Grief

 By: Dr.Solomon Y.(Psychiatry R-2)

 Venue: Bahir Dar University, Tibebe Ghion Specialized hospital

1 Grief,By Dr.Solomon Y./Psych R-2/ 02/28/2025

 Outline

Defination of grief
Prolonged grief and complicated grief
Psychological response to grief
Grief process

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 Objectives
 To discuss on the defination and basic concepts of grief.
 To elaborate on the psychological response,stages and process of greif.
 To discuss on the area of need interms of social support and proffesional
care for prolonged grief
 To verify on the trends of social support for grief in Ethiopia.

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 What is grief
 Grief is the response to bereavement,which is the situation in which a loved
one has died
 Should not be diagnosed as a mental disorder.

 It’s the emotional suffering you feel when something or someone you love is
taken away.

 The more significant the loss, the more intense your grief will be.

 Prototype of reactive depression, occurs in response to significant separations

and losses,
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  DSM-5 tends to limit the concept of normal grief to loss due to the death of a
loved one—a condition that it considers as an exclusionary criterion for
major depression

 The boundary behavior and clinical depression are blurred in reactions to

such complex losses

 Bereavement reactions are characterized by the prominence of sympathetic

arousal and restlessness
 physiological and behavioral mechanisms to facilitate the search for the lost
object
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  Bereavement and loss do not generally seem to cause depressive disorder,
except in individuals predisposed to mood disorder

 Even subtle losses in life can trigger a sense of grief

you might grieve after moving away from home, graduating from college, or
changing jobs.

 Grief can also result from the loss of a significant relationship or the loss of
an important aspect of one’s identity.

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 Criterions Grief MDD

Predominate Feelings of emptiness and loss, Persistent depressed mood and the inability
affect to anticipate happiness or pleasure.

Dysphoria Decrease in intensity or occur in More persistent and nottied to specific

waves thoughts or preoccupations

Pain of grief Positive emotions and humor Pervasive unhappiness and misery

Preoccupation with thoughts and Self-critical or pessimistic ruminations

Thought content memories of the deceased.

Self esteem Generally preserved, Feelings of worthlessness and self-loathing

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 Persistent grief
 The grief response is persistent and pervasive, lasting for at least 6 months
after the loss

 The response is also beyond the expected sociocultural norms and results in
significant impairment in individual, family, social, educational, and
occupational functioning

 It may include problems coping without the loved one and having difficulties
with positive memories of the deceased, in trusting others, with social
interactions, or regarding meaning in life

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  Prolonged grief disorder is generally more prevalent among women, and it
may also be associated withincreased alcohol and other substance use, as
well as heightened suicidal ideation

 Unlike with PTSD, the focus of prolonged grief disorder is on the

preoccupation of the memories around the context of the loss

 Unlike a major depressive episode, depressive thoughts and emotions

characteristic of prolonged grief disorder are directly related to the
bereavement

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 Symptoms of grief

Emotional symptoms of grief

Shock and disbelief,Sadness ,Guilt,Anger ,Fear
Physical symptoms of grief
Fatigue,Nausea,Lowered immunity ,Weight loss or weight gain ,Aches
and pains ,Insomnia

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 The stages of grief
 Introduced by psychiatrist Elisabeth Kübler-Ross In 1969

Denial: “This can’t be happening to me.”

Anger: “Why is this happening? Who is to blame?”
Bargaining: “Make this not happen, and in return I will____.”
Depression: “I’m too sad to do anything.”
Acceptance: “I’m at peace with what happened.

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  If you are experiencing any of these emotions following a loss, it may help to
know that your reaction is natural and that you’ll heal in time

 There is not a typical response to loss, as there is no typical loss

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 How to cope with grief
 While experiencing loss is an inevitable part of life, there are ways to help
cope with the pain.

1. Acknowledge your pain.

2. Accept that grief can trigger many different and unexpected emotions.
3. Understand that your grieving process will be unique to you.
4. Seek out face-to-face support from people who care about you.
5. Support yourself emotionally by taking care of yourself physically.
6. Recognize the difference between grief and depression.

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 The grieving process
 Grieving is a highly individual experience; there’s no right or wrong way to
grieve

 How you grieve depends on many factors, including your personality and
coping style, your life experience, your faith, and how significant the loss
was to you.

 Inevitably, the grieving process takes time.

 Healing happens gradually; it can’t be forced or hurried—and there is no

“normal” timetable for grieving
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  Some people start to feel better in weeks or months. For others, the grieving
process is measured in years

 Whatever your grief experience, it’s important to be patient with yourself and
allow the process to naturally unfold.

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 Myths and facts about grief
 Myth: The pain will go away faster if you ignore it.
 Fact: Trying to ignore your pain or keep it from surfacing will only make it
worse in the long run
 Myth: It’s important to “be strong” in the face of loss.
 Fact: Feeling sad, frightened, or lonely is a normal reaction to loss.
 Myth: If you don’t cry, it means you aren’t sorry about the loss.
 Fact: Crying is a normal response to sadness, but it’s not the only one.

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  Myth: Grief should last about a year.
 Fact: There is no specific time frame for grieving. How long it takes differs
from person to person.
 Myth: Moving on with your life means forgetting about your loss.
 Fact: Moving on means you've accepted your loss—

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 Seek support for grief and loss

 The pain of grief can often cause you to want to withdraw from others and
retreat into your shell

 Having the face-to-face support of other people is vital to healing from loss

 Even if you're not comfortable talking about your feelings under normal
circumstances, it’s important to express them when you’re grieving.

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  While sharing your loss can make the burden of grief easier to carry, that
doesn’t mean that every time you interact with friends and family, you need
to talk about your loss

 Comfort can also come from just being around others who care about you.

 The key is not to isolate yourself.

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 Finding support after a loss
 Turn to friends and family members
Rather than avoiding them, draw friends and loved ones close, spend time
together face to face, and accept the assistance that’s offered .
 Draw comfort from your faith
If you follow a religious tradition, embrace the comfort its mourning rituals can
provide.
Spiritual activities that are meaningful to you—such as praying, meditating, or going
to church—can offer solace.
 Join a support group
Sharing your sorrow with others who have experienced similar losses can help.

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  Talk to a therapist or grief counselor
If your grief feels like too much to bear, find a mental health professional

 Using social media for grief support

 Memorial pages on Facebook and other social media sites have become popular ways to
inform a wide audience of a loved one’s passing and to reach out for support.
 As well as allowing you to impart practical information, such as funeral plans, these
pages allow friends and loved ones to post their own tributes or condolences.

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 Take care of yourself as you grieve
 When you’re grieving, it’s more important than ever to take care of yourself.

 The stress of a major loss can quickly deplete your energy and emotional
reserves.

 Looking after your physical and emotional needs will help you get through
this difficult time

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  Face your feelings.
You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you
have to acknowledge the pain.

 Express your feelings in a tangible or creative way

 Write about your loss in a journal.
 If you’ve lost a loved one, write a letter saying the things you never got to say; make a
scrapbook or photo album celebrating the person’s life
 Try to maintain your hobbies and interests

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02/28/2025
  Don’t let anyone tell you how to feel, and don’t tell yourself how to feel
either

 Plan ahead for grief “triggers.”

Anniversaries, holidays, and milestones can reawaken memories and feelings.
Be prepared for an emotional wallop, and know that it’s completely
normal

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  Look after your physical health.
The mind and body are connected.
When you feel healthy physically, you’ll be better able to cope
emotionally.
Combat stress and fatigue by getting enough sleep, eating right, and
exercising
 Don’t use alcohol or drugs to numb the pain of grief or lift
your mood artificially.

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 When grief doesn't go away...
 As time passes following a significant loss, such as the death of a loved one,
it’s normal for feelings of sadness, numbness, or anger to gradually ease

 Emotions become less intense as you begin to accept the loss and start to
move forward with your life.

 However, if you aren’t feeling better over time, or your grief is getting worse,
 a sign that your grief has developed into a more serious problem, such as
 complicated grief or major depression.

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 Symptoms of complicated grief
 Intense longing and yearning for your deceased loved one
 Intrusive thoughts or images of your loved one
 Denial of the death or sense of disbelief
 Imagining that your loved one is alive
 Searching for your deceased loved one in familiar places
 Avoiding things that remind you of your loved one
 Extreme anger or bitterness over your loss
 Feeling that life is empty or meaningless

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 Psychotherapy for complicated grief
IPT

 Grief-focused cognitive behavior therapy (CBT)

Particularly effective when it incorporates exposure therapy that promotes emotional
processing of memories of the loss

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  Complicated grief therapy (CGT)
 Based on principle of both interpersonal therapy and CBT
 It includes prolonged exposure techniques and also focuses on personal
goals and relationships

 Can antidepressants help grief ?

 As a general rule, normal grief does not warrant the use of antidepressants
 While medication may relieve some of the symptoms of grief, it cannot treat the
cause,
 Best considered in the context of comorbid psychiatric conditionssuch as major
depressive disorder or PTSD,especially if there is a lack of response to CBT or CGT.

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 Grief social support in Ethiopia context(Research)

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 References
 Kaplan and Sadock's Comprehensive 10th ed.
 Tasman Psychiatry Book
 American psychology association on grief(Melinda Smith, M.A., Lawrence
Robinson, and Jeanne Segal, Ph.D. Last updated: March 2018.)

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 Thanks

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