Bereavement
Treatment
While there have been no randomized, controlled, clinical trials of treatment for traumatic grief, inferences can be made from studies done treating PTSD, separation anxiety disorder, and depression.
Pharmacotherapy. Considering a review of this literature done by Jacobs, it seems that selective serotonin reuptake inhibitors might be more effective for the broad range of traumatic grief symptoms than tricyclic antidepressants. The latter tend to affect intrusive, anxious, and depressive symptoms alone, while the former reduce these symptoms as well as manifestations of avoidance, particularly avoidance stemming from distress over reminders of the loss.
Psychotherapy. Though findings have been mixed, both psychodynamically oriented treatments and behavioral/cognitive treatments have, in some studies, demonstrated effectiveness in treating pathological grief. When addressing bereavement-related distress, it is important for the therapist to review the relationship to the deceased person and the circumstances of the death. In addition, the therapist should advise the patient on what to expect from the grieving process. Though as yet there is no treatment designed to specifically address the symptoms of traumatic grief, M. Katherine Shear and Ellen Frank are developing and testing one such therapy based on Edna Foa's treatment for PTSD. Continued strides in this direction are cause for optimism in the search for efficacious treatments for traumatic grief and other bereavementrelated disorders.
GABRIEL K. SILVERMAN HOLLY G. PRIGERSON
See also ANTIDEPRESSANTS; ANXIETY; COGNITIVE-BEHAVIORAL THEORY; DEPRESSION; WIDOWHOOD.
BIBLIOGRAPHY
BOWLBY, J. Attachment and Loss. Vol. 3, Loss, Sadness and Depression. New York: Basic Books, 1980.
CHEN, J. H.; BIERHALS, A. J.; PRIGERSON, H. G.; KASL, S. V.; MAZURE, C.; SHEAR, M. K.; REYNOLDS, C. F.; DAY, N.; and JACOBS, S. "Gender Differences in Health Outcomes Resulting From Bereavement-Related Emotional Distress." Psychological Medicine 29 (1999): 367–380.
CLAYTON, P. J. "Bereavement." In Handbook of Affective Disorders. Edited by E. S. Paykel. London: Churchill Livingstone, 1982. Pages 403–415.
HOROWITZ, M. J. Stress Response Syndromes: PTSD, Grief, and Adjustment Disorders. Northvale, N.J.: Jason Aronson, 1997.
JACOBS, S. Traumatic Grief: Diagnosis, Treatment, and Prevention. Philadelphia: Brunner/Mazel,1999.
LINDEMANN, E. "Symptomatology and Management of Acute Grief." American Journal of Psychiatry 101 (1944): 141–148.
LUND, D. A.; CASERTA, M. S.; and DIMOND, M. F. "The Course of Spousal Bereavement in Later Life." In Handbook of Bereavement. Edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson. Cambridge: Cambridge University Press, 1993. Pages 240–254.
"Number of Deaths, Death Rates, and Age- Adjusted Death Rates for Ages 15 Years and Over, by Race, Sex, and Marital Status: United States, 1998." National Vital Statistics Reports 48, no. 11 (24 July 2000): 78–79, Table 22.
PARKES, C. M., and BROWN, R. J. "Health After Bereavement: A Controlled Study of Young Boston Widows and Widowers." Psychosomatic Medicine 34 (1972): 449–461.
PRIGERSON, H. G.; SHEAR, M. K.; JACOBS, S. C.; REYNOLDS, III, C. F.; MACIEJEWSKI, P. K.; DAVIDSON, J. R. T.; ROSENHECK, R.; PILKONIS, P. A.; WORTMAN, C. B.; WILLIAMS, J. B. W.; WIDIGER, T. A.; FRANK, E.; KUPFER, D. J.; and ZISOOK, S. "Consensus Criteria for Traumatic Grief: A Preliminary Test." British Journal of Psychiatry 174 (1999): 67–73.
PRIGERSON, H. G.; FRANK, E.; KASL, S. V.; REYNOLDS, III, C. F.; ANDERSON, B.; ZUBENKO, G. S.; HOUCK, P. R.; GEORGE, C. J.; and KUPFER, D. J. "Complicated Grief and Bereavementrelated Depression as Distinct Disorders: Preliminary Empirical Validation in Elderly Bereaved Spouses." American Journal of Psychiatry 152 (1995): 22–30.
PRIGERSON, H. G.; BIERHALS, A. J.; KASL, S. V.; REYNOLDS, III, C. F.; SHEAR, M. K.; NEWSOM, J. T.; and JACOBS, S. "Complicated Grief as a Disorder Distinct From Bereavement-related Depression and Anxiety: A Replication Study." American Journal of Psychiatry 153 (1996): 1484–1486.
PRIGERSON, H. G.; BRIDGE, J.; MACIEJEWSKI, P. K.; BEERY, L. C.; ROSENHECK, R. A.; JACOBS, S. C.; BIERHALS, A. J.; KUPFER, D. J.; and BRENT, D. A. "Influence of Traumatic Grief on Suicidal Ideation Among Young Adults." American Journal of Psychiatry 156 (1999): 1994–1995.
PRIGERSON, H. G.; MACIEJEWSKI, P. K.; and ROSENHECK, R. "The Interactive Effects of Marital Harmony and Widowhood on Health, Health Service Utilization and Costs." The Gerontologist 40 (2000): 349–357.
PRIGERSON, H. G.; SHEAR, M. K.; FRANK, E.; BEERY, L. C.; SILBERMAN, R.; PRIGERSON, J.; and REYNOLDS, III, C. F. "Traumatic Grief: A Case of Loss-Induced Trauma." American Journal of Psychiatry 154 (1997): 1003–1009. PRIGERSON, H. G.; BIERHALS, A. J.; KASL, S. V.; REYNOLDS, III, C. F.; SHEAR, M. K.; DAY, N.; BEERY, L. C.; NEWSOM, J. T.; and JACOBS, S. "Traumatic Grief as a Risk Factor for Mental and Physical Morbidity." American Journal of Psychiatry 154 (1997): 616–623.
RAPHAEL, B.; MIDDLETON, W.; MARTINEK, N.; and MISSO, V. "Counseling and Therapy of the Bereaved." In Handbook of Bereavement. Edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson. Cambridge: Cambridge University Press,1993. Pages 427–453.
REYNOLDS, C. F.; MILLER, M. D.; PASTERNAK, R. E.; FRANK, E.; PEREL, J. M.; CORNES, C.; HOUCK, P. R.; MAZUMDAR, S.; DEW, M. A.; and KUPFER, D. J. "Treatment of Bereavement-Related Major Depressive Episodes in Later Life: A Controlled Study of Acute and Continuation Treatment with Nortriptyline and Interpersonal Psychotherapy." American Journal of Psychiatry 152 (1999): 202–208.
SANDERS, C. M. "Risk Factors in Bereavement Outcome." In Handbook of Bereavement. Edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson Cambridge: Cambridge University Press, 1993. Pages 255–267.
SHUCHTER, S. R., and ZISOOK, S. "The Course of Normal Grief." In Handbook of Bereavement. Edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson. Cambridge: Cambridge University Press, 1993. Pages 23–43.
SILVERMAN, G. K.; JACOBS, S. C.; KASL, S. V.; SHEAR, M. K.; MACIEJEWSKI, P. K.; NOAGHIUL, F. S.; and PRIGERSON, H. G. "Quality of Life Impairments Associated with a Diagnosis of Traumatic Grief." Psychological Medicine 30 (2000): 857–862.
SILVERMAN, G. K.; JOHNSON, J. G.; and PRIGERSON, H. G. "Preliminary Explorations of the Effects of Prior Trauma and Loss on Risk for Psychiatric Disorders in Recently Widowed People." Israel Journal of Psychiatry (in press).
SURTEES, P. G. "In the Shadow of Adversity: The Evolution and Resolution of Anxiety and Depressive Disorder." British Journal of Psychiatry 166 (1995): 583–594.
SUTHERLAND, S., and DAVIDSON, J. "Pharmacotherapy for Post-Traumatic Stress Disorder." Psychiatric Clinics of North America 17 (1994): 409–423.
TURVEY, C. L.; CARNEY, C.; ARNDT, S.; WALLACE, R. B.; and HERZOG, R. "Conjugal Loss and Syndromal Depression in a Sample of Elders Aged 70 Years or Older." American Journal of Psychiatry 156 (1999): 1596–1601.
Additional topics
Medicine EncyclopediaAging Healthy - Part 1Bereavement - Components Of Normal Grief, Pathological Grief, Risk Factors For Pathological Grief, Treatment