Traumatic Grief as Distinct Disorder: A Rationale, Consensus Criteria, and a Preliminary Empirical Test
13 important questions on Traumatic Grief as Distinct Disorder: A Rationale, Consensus Criteria, and a Preliminary Empirical Test
Symptoms of Traumatic Grief are ____ bereavement-related depression or anxiety
Robins and Guze's (1970) taxonomic principles (5)
2. laboratory studies that define the disorder
3. the delimitation of the proposed disorder from other disorders
4. follow-up studies of the disorder
5. family studies of disorder
Empirical evidence strongly supports unity among proposed TG symptoms however they can be conceptualized as falling into two categories
2) symptoms of traumatic distress (feeling of disbelief, mistrust, anger, and detachment from others, feeling shocked, experience of somatic symptoms of deceased)
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Why the name Traumatic Grief (TG) and not Complicated Grief (CG)?
- Other adjectives such as pathologic, neurotic, distorted etc. seemed derogatory and value-laden
- consider Grief reaction to be a stress response syndrome (similar symptoms to PTSD)
- appears to be a 'separation trauma'
Why is there resistance to include TG as distinct diagnostic category?
Major Depressive Disorder (MDD) vs. TG
- predict wide variety of mental and physical health disorders adjusting for and separate from the outcomes associated with depression
- have distinctive clinical course and response to DST
- distinct neurodocrine responses and responses to pharmacological treatment compared to those found for bereavement-related depression
- distinct EEG sleep profiles from MDD
- distinct risk factors from depression
Possible to meet TG criteria but be missed by MDD diagnosis
Adjustment Disorder (AD) vs. TG
- There is the stipulation that AD 'must resolve within 6 months of termination of the stressor' (TG symptomatology may last for years)
- Criterion D: symptoms cannot be a consequence of bereavement
Re-experiencing, avoidance, and hyper arousal differences in PTSD and TG
avoidant thoughts and behaviours appear to be less central than the numbness and dissociative features of disorder;
hyper arousal related to searching for the missing loved one rather than being rooted in threat posed by dangerous event
Clinical perspective of advantages of distinct TG category
Research perspective of advantages of distinct TG category
View by Prigerson and Jacobs on making TG distinct diagnostic entity:
harm done by not diagnosing those at risk (false negatives) is a greater concern than the misdiagnosis of those who are grieving normally (false positives)
2 assessment tools for TG
- Inventory of Traumatic Grief (provides self-report symptoms severity score. Also includes instructions to assist raters in determining whether or not responses would meet thresholds required for diagnosis.)
Limitations of data used by Prigerson and Jacobs
- absence of information about nonparticipants
- items from Widowhood Questionnaire did not contain exact wording of proposed criteria (was scored on scale rather than present/not present)
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