# Grief and Bereavement - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAFP - Family Physicians Working with Bereaved Patients (Am Fam Physician 2002;65:967) · Grief and Prolonged Grief Disorder - StatPearls, NCBI Bookshelf NBK507832 (statpearls-grief-and-prolonged-grief-disorder-NBK507832.txt) - Verified date: 2026-08 ## Verified against - Grief Support Following In-Hospital Deaths - StatPearls, NCBI Bookshelf NBK441927 (grief-bereavement-clinical.txt) - Grief and Prolonged Grief Disorder - StatPearls, NCBI Bookshelf NBK507832 (statpearls-grief-and-prolonged-grief-disorder-NBK507832.txt) ## Treatment metadata - Support, watchful waiting, grief-specific therapy (Support & Referral) ## Complete treatment card ```text GRIEF AND BEREAVEMENT Sources: AAFP - Family Physicians Working with Bereaved Patients (Am Fam Physician 2002;65:967) · Grief and Prolonged Grief Disorder - StatPearls, NCBI Bookshelf NBK507832 (statpearls- grief-and-prolonged-grief-disorder-NBK507832.txt) Review status: REVIEWED against Grief Support Following In-Hospital Deaths - StatPearls, NCBI Bookshelf NBK441927 (grief-bereavement-clinical.txt), Grief and Prolonged Grief Disorder - StatPearls, NCBI Bookshelf NBK507832 (statpearls-grief-and-prolonged-grief-disorder-NBK507832.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Acute grief is sadness, tearfulness and possibly insomnia, and usually needs no treatment; most people recover adequately within a year of the loss [insomnia · low mood] - Feelings: shock, numbness, sadness, denial, anger, guilt, helplessness, low mood and yearning - a person may cry for no reason [low mood · numbness · shock] - Thoughts: disbelief, confusion, poor concentration, preoccupation, and hallucinations [confusion · hallucinations · poor concentration] - Physical sensations: tightness or heaviness in the chest or throat, nausea, dizziness, headache, numbness, muscle weakness and fatigue [dizziness · fatigue · headache · muscle weakness · nausea · numbness] - Behaviour: difficulty sleeping, loss of interest in daily activities, and becoming more aggressive or irritable [insomnia · irritability · loss of interest] - Somatic: chest tightness and choking, breathlessness, abdominal distress and lethargy [breathlessness · chest pain · lethargy] - Patients are often reluctant to raise their grief and may not connect it to their physical complaints, so ask directly TESTS (5) - DSM-5 prolonged grief disorder: the death was at least 1 year ago in adults, at least 6 months ago in children and adolescents - Plus intense yearning for, or preoccupation with, the deceased, with thoughts or memories on most days - Plus at least 3 of these for at least 1 month, causing distress or disability: identity disruption, disbelief about the death, avoidance of reminders, intense emotional pain, difficulty reintegrating into relationships and activities, emotional numbness or inability to feel a positive mood, loneliness, a sense that life is meaningless - And impairment of social, educational or occupational function, with symptoms exceeding the patient's own cultural or religious norms - The Brief Grief Questionnaire and the Inventory of Complicated Grief reliably identify complicated grief IF NOT THIS - what else fits (7) - Yearning and sorrow, preoccupation with the deceased, and an inability to accept the reality of the death separate prolonged grief disorder from major depression and from PTSD - Takotsubo cardiomyopathy: chest pain and breathlessness after severe emotional or physical stress, with ECG changes mimicking infarction but no coronary occlusion - About 7% of bereaved people develop prolonged grief disorder - Higher risk after the death of a spouse or child, the death of a parent in the patient's own childhood, a sudden unexpected or horrific death, multiple deaths, or death by murder or manslaughter - Also higher with low self-esteem, low trust in others, previous psychiatric illness or suicidal acts, a young deceased person, poor perceived social support, and dependent or ambivalent attachment to the deceased - Anticipatory grief follows an expected loss and affects the dying person, the family, and the treating clinicians - Disenfranchised grief follows a loss that cannot be openly acknowledged or publicly mourned - a pet, a perinatal loss, the loss of a body part Source StatPearls "Grief and Prolonged Grief Disorder" (NBK507832) - disease-level clinical article; it draws the normal-grief against prolonged-grief-disorder boundary Status traced to the source above 1. SUPPORT, WATCHFUL WAITING, GRIEF-SPECIFIC THERAPY (SUPPORT & REFERRAL)[1st line] Adult Acknowledge the loss, let the person talk, and see them again. Most people do not need a doctor to do anything else - the article puts adaptation at 6 months to 1 year for most bereaved people, and makes the goal of normal grief exactly that: adapting to the loss and coming back into ordinary social life and daily activity. No medicine is indicated for uncomplicated grief - not an antidepressant, and above all not a benzodiazepine. When grief is still disabling the person a year on it becomes prolonged grief disorder, and the treatment for that is a specific psychotherapy, not a prescription: prolonged or complicated grief therapy, which draws on cognitive behavioural therapy and other techniques to help the person accept the loss and rebuild a sense of meaning and satisfaction in a life the dead person is no longer in. Refer for that rather than prescribing. - Review at intervals over the first year Peds A grieving child is not a small grieving adult. Regression, somatic complaints and behaviour change are the usual presentation rather than stated sadness. No drug; involve the school and the family. The article reports evidence that cognitive behavioural therapy works better in children than some of the other approaches do. Source Grief and Prolonged Grief Disorder - StatPearls, NCBI Bookshelf NBK507832 Why Acknowledge the loss, let the person talk, and see them again. Most people do not need a doctor to do anything else - the article puts adaptation at 6 months to 1 year for most bereaved people, and makes the goal of normal grief exactly that: adapting to the loss and coming back into ordinary social life and daily activity. No medicine is indicated for uncomplicated grief - not an antidepressant, and above all not a benzodiazepine. When grief is still disabling the person a year on it becomes prolonged grief disorder, and the treatment for that is a specific psychotherapy, not a prescription: prolonged or complicated grief therapy, which draws on cognitive behavioural therapy and other techniques to help the person accept the loss and rebuild a sense of meaning and satisfaction in a life the dead person is no longer in. Refer for that rather than prescribing. Caution Benzodiazepines are the specific mistake to avoid. They blunt the processing of the loss rather than easing it, and prolong the very thing they were given for. Grief and depression are separable at the bedside. Pervasive hopelessness, worthlessness, guilt, total loss of pleasure and suicidal thinking belong to depression, not to grief - if they are there, treat depression. The article asks for the same separation to be made and adds a third to it: prolonged grief, post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are three different diagnoses. Prolonged grief disorder is grief still disabling the person more than a year after the death. It does not respond to ordinary antidepressant treatment and needs a grief- specific psychological therapy - refer rather than prescribe. Ask about suicidal thinking directly. Bereavement is a risk period, particularly for an older man who has lost a spouse. RED FLAG - Takotsubo (stress) cardiomyopathy can be triggered by intense grief, presents like a heart attack, and needs admission under cardiology rather than reassurance or watchful waiting. The article states the same in a single line. RED FLAG - Early mental health or social work referral is indicated for signs of complex grief, such as intense anger or prolonged denial. The article's argument for bringing in the wider team early is that it reaches the people heading for prolonged grief disorder before the 6 and 12 month marks that define it. No drug row is offered here, and the article does leave a door open - but it opens onto another diagnosis, not onto grief. It allows that someone with prolonged grief may be helped by medicine aimed at the anxiety or the depression the bereavement brought with it, and that while time is what heals most people, a few are helped by counselling or a temporary course of drug treatment. It names no drug and no dose. If the anxiety or the depression meets its own criteria, prescribe for that diagnosis - not for the bereavement. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)