Bereavement

Bereavement refers to an emotional state of loss usually experienced after the death of a loved one. The word itself is related to the old English term bereafian meaning to rob. It is often confused or used interchangeably with the terms grief or mourning. However, it is important to distinguish between these concepts for the purposes of understanding and treating bereaved persons. Put simply, bereavement is the state of being after a loss, whereas grief is the reaction to the loss, and mourning is the cognitive and emotional processing of the loss.

Bereavement, grief, and mourning are all contextual and vary with personal history, support systems, life cycle, culture, and beliefs of individuals or communities who have experienced a loss. A loss does not always refer to a death or loss of a loved one. Grief reactions and a state of bereavement can follow loss of material objects, employment, physical functioning, personal freedom, social status, or even the loss of a sense of safety or security. Anticipatory grief, or the expectation of an impending loss, whether regarding oneself or another person, can be as severe as the response to the loss itself.

Like major depression or anxiety, the emotional response is often accompanied by physical symptoms as well as complex social, behavioral, and cognitive changes. Bereavement, grief, and mourning are part of a normal response to a loss, but when the symptoms are intense—including morbid preoccupation of worthlessness, suicidal ideation, psychotic symptoms, psychomotor retardation, or melancholic de-pression—then there may be marked functional impairment that is not normal and requires expert evaluation and treatment.

Mild forms of these symptoms are to be expected for some time following a loss; however, when they are prolonged (more than two months) treatment should be sought. Physiologic symptoms of grief overlap with those of depression and may include decreased sleep, decreased appetite, nightmares, exacerbation of preexisting conditions, and even auditory or visual hallucinations.

Intense or unresolved grief reactions, prolonged grief, or failure to mourn appropriately can lead to serious and permanent health effects including posttraumatic stress and major depressive disorder. It may also result in physical symptoms in any body system or somatization, such as headaches or gastrointestinal problems.

Many psychiatric illnesses can trace their roots to unresolved grief that may go undetected until stressors or additional loss events bring them to the surface. Complicated grief can be fatal as there is an increased risk of death by suicide in recently and remotely bereaved persons. This is particularly true in older men, and in teens following the death of a parent or friend.