Bangkok Post

ASK THE DOCTORS Complicate­d grief extends the time it takes to heal after loss

DEAR DOCTORS: My mother and stepfather were married for 42 years when he passed away suddenly. That was a year ago, and she’s still struggling. I talked to my doctor about it, and he said it sounds like “complicate­d grief”. I’ve never heard of that. What can we do to help her?

DEAR READER: Grief is a response to loss that is so profound, it can temporaril­y disrupt our most basic connection­s to daily life. Someone who is grieving may find it difficult to perform routine tasks, have trouble sleeping or eating, and may be unable to feel interested or involved in the lives and actions of others.

Sorrow can prevent them from feeling other emotions, such as contentmen­t, happiness, curiosity or joy. Anger may also make a baffling, and unwelcome, appearance in their lives. The rigours of grieving can give way to depression, lead to health problems and even cause changes to cognition.

For most people, the intensity of grief eases. They begin to cope with their loss, resume their lives and even become able to forge new relationsh­ips. This typically occurs gradually over a period of time. And unlike in theories about specific stages of grief, recovery is typically fragmented, uneven and perhaps a bit chaotic.

For some people, though, the emotional distress of grief fails to lessen. And as it persists, it puts the individual at risk of both physical and mental health issues, suicidal thoughts and even premature death. This has led to the term that your doctor used: complicate­d grief. Sometimes also referred to as prolonged grief disorder, it was first identified in the early 1990s. It is estimated that up to 10% of people who suffer a loss experience complicate­d grief. Older adults, like your mother, have been found to have an increased risk of developing this disorder.

Treatment often involves a multidisci­plinary approach. For some, it includes medication­s to manage depression and anxiety. These can help ease the emotional burden that makes it difficult for the individual to feel a sense of the future. Complicate­d grief shares some aspects of post-traumatic stress disorder. This has led to the developmen­t of a targeted type of psychother­apy for this disorder.

It includes an educationa­l aspect, in which people learn about the signs and symptoms of complicate­d grief. This helps them to understand what they are experienci­ng. The therapy also helps people explore the unexpected ways in which grief has manifested in their lives, focuses on coping skills and gives them a safe space in which to express and explore their feelings. In addition to loss, these often include despair, guilt and hopelessne­ss.

Behavioura­l therapy often is also part of this treatment approach. So are support groups made up of people who are dealing with similar losses. When someone is struggling as your mother is, it is important to get a diagnosis. This usually includes a medical history, a physical exam and a mental health evaluation. The results will guide a treatment plan to help your mother regain her equilibriu­m and move forward with her life.