Understand what prolonged grief is, considered a mental disorder by the WHO

O mourning it is an emotional reaction associated with a loss. Although it is commonly related to death, the experience can also be experienced after significantly painful situations, such as the end of a relationship, the end of a friendship and the loss of a job, in addition to goodbyes and disappointments.

The way each person feels and processes grief is unique, which indicates that there is no set duration or completely defined behavior patterns.

Some characteristics are common to this experience, such as deep sadness, loss of interest and a feeling of strong discouragement, as if life had lost its meaning. The impacts are also reflected in physical symptoms such as body aches, memory loss and sleep changes such as difficulty sleeping and daytime sleepiness.

Considered a natural process in the face of loss, grief can pose a health problem when it becomes intense and prolonged. The World Health Organization (WHO) defines prolonged grief as a mental disorder, according to the International Classification of Diseases (ICD). The problem is also now considered a mental disorder in the new version of the diagnostic manual of the American Psychiatric Association (APA).

prolonged grief disorder

Prolonged grief disorder is a disorder in which there is a persistent and pervasive response characterized by longing or persistent worry after a loss. At the same time, there is intense emotional pain that involves feelings as diverse as sadness, guilt, anger, and denial.

People in this situation may have difficulty accepting death, for example, feeling that they have lost a part of themselves. There is an inability to experience a positive mood, associated with a difficulty in engaging in social activities.

According to the WHO, the bereavement response in these more severe cases persists for an unusually long period of time after the loss, being more than six months at a minimum. Grief is considered prolonged when it goes beyond what fits the social, cultural or religious norms expected in the context of each individual. Another indicator of the disorder is when the disturbance causes significant damage to the routine of personal, family, social, educational and occupational life.

Symptoms are similar to depression and anxiety. According to the Ministry of Health, the difference between the disorders lies in the motivating factor for suffering. In prolonged grief, loss is the trigger for the problem.

Psychologist Samantha Mucci, professor at the Department of Psychiatry at the Federal University of São Paulo (Unifesp), explains that in the natural grieving process, loss is marked by acute pain that tends to be re-signified over time, which does not happen. in prolonged mourning.

“There are times when the person will be more focused on the loss and others when he will return to his life of work and studies. When this individual is very focused on the loss and is unable to resume life and reintegrate with memories, we can think of a prolonged grieving process”, explains Samantha.

Experience of grief for children and adolescents

Prolonged grief disorder can occur at all ages. Since the specific concepts of death and loss are different for each age group, the answer may also differ depending on age and developmental stage.

Children often do not explicitly describe the experience of homesickness or persistent preoccupation with death. These symptoms may be more likely to manifest in situations such as play or other behaviors involving themes of separation or death. Bereaved children can express homesickness while waiting for the deceased to return or returning to the places where they last saw them.

Some children may develop a worry that others might die, in addition to separation anxiety centered on concerns for the well-being and safety of their caregivers. In younger children, intense sadness or emotional pain may come on intermittently with seemingly appropriate moods. Anger related to loss, on the other hand, can be revealed in children and adolescents in situations of irritability, protest and tantrums or other behavior problems.

According to the Brazilian Society of Pediatrics (SBP), the context of death raises a set of questions, especially in young children, who can mix fantasy and reality. Faced with the death of the mother or father, for example, the child may believe that the departure is associated with inappropriate behavior.

“In children’s minds, angry feelings and aggressive behavior can cause the death of a loved one. In view of this, the child may experience embarrassment in the grieving process, and, in the midst of a feeling of guilt, initiates self-punishing behaviors, entering a depressive process. It is therefore important to observe how children are dealing with the death of a loved one, observing their behaviors and feelings so that they can count on the specialized help of a psychologist, when necessary”, states the SBP.

Symptoms related to the death of a loved one in children can be influenced by several factors. Delayed onset or worsening of symptoms, for example, may occur in response to a change in a child’s or adolescent’s social environment or in the way parents or caregivers deal with the situation.

“Until the age of 10, the child has no understanding of how death works. She thinks the person can still come back, so she ends up creating magical fantasies and thoughts”, explains Samanta. According to the specialist, mood disorders that are not treated in childhood and adolescence contribute to the fact that in adulthood, the individual is more predisposed to the development of physical illnesses and mental health disorders.

According to the SBP, before the age of 3, the child perceives death only as absence and lack. Between the ages of 3 and 5, death resembles a state of sleep. At that moment, the child, immersed in his fantasies, believes that thoughts, desires and words can cause or prevent death. From 5 to 7 years, the individual can understand death as “irreversible” or “inevitable”. As early as 10 and 11 years old, they are able to have a more abstract understanding of death, formulating hypotheses about its causality.

Among children and adolescents, prolonged grief is often accompanied by feelings of abandonment and rejection. At this stage, some signs may draw attention:

• Isolation
• retraction
• Difficulty concentrating or socializing
• Signs of acute distress

Grief is always linked to losses, but it is not only related to death. The loss of family ties due to the separation of parents, for example, can also be a trigger for prolonged grief.

In adult life, the main symptoms of prolonged grief are related to difficulty in concentration and productivity, feelings of undervaluing life and incapacity.

“In adults, pain is much more linked to the will to live or not and the will to produce. The person begins to have symptoms such as loss of libido, of desire, of desire to date, to have a personal life. He also isolates himself, like children and adolescents, but with a different intensity”, says the psychologist.