Grief (bereavement) is the emotional and physical
response to the death of a loved one. Grief is associated with a wide range
of emotions, including sadness, anger, guilt, and despair. Each individual
may experience a different set of specific emotions, but, in general, these
emotions diminish as time passes and with support from family and friends.
The June 1, 2005, issue of JAMA includes an article
evaluating a new type of psychotherapy (talk therapy)
developed specifically to treat people with complicated grief.
Sometimes grief progresses from an emotionally painful but normal experience
to a disorder requiring additional evaluation and treatment.
Complicated grief may
be present when the emotions are particularly long-lasting or severe and include
inability to accept the loved one's death, persistent thoughts regarding the
death, and preoccupation with thoughts about the loved one.
Major depressive disorder should
be considered when the duration of grief lasts more than 2 months and is associated
with persistent feelings of guilt (other than those associated with the loved
one's death), preoccupation with thoughts about death (other than the loved
one's), feelings of worthlessness, psychomotor retardation (the slowing down of normal movements), and the inability to perform
Posttraumatic stress disorder may be present if the death occurred in a violent or traumatic manner,
particularly if the patient also witnessed it. In these cases, the person
has recurrent disturbing recollections of the death, avoidance of situations
associated with the death, and increased arousal (activation),
such as difficulty sleeping, difficulty concentrating, and anger outbursts.
Optimal treatment for abnormal grief depends on the specific condition
(see above) and the individual's symptoms. Treatment should be based on an
evaluation by your doctor, with possible referral to a psychiatrist (a medical doctor with specialized training in the treatment
of mental disorders). In all cases, maintaining good general health through
exercise, healthful diet, adequate sleep, and avoidance of alcohol and illegal
drugs is important during the grieving process.
Psychotherapy sessions with a psychiatrist or a psychologist (a professional trained in the nonmedical
treatment of mental disorders)—during these sessions, the individual
has an opportunity to discuss feelings of loss and learn ways to cope with
the associated emotions.
Mutual support groups—some persons may find
it helpful to share their feelings with others who are having similar experiences.
Medications—antidepressant medication may
be prescribed to help alleviate some of the symptoms, particularly if a major
depressive disorder is diagnosed. Short-term medication for sleep may also
National Mental Health Association 800/969-NMHAhttp://www.nmha.org
National Institute of Mental Health 866/615-6464 http://www.nimh.nih.gov
American Psychiatric Association 703/907-7300 http://www.psych.org
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at http://www.jama.com. Patient Pages on depression were published in the June 18, 2003, and
September 27, 2000, issues; and a Patient Page on posttraumatic stress disorder
was published in the August 1, 2001, issue.
Sources: National Mental Health Association, American Psychiatric Association
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate
in most instances, but they are not a substitute for medical diagnosis. For
specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied
noncommercially by physicians and other health care professionals to share
with patients. Any other print or online reproduction is subject to AMA approval.
To purchase bulk reprints, call 718/946-7424.
TOPIC: MENTAL HEALTH
Sarah Ringold, Cassio Lynm, Richard M. Glass. Grief. JAMA. 2005;293(21):2686. doi:10.1001/jama.293.21.2686