Can Grief be a Mental Disorder?

Abstract

Despite growing empirical evidence, the distinction between normal and pathological grief remains controversial. Few studies have investigated public attitudes towards distinguishing normal from pathological grief. An international sample of 348 participants from a wide range of cultures was asked if certain expressions of grief could be considered a mental disorder and to explain their answer. Analysis revealed that the majority (74.7%) agreed that grief could be considered a mental disorder. The presence of pervasive distress, of harm to self and/or others, functional impairment, and persistent grief were described as the circumstances under which grief can be a mental disorder. Reasons grief is not a mental disorder were that it is normal, temporary, in response to an event, and that efforts to include it in diagnostic manuals will lead to medicalization and stigma. The investigation of public norms informs the inclusion of pathological grief in diagnostic nosology.

Social support following bereavement: The role of beliefs, expectations, and support intentions

“…For the small proportion of bereaved individuals who are at high risk for developing complications of bereavement (Aoun et al, 2015;Kersting et al, 2011), a slight majority of participants in this study would not support a diagnostic classification. This finding is similar to figures in a health professional sample (Ogden & Simmonds, 2014) but is considerably lower than in general community samples (Breen et al, 2015, Rüsch et al, 2012 and bereaved populations (Johnson et al, 2009). The one-quarter of participants who were undecided may indicate a perception of not being able to hold an informed opinion or indeed conceptualize the consequences of such a decision.…”

“…Endorsement of a grief-related classification in diagnostic nosology. These opinions were measured using a two-item scale modified from Breen et al (2015). The first item asked participants to rate the extent to which they agreed with a grief-related classification for individuals showing a complex set of symptoms indicating difficult adjustment to a death.…”

“…In studies of health professionals, only 43.1% endorsed a grief-related classification in diagnostic nosology, despite 73.1% having witnessed client presentations that would meet diagnostic criteria (Ogden & Simmonds, 2014). In general, community samples' endorsement has been greater, ranging from 51% (Rüsch, Evans-Lacko, & Thornicroft, 2012) to 75% (Breen, Penman, Prigerson, & Hewitt, 2015); however, some still remain less likely to recommend professional support for bereavement-related distress than other mental health issues (Holzinger, Matschinger, Schomerus, Carta, & Angermeyer, 2011). Whereas in bereaved samples, 96.3% expect relief from a diagnosis and 98.5% would be receptive to receiving treatment for their grief (Johnson et al, 2009), others still propose that an understanding of the phenomenon is more important than any diagnostic label (Ghesquiere, 2013).…”

Attitudes of palliative care clinical staff toward prolonged grief disorder diagnosis and grief interventions

“…Likewise, the attitudes of clinical staff toward a PGD diagnosis and intervention for grief were overall positive, with the majority indicating that grief intervention is valuable and that a PGD diagnosis would help carers get the best help possible. The proportion supporting the inclusion of PGD as a diagnosis (74%) is strikingly similar to those found amongst international members of the general public (75%; Breen et al, 2015) and Australian psychologists and counsellors (73%; Ogden & Simmonds, 2014). However, negative attitudes toward a PGD diagnosis were also prevalent in the current sample, although to a lesser degree.…”

“…An Australian survey of psychologists and counsellors opinions regarding PGD showed a strong level of clinical support for the recognition of PGD (73%), but many held concerns about the implications of pathologising grief (Ogden & Simmonds, 2014). This tension between support and concern was also reflected in an international survey of members of the public, in which 75% agreed that grief could be considered a mental disorder but they also held reservations about potential medicalization and stigma of grief (Breen, Penman, Prigerson, & Hewitt, 2015). It is possible that such concerns about pathologising and intervening with carer grief would influence the likelihood of clinical staff making referrals for psychological intervention.…”