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Bereavement disorder

Presenting complaints
The patient

  • feels overwhelmed by loss
  • is preoccupied with the lost loved one
  • may present with somatic symptoms following loss.
Diagnostic features

Normal grief includes preoccupation with loss of loved one.
However, this may be accompanied by symptoms resembling depression, such as:
  • low or sad mood
  • disturbed sleep
  • loss of interest
  • guilt or self-criticism
  • restlessness
The patient may
  • withdraw from usual activities and social contracts
  • find it difficult to think of the future
  • Differential diagnosis
If a full picture of depression is still present 2 months after the loss, consider depression. See Depression - F32.

Symptoms that cannot be related to the loss of a loved are inappropriate guilt and feelings of worthlessness. Marked psychomotor slowing may directly indicate depression.

Symptoms resembling depression may not, however, be indicative of depression (e.g., guilt about actions not taken by the person before the death of the loved one; thoughts of death reflected in statements such as "I should die and join the beloved one" or "I should have died instead"; some hallucinations such as seeing the deceased person or hearing his or her voice.

Bereavement disorder - management guidelines

Essential information for patient and family
  • Important losses are often followed by intense sadness, crying, anxiety, guilt or irritability.
  • Bereavement typically includes preoccupation with the deceased (including hearing or seeing the person)
  • A desire to discuss the loss is normal
Counselling of patient and family
  • Allow the bereaved person to talk about the deceased and the circumstances of the death.
  • Encourage free expression of feeling about the loss (including feelings of sadness, guilt or anger)
  • Offer reassurance that recovery will take time. Some reduction in burdens (work, social commitments) may be necessary.
  • Explain that intense grieving will fade slowly over several months but that reminders of the loss may continue to provoke feelings of loss and sadness.
Medication

Decisions about antidepressant medication should be delayed for three months or more. If significant depressive symptoms persist longer than three months, see Depression - F32 for advice on use of antidepressants.

If severe insomnia occurs, short-term use of hypnotic drugs may be helpful (e.g., temazepam 15mg each night) but use should be limited to two weeks.

Specialist consultation

Consider consultation if severe symptoms of grief persist for longer than six months, and in any case before prescribing antidepressant medication.

Bereaved children may benefit from family counselling. 
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