Persistent Complex Bereavement Disorder
Tracy Lee • May 26, 2020
Complicated grief disorder has been redefined as persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Persons suffering persistent complex bereavement disorder (PCBD) experience an extreme yearning for their deceased loved one over an extended or prolonged time. This grief disorder is unusually disabling and often accompanied by destructive thoughts and behaviors. These survivors are in pressing need of assistance from professional intervention as their experience destroys their ability to resume a healthy life on their own.
GRIEF BRIEF 214
BEREAVEMENT
Bereavement is the period of time spent adjusting to loss.
During bereavement, survivors generally experience varying levels of grief’s symptoms.
Shock, numbness, sadness, yearning, disbelief, fatigue, crying, emptiness, fear, anger, guilt, and pain are included as a few of the symptoms of grief.
Survivors may experience disturbances in their abilities to function at their usual capacity and may suffer changes in their daily patterns of eating, sleeping, working, tolerance levels, and interactions with others.
If these symptoms become incapacitating, or if the survivor suffers from them for a prolonged period of time (beyond six months), it may be prudent to consider the assistance of a mental health professional. (Mourning Light III, 2019)
Persistent complex bereavement disorder (PCBD) is characterized by unshakeable grief that does not follow the general pattern of improvement over time; instead, individuals continue to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of functioning, or that cause extreme distress (Shear, Simon, Wall, Zisook, Duan, Reynolds, 2011).
The symptoms of grief closely correlate with the symptoms of persistent complex bereavement disorder (PCBD). The underlying difference is that the symptoms of grief generally correct themselves back to a place of functionality within a relatively brief period (usually within six months), while those who suffer persistent complex bereavement disorder experience a deepening intensity of symptoms in a continuing fashion.
Approximately 10 to 12 percent of bereaved individuals experience a syndrome of grief that does not resolve naturally and persists for an indefinite period with varying degrees of incapacitation. This has been labeled complicated or prolonged grief disorder and can have adverse long-term health effects (Prigerson, Horowitz, Jacobs, Parkes, Aslan, Goodkin, Raphael & Marwit, 2009). Normal grief is not generally considered a severe threat to the health and welfare of the survivor.
Certain risk factors seem associated with PCBD, including the first-degree relationship to the deceased, separation anxiety in childhood, controlling parents, abuse by or death of parents during childhood, a poorly functioning marriage or insecure attachment style prior to widowhood, emotional dependency of the deceased, lack of preparation for the death and in-hospital death of the loved one. (Ott, Lueger, Kebler & Prigerson, 2007) A prolonged state of abnormal grief has been associated with elevated rates of suicidal ideation and suicide attempts. Cancer, hypertension, and cardiac events are more likely after several years, and immune disorders and evidence of immune dysfunction are more frequent. Adverse health behaviors are more frequent and reported functional impairment is greater. Health care services are used to a greater extent, and more sick leave is taken. (Lannen, Wolfe, Prigerson, Onelov $ Kreicbergs, 2008) Personality traits such as a negative outlook and specific factors like a violent cause of death (such as suicide) may be associated with the onset of complicated grief, along with insecure attachment style or a history of trauma. Individuals who were formerly caregivers to the deceased may also be at greater risk. (Lobb, Kristjanson, Aoun, Monterosso, et al., 2010)
There is no single treatment method for PCBD, however, Complicated Grief Treatment (CGT), developed through Columbia University’s School of Social Work, has proven uniformly positive with an average response rate of 70 percent. Funded by the National Institute of Mental Health, CGT has been evaluated in three separate clinical trials. It is by far the most documented treatment offered for grief ailments.
Grief is not a voyage that one day ends. It is an ongoing, continuous journey. One does not experience the loss of a loved one and then, after a brief time, return to life as though nothing has happened. The death of a loved one changes the mechanical, psychological, and emotional make-up of a survivor’s life. Nothing is, nor ever will be, as it once was. These facts affect a change in the survival strategies of the living. For those who are unable to overcome these changes and implement new strategies of survival, PCBD looms on their horizon. These survivors have generally exhausted their supply of supportive companionship and their effectiveness of personal coping mechanisms. They live in a space without anywhere to turn for guidance, assistance, or peace. For these individuals, Complicated Grief Therapy may be their greatest life-preserver.
My name is Tracy Renee Lee. I am a Certified Grief Counselor (GC-C), Funeral Director (FDIC), published author, syndicated columnist, and co-founder of the “Mikey Joe Children’s Memorial” and Heaven Sent, Corp. I write books, weekly bereavement articles, and Grief BRIEFs related to understanding and coping with grief. I am the American Funeral Director of the Year Runner-Up and recipient of the BBB’s Integrity Award.
It is my life's work to comfort the bereaved and help them live on.
The past two weeks have been difficult for me. I have suffered the loss of a dear friend and have served families that have suffered great losses. The COVID-19 pandemic has caused unwarranted loss, stress, and heartache to so many people this year. Not only have we lost loved ones, but we have lost our economy, our comfort, and our security as Americans. Everywhere I look, it seems that people are rude and uncaring toward each other when what we need is love. I wish we could be kind to each other, considerate to each other, and help each other through our difficulties rather than burning cities, burning businesses, and tearing apart what makes up great, our Union. Americans are the most blessed people in the world. We live in a time of convenience and wealth. Why is it then that we can’t add kindness and respect to our society? Why must there be murders and brutal attacks on innocent people walking down the street? I work with families every day who would give all that they have for just one more moment with their loved one to say, “I’m sorry” or “I love you.” Time is so precious, but even more precious is the way that we treat others. For if we treat others with contempt, we will reap the bitter reward of hatred. Hate eats a person from the inside out, and no matter how hard a hateful person tries to find happiness, it will never come to them. I know this because I see it every day. A hateful heart has no room for happiness. Happiness only comes to those who love. Love is like light. Light is the only thing that is stronger than the dark. If you have a completely dark room and you strike a match, the light from that match will push the darkness away and light up the room. Conversely, if you have a room filled with light and you cup your hands to create a spot of darkness. As soon as you open your hands, the dark is gone. Light overpowers it just as love overpowers hate. Love is the only thing that is stronger than hate. If you strike an ember of love in the heart of someone full of hate, love will grow and overtake their hatred. In my profession, love is very important. I see all too often those who have pushed love aside thinking that they were winning an argument or for some other ridiculous reason. What I see when this happens is that at the end of life, those who were foolish and let hatred get the best of them suffer the most. They remain miserable for the rest of their lives. Don’t be one of these people. Don’t let hatred get the best of you. And most assuredly, let us not allow hatred to overtake our country. I don’t want to live in a world filled with hatred and discontent. I want happiness and love for all. I especially want love in your life when you suffer loss because believe me, when the grim reaper knocks, it’s too late to cry for one more moment to say, “I’m sorry” or “I love you.” At that moment, the weight of hatred crushes every hope you ever had to make amends, to accomplish happiness, or to right any wrong you may have perpetrated. It’s too late and you are the person who will suffer the consequences of your vicious actions. You are the person who will have no friends, no love, and who will die alone; miserable because of your hatred and terrible deeds. I know because I see it in so many people who thought they could just make a statement, a judgment, or an action and not suffer the consequences. In the end, it’s the hateful people who suffer the consequences. They die alone without love or support. Their needs are not met and they writhe in misery. I lost a dear friend this past week. He was kind, loving, and good. He made the world a better place, and he made my life happier through his actions of kindness toward me. I wish everyone alive could have known my friend. Christ died to make man holy, and my friend John took up his offer. John was a holy man. He lived his life serving others, teaching others, and helping anyone who needed help. He was filled with love and he shared his love with those who needed it. If we could all be like John, the world would be an amazingly happy and beautiful place. John is gone and I feel the weight of his loss deeply in my soul. He leaves a legacy of service to our nation, service to Christ, and service to anyone who needed it. He was a good man, a great man, and now he is gone. I will have the honor of directing his memorial service in a few days. The church will be bursting as those who John served make their way there to express their sorrow and love for him. I will be one of those people. John’s legacy will continue in his absence because he ignited goodness, love, and service in the hearts of those about him. May we all understand and embrace John’s mission in life to serve and love our fellow beings. Doing so will bring us the greatest rewards. It will fill our lives with the greatest gifts on earth; joy, happiness, and love. This is my prayer for you, for our nation, and for the world during this time of uncertainty and discontent. Thank you, John, for being my friend, and my God bless you as you arrive home, never to suffer more, the pains of the world nor heartaches of men. Godspeed.
I received a first call late last night and was therefore at the hospital when I ran into an acquaintance of mine. As we spoke, she told me that her father had recently died. She began to cry and I offered to send over a set of my grief books (Mourning Light I, II, & III) to her office the following morning. I wrote her a sympathy card and delivered the books about 15 minutes ago. She had not yet arrived at her office, so I left the books and card with her secretary. The following is the note I wrote in the sympathy card. I thought I would share it, in hopes that it might help others who mourn as well. Dear Friend, February will be the 2nd anniversary of my grandson’s death. It is said that “Death is Final”; that is untrue. The pain and loneliness remain in my soul, and it feels as though I held his lifeless body, yesterday, in my arms. That day broke me; it almost killed me. Had I not had the love and support of my husband and children, I don’t think my sanity would have remained with me. The pain continues to crush my soul with anguish. There are 4 things that have helped me survive the debilitating pain of losing my grandson, and I wanted to share them with you in hopes that you might find peace in them as well. Prayer Prayer was, and continues to be, my saving grace. Without the love and promise of Christ’s redeeming grace, peace would remain unobtainable. Recounting my Experience Sharing my story out loud made it real. It took away my fear. It gave me power over the chaos of pain. Information As a certified grief counselor, knowing what to expect and whether it was normal or abnormal helped keep my worries at bay. The books that I have sent over are filled with information, plainly and simply written, to help you understand and identify the symptoms of grief, as well as recovery’s signs and secrets. Journaling Writing down my anguishes, thoughts, pains, worries, and fears helped me to let them go. I was able to organize myself, and it gave me hope for my future. I am sorry for the dreadful sorrow in your heart, and the pain that infiltrates your daily existence. I understand that breathing feels unnatural, it takes effort to continue on, and that peace eludes you. I wish that death did not exist, but it is a reality that the both of us know all too well; one that we must endure. I believe that families are forever, that we are all God’s children, and that we will reunite with our loved ones across the veil as we too, one day, experience death. Until that day arrives, however, I pray that you and I will live our lives as emissaries of Christ, basking in his grace, and recipients of his glory. I hope that as you suffer the loss of your daddy that you will feel comfortable in reaching out to others, and that you might call me should you need assistance. The pain of grief should never be carried nor suffered in silence, nor alone. Reach out and allow those who love and care for you to lighten your burdens. Life will never be as it once was, but it will improve as you share priceless moments of peace with those who remain by your side. I hold you in high esteem, and pray that Christ’s promise will grace your soul. With Deepest Regards, Tracy Lee My name is Tracy Renee Lee. I am a Certified Grief Counselor (GC-C), Funeral Director (FDIC), published author, syndicated columnist, and co-founder of the “Mikey Joe Children’s Memorial” and Heaven Sent, Corp. I write books, weekly bereavement articles, and Grief BRIEFs related to understanding and coping with grief. I am the American Funeral Director of the Year Runner-Up and recipient of the BBB’s Integrity Award. It is my life's work to comfort the bereaved and help them live on, as well as educate adults in the needs of surviving children.