When Grief Won't Go Away

Medical Reviewer

Depression, following the death of someone close, is an intense, traumatic but essentially natural process. In the normal course of events the process of bereavement may last anything from a few weeks to several months. The passage of time helps people to move on, but a few people find the debilitating effects of loss become a permanent feature of their lives. Psychologists call this complicated grief.

Why is it that some people are able to move on yet others are not? In what may appear to be an ironic twist, Dr Mary-Frances O'Conner, a clinical psychologist and assistant professor of psychiatry at UCLA, believes the answer lies in the pleasure center of the brain. O'Conner's findings will be published in the August 15 edition of NeuroImage.

A reasonable amount is known about how the brain processes information during 'ordinary' grief. By using functional magnetic resonance imaging (fMRI), areas of the brain associated with processing pain are seen to be active in people who are grieving. Until recently, little was known or understood about the difference in people who experience complicated grief.

In a novel research study, 23 women who had lost a mother or sister to breast cancer within the previous five years were interviewed. Eleven were found to be experiencing complicated grief. Breast cancer is considered a particularly emotive area in women who are grieving, partly because they may have an increased risk themselves based on a family history.

The women were then shown 60 images of either the deceased relative or a stranger paired with a grief-related word (e.g. cancer) or a neutral but structurally similar word (e.g. ginger). As anticipated, the fMRI scans showed marked activity in the pain-processing areas of the brain associated with physical and social pain when both groups of women saw images of their loved one paired with grief-related words. However, only women with complicated grief showed significant activation of the nucleus accumbens area of the brain which is associated with rewards.

In complicated grief, neurons in the reward center of the brain are activated and this may give memories addictive properties.

"   . . when our loved ones are alive, we get a rewarding cue from seeing them or things that remind us of them", O'Connor said. "After the loved one dies, those who adapt to the loss stop getting this neural reward. But those who don't adapt continue to crave it, because each time they do see a cue, they still get that neural reward."

Complicated grief is being considered for inclusion into version five of the Diagnostic and Statistics Manual (DSM-V) used for psychiatric diagnosis.