How Do We Distinguish Normal from Abnormal Grief?

Medical Reviewer

People experience grief differently, yet despite these differences certain general patterns or phases can be identified. The loss of a loved one, or a close friend, is frequently met with an initial sense of shock that can last for hours or even a few days. Following the initial sense of disbelief emotions begin to stir. Dejection, sorrow, yearning, regret, and even anger and bitterness are common and normal. Over time the grieving person begins to settle a little. They may confide their emotions, or they may begin to express their feelings in writing, art or music. This grieving process may last for months, a year, or even longer. For many people it may be accompanied by intense memories, dreams and anxiety; and sometimes even physical upsets like stomach cramps or palpitations.

The aforementioned description of grief may sound ghastly, which it is, but it is a natural process. Despondency and depression after loss is a natural emotion but so is the anger associated with abandonment. As many men as women feel these emotions and, quite commonly, show symptoms of major depression. Typically these manifest as sleep disturbances and changes in diet, but again, no treatment is usually necessary.

The tipping point between normal grief to something more concerning is a little blurred. Over time it is normal to expect the person who is grieving to adapt to their change of circumstances. Sometimes emotional or behavioral disturbances are so disproportionately strong or protracted that a diagnosis of maladaptive stress reaction (also called adjustment disorder) is diagnosed.

Maladaptive stress reaction, or adjustment disorder, is the term applied to extremes of emotion and/or behavior following one or more life stressors. Bereavement is therefore just one example where a diagnosis may be made. Other examples include interpersonal conflicts or struggling with studies. In the case of grief, symptoms normally appear within three months following bereavement. Anguish is a common symptom as is despondency, hopelessness, agitation, trembling and physical complaints. In some cases the person may self-medicate with alcohol, although of itself this might also be viewed as a normal and transient feature of grieving. Although subjective, it is the extremes of emotion or behavior that would normally determine whether a diagnosis of maladaptive stress reaction is made.

Support is key to helping the person to adjust to their loss. If treatment is sought or recommended this is usually in the form of psychotherapy, counseling, or cognitive therapy. Depending on symptoms the doctor might also prescribe medication for anxiety, depression or possibly even stimulants if the person is very withdrawn.