The varieties of grief experience.
The bereavement literature has yet to show consensus on a clear definition of normal and abnormal or complicated grief reactions. According to DSM-IV, bereavement is a stressor event that warrants a clinical diagnosis only in extreme cases when other DSM categories of psychopathology (e.g., Major Depression) are evident. In contrast, bereavement theorists have proposed a number of different types of abnormal grief reactions, including those in which grief is masked or delayed. In this article, we review empirical evidence on the longitudinal course, phenomenological features, and possible diagnostic relevance of grief reactions. This evidence was generally consistent with the DSM-IV's view of bereavement and provided little support for more complicated taxonomies. Most bereaved individuals showed moderate disruptions in functioning during the first year after a loss, while more chronic symptoms were evidenced by a relatively small minority. Further, those individuals showing chronic grief reactions can be relatively easily accommodated by existing diagnostic categories. Finally, we found no evidence to support the proposed delayed grief category. We close by suggesting directions for subsequent research.
Bonanno
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GA
Department of Counseling and Clinical Psychology, Teachers College, Columbia University, Box 218, 525 West 120th Street, New York, NY 10027, USA. gab38@columbia.edu
Kaltman
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D002908:Chronic Disease; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology*; D006117:Grief; D006801:Humans; D008016:Life Change Events; D011379:Prognosis; D012720:Severity of Illness Index; D013315:Stress, Psychological