and stressor related disorders

Psychosocial

• loneliness, disruption in daily routins, substantial loss of coherence and impaired sleep

1. Shock and numbness

2. Yearning and Searching

3. Despair and Disorganization

4. Reorganization and Recovery

Synthesized model of Küber-Ross and Bowlby

more comprehensive model

beginning with numbness-disbelief

ending with acceptance and eventual recovery

Measured frequency of disbelief, yearning, anger, depression,and acceptance (using single-item scales) at multiple points intime following a loss (during a 24-month period).Time periods varied across participants, providing measures across thetwo-year span of time post-loss.

Also proposed a delayed grief response —> those who were not depressed pre-loss or at 6 months, but were depressed at 18 months (little evidence for this pattern in current study, but previously documented in research & clinical practice

Mixed findings, easing and intesifying was found

• extended ilnesses (6+ months) associated with poorer adjustment in bereavement for loved ones compared to shorter illnesses

• silverman says you cannot grieve in advance

• nature of death (e.g. sudden)

• nature of relationship

• individual diferences (personality, age, experience)

• Social factors (support)

both individual & situational

typically worse if death is sudden, stigmatized, preventable, resulting from suicide, act of violence/ traumatic event

• most common truamatic experience

• most likely to be rated as the worst

• increased incidence (after unexpected death) was observed for depressive episodes, panic disorder, PTSD

Parents in suicide/ drug group had significantly more mental health challenges

lack of clarity over who or what has been lost; and/ or whether loss should be difficult

e.g.

• infertility

• miscarriage/ abortion

• divorce

• disease

• drug abuse of loved one

• major move/ life transition

  
  

Harris (2020) - all losses compromise our “assumptive world” and may lead to feelings of grief

The assumptions that individuals form about the world arebased upon their early life experiences and attachments.

“Grief is a process that is both adaptive and necessary in order to rebuild theassumptive world after its destruction from significant loss experiences.”

• highly stressful life event

• early parental loss affects about 5% of population

• bereaved children are at higher risk of behavioural problems, mental/physical illness, increased stress reactivity, mortality (into early adulthood), and suicide

• one of the most stressful events a person can experience

• one third of spousal bereavement occurs before the age of 45

• effects of spousal loss — higher risk of dying from any cause

• older people that have los a spouse have a higher risk of dying

• 66% increased chance of dying within the first three months

• typically the hardest loss to endure

• greatest stress/ most lasting grief

• more intense feelings of grief compared to loss of spouse/parent

• can be intense and overwhelming, multiple losses are common

• severity depends on degree of attachment

• up to 6 months post-loss, grief scores relate to human loss, no difference

Older adults, spousal loss as well as death of frinds, siblings and cousins

• task oriented

• emotion focused

• neuroticism (grieving mothers, strongest predictor compared to coping/ other traits)

• low extraversion

• low openness

historically, grief was seen as normal and natural

Mid twentieth century, with rise of psychology and psyciatry, grief was seen as potentially disruptive

—> something to be worked through until completion??

grieving process does not progress as expected

• prolonged acute grief with intense yearning and sorrow

• frequent troubling thoughts about death

• excessive avoidance of reminders of the loss

May NOT be the same as depression

• violent deaths

• unexpected death

• high levels of anticipatory grief

• death in hospital for family of cancer patients

• traumatic contexts

• cultural traumas

• more likely to be transgenerational

Complicated grief, traumatic grief and persistent complex bereavement disorder

Diagnostic criteria

A. Death of a person who was close in past year (6months for children)

B. Persistent frief response most days since the death (incl. every day for past month, including one or both of following

• intense yearning/longing for deceased person

• preoccupied with thoughts/memories of the deceased person

C. At least 3 of the following symptoms most days since death

1. Identity disruption (e.g., feeling as if part of oneself has died).

2. Marked sense of disbelief about the death.

3. Avoidance of reminders that the person is dead.

4. Intense emotional pain (e.g., anger, bitterness, sorrow).

5. Difficulty reintegrating into one’s relationships and activities.

6. Emotional numbness (absence or marked reduction of emotions).

7. Feeling that life is meaningless as a result of the death.

8. Intense loneliness as a result of the death

D. Disturbance causes clinically significant distress or impairment insocial, occupational, or other important areas of functioning.

E. Duration and severity of the bereavement reaction clearly exceedexpected social, cultural, or religious norms for given culture/context.

F. Symptoms are not better explained by another disorder; notattributable to effects of a substance or another medical condition.

Estimated to occur in approx. 10% of bereaved (Lundorff et al., 2017)