Thursday's Therapy - Can You Die of a Broken Heart? ~Washington Post / Answering Questions Regarding "Broken Heart Syndrome" ~Johns Hopkins University

Broken heart syndrome,

also called stress-induced cardiomyopathy

or takotsubo cardiomyopathy,

can strike even if you're healthy.

People dealing with a great loss of a loved one,

divorce, physical separation, anxiety everyday

brought on by stress. Causes are

brought on by a stressful emotional event.

You can die of a broken heart -- it's scientific fact!

Thursday's Therapy

Can You Die of a Broken Heart?

~Washington Post

/

Answering Questions Regarding

"Broken Heart Syndrome"

~Johns Hopkins University

Viewer Discretion Is Advised.

~X-ray of "Broken Heart Syndrome"

~U.S. National Library of Medicine

~~~~~

Study Suggests 

You Can Die of a Broken Heart

Stress Hormones Cause Fatal Spasms, 

Scientists Find

By Rob Stein

Washington Post Staff Writer

Thursday, February 10, 2005; Page A03

As Valentine's Day approaches, scientists have confirmed the lament of countless love sonnets and romance novels: People really can die of a broken heart, and the researchers now think they know why.

A traumatic breakup, the death of a loved one or even the shock of a surprise party can unleash a flood of stress hormones that can stun the heart, causing sudden, life-threatening heart spasms in otherwise healthy people, researchers reported yesterday.

The phenomenon can trigger what seems like a classic heart attack and can put victims at risk for potentially severe complications and even death, the researchers found. By giving proper medical care, however, doctors can mend the physical aspect of a "broken heart" and avoid long-term damage.

"When you think about people who have died of a 'broken heart,' there are probably several ways that can happen," said Ilan S. Wittstein of the Johns Hopkins School of Medicine in Baltimore, whose findings appear in today's New England Journal of Medicine. "A broken heart can kill you, and this may be one way."

No one knows how often it happens, but the researchers suspect it is more frequent than most doctors realize -- primarily among older women -- and is usually mistaken for a traditional heart attack.

That is what happened to Sylvia Creamer, 73, of Walkersville, Md., who experienced sudden, intense chest pain after giving an emotional talk about her son's battle with mental illness.

"I started having this heavy sensation just pushing down on my chest," said Creamer, who was taken to a hospital where doctors began treating her for what they thought was a heart attack. But Creamer's arteries were fine, and Wittstein and his colleagues subsequently determined that she had instead experienced an unusual heart malfunction. She quickly recovered.

The idea that someone can die from a broken heart has long been the subject of folklore, soap operas and literature. Researchers have known that stress can trigger heart attacks in people prone to them, and a syndrome resembling a heart attack in otherwise healthy people after acute emotional stress has been reported in Japan. But very little was known about the phenomenon in this country, and no one had any idea how it happened.

The new insight is perhaps the most striking example of the link between mind and body, several experts said.

"This is another in a long line of accumulating, well-documented effects of stress on the body," said Herbert Benson, a mind-body researcher at Harvard Medical School. "Stress must be viewed as a disease-causing entity."

The findings also underscore the growing realization that there are fundamental physiological differences between men and women, including how they respond to stress.

"This is why we need to do more research involving women," said cardiologist Deborah Barbour, speaking on behalf of the American Heart Association. "We can't extrapolate a man's response to a woman."

It remains unclear why women would be more vulnerable, but it may have something to do with hormones or how their brains are wired to their hearts.

"Women react differently to stress, particularly emotional stress. We see that in our daily lives," said Scott W. Sharkey of the Minneapolis Heart Institute, who described 22 similar cases last week in the journal Circulation.

Accurately diagnosing the phenomenon, known technically as stress cardiomyopathy, should help improve treatment for patients who might otherwise receive drugs or other therapies that could do more harm than good, Sharkey and others said.

Wittstein and his colleagues studied 19 patients who had what appeared to be traditional heart attacks between 1999 and 2003 after experiencing sudden emotional stress, including news of a death, shock from a surprise party, being present during an armed robbery and being involved in a car accident. All but one were women. Most were in their sixties and seventies, though one was just 27. None had a history of heart problems.

When the researchers compared them with people who had classic heart attacks, they found that they had healthy, unclogged arteries but that levels of stress hormones in their blood, such as adrenaline, were two to three times as high as in the heart attack victims -- and seven to 34 times higher than normal.

"Our hypothesis is that massive amounts of these stress hormones can go right to the heart and produce a stunning of the heart muscle that causes this temporary dysfunction resembling a heart attack," Wittstein said. "It doesn't kill the heart muscle like a typical heart attack, but it renders it helpless."

Tests also found distinctive patterns in the electrical firing and contractions of the hearts of those who experienced the syndrome, which should enable doctors to diagnose the condition quickly, Wittstein said.

While victims of classic heart attacks often experience long-lasting damage and take weeks or months to recover, these patients showed dramatic improvement within a few days and complete recovery with no lingering damage within two weeks.

That was the case for Meg Bale, 70, of Bloomington, Minn., who had an attack after Sen. Paul D. Wellstone (D-Minn.) died in a plane crash in 2002. She began experiencing severe chest pain that shot down her arm after attending an emotional gathering at Wellstone's office, and she ended up being taken to an emergency room.

"For me, it was just such a shock. I really thought he was something special -- he had real heart," Bale said. "I felt just awful."

~Washington Post

~~~~~

Frequently Asked Questions about Broken Heart Syndrome

For more information on Stress Cardiomyopathy, visit the Johns Hopkins Heart and Vascular Institute's website.

1. What is "stress cardiomyopathy"?

Stress cardiomyopathy, also referred to as the “broken heart syndrome,” is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). This condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger, and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, difficulty breathing (such as a flare of asthma or emphysema), or significant bleeding. 

           

2. What are the symptoms of stress cardiomyopathy?

Patients with stress cardiomyopathy can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected, stress.

           

3. Is stress cardiomyopathy dangerous?

Stress cardiomyopathy can definitely be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can have congestive heart failure, low blood pressure, shock, and potentially life-threatening heart rhythm abnormalities. The good news is that this condition improves very quickly, so if patients are under the care of physicians familiar with this syndrome, even the most critically ill tend to make a quick and complete recovery.

4. How does sudden stress lead to heart muscle weakness?

First, it is important to understand what “stress” is. “Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar, or can be emotional, such as receiving news that a loved one has passed away. When these abnormalities occur, the body produces various hormones and proteins such as adrenaline and noradrenaline which are meant to help cope with the stress. For example, if a person is suddenly threatened and fears physical harm, the body produces large amounts of adrenaline to help that person either defend himself/herself or run faster to escape the danger. With stress cardiomyopathy, we believe that the heart muscle is overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. The precise way in which adrenaline affects the heart is unknown. It may cause narrowing of the arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart. Alternatively, the adrenaline may bind to the heart cells directly causing large amounts of calcium to enter the cells which renders them temporarily dysfunctional. Whichever the mechanism, it appears that the effects of adrenaline on the heart in this syndrome are temporary and completely reversible. As will be discussed further in question 5, one of the main features of this syndrome is that the heart is only weakened for a brief period of time and there tends to be no permanent or long-term damage.

5. How does stress cardiomyopathy differ from a heart attack?

Stress cardiomyopathy can easily be mistaken for heart attack. Patients with this syndrome can have many of the same symptoms that heart attack patients have including chest pain, shortness of breath, congestive heart failure, and low blood pressure. With a closer look, however, there are some major differences between the two conditions. First, most heart attacks occur due to blockages and blood clots forming in the coronary arteries, the arteries that supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent and irreversible damage. This is completely different from what is seen with stress cardiomyopathy. First, most of the patients with stress cardiomyopathy that both we and others have seen appear to have fairly normal coronary arteries and do not have severe blockages or clots. Secondly, the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Fortunately, this stunning gets better very quickly, often within just a few days. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.

   

6. I am under a great deal of stress every day. Is it possible that I have been walking around with stress cardiomyopathy and did not even know it?

While there is no debate that chronic stress can have effects on human health, stress cardiomyopathy appears to be a condition that comes on suddenly and unexpectedly and resolves quite quickly. If you are a person who frequently has symptoms of chest pain or shortness of breath when under significant stress, you should be evaluated by your doctor. He or she may want to perform some basic tests to make sure you are in god health. It is unlikely, however, if your symptoms have been going on for a while that you have stress cardiomyopathy.

   

7. Who is at risk for getting stress cardiomyopathy?

Because stress cardiomyopathy is a relatively newly appreciated syndrome, we are only beginning to understand why it happens and who is most likely to get it. Most of the patients we have seen with it do not have a previous history of heart disease. It is quite clear from the available medical literature so far, however, that stress cardiomyopathy affects primarily women. In addition, it tends to occur most frequently in middle aged or elderly women (average age about 60). While it can also occur in young women and even in men, the vast majority of the patients we have seen with this are post-menopausal women. The exact reason for this is unknown, and further research will be necessary to help explain this observation.

8. Once a person has had stress cardiomyopathy, will they get it again the next time they are under severe stress?

From what we have seen so far, the answer to this question appears to be no. While it is possible that the syndrome could recur, this is not what we have observed at our hospital. In the five years that we have been following patients with stress cardiomyopathy, none have experienced the syndrome a second time. Further, several of our patients went on to have other stressful events in their lives and none developed the syndrome again.

9. If I have had stress cardiomyopathy, what is my long-term prognosis?

Because the heart muscle is not permanently damaged with this syndrome, patients typically make a rapid and complete recovery. From our experience and from what has been published by other groups, the long-term prognosis for patients with stress cardiomyopathy appears to be excellent.

~Johns Hopkins University

Pictures:
Conglomerate of pictures on Broken Heart Syndrome, by ~Grieving Mothers
X-Ray: ~U.S. National Library of Medicine X-ray of "Broken Heart Syndrome"

Broken Heart Syndrome articles used:

Washington Post:
http://www.washingtonpost.com/wp-dyn/articles/A11446-2005Feb9.html

Johns Hopkins University:
http://www.hopkinsmedicine.org/asc/faqs.html

Broken Heart Syndrome X-Ray may be found at
http://abcnews.go.com/Health/slideshow/photos-xray-medical-scans-2033647

Thursday's Therapy - Complex Grief, Depression, or Bereavement? ~David Joel Miller, LMFT, LPCC

Thursday's Therapy

Complex Grief, Depression, or Bereavement?

~David Joel Miller, LMFT, LPCC

Is it Complex Grief, Depression, or Bereavement?

Posted on April 22, 2012

~David Joel Miller,

Marriage and Family Therapist, Licensed Professional Clinical Counselor

Just what is Complex Grief, compound grief and why have people been asking about them recently?

Complex grief is also called complicated grief, traumatic grief, prolonged grief, chronic grief or extreme grief.

The Idea behind Compound grief and its many other labels is that while most everyone experiences grief at some point in their life, sometimes that grief becomes debilitating and people with these issues need help. The questions become, is this a mental illness and how should people with severe grief issues be helped.

One thing therapy shouldn’t do is turn everyone into a mental patient and start requiring treatment for all. In professional lingo this is called pathologizing clients. There is plenty to do helping people who genuinely need help so we don’t need to enlarge the number of disorders just to keep counselors busy.

Grief is a normal part of life. People we love die. The loss of a close family member should make you sad. When does this move from a normal part of life to a disorder requiring treatment. And who should pay for this? Insurance companies may cover necessary treatment but they will draw the line if normal human emotions become the subject of treatment. The more diseases we create the more health care will cost. Besides if someone really has extreme impairment as a result of bereavement that becomes Major Depression and gets treated right? Not exactly. 

Currently grief is excluded from the DSM-4 criteria for depression. The reasoning for this was that if everyone is likely to experience this sooner or later then it is not a mental illness. Just how much the death of a family member is expected to affect us is mostly a result of culture. Some cultures (mourn) for a year or more. The widow or widower wears black and is granted time to grieve their loss.

In western society we limit grief to 60 days. Many other acute life events are limited to 30 days. After that you are supposed to get back to work and living. Since the DSM guide to mental illnesses is published by the American Psychiatric Association it reflects American and western values. That may not be appropriate for people of other cultures regardless of where they live.   

Currently the loss of a close person is included in the DSM as V62.82 Bereavement. V codes normally are not covered by most insurance plans. At least two factions are working to change this.  

Those who are working on the new DSM-5 report that Complex grief is a disorder proposed by groups outside the APA which is being considered. Additionally people within the APA have suggested removing the exclusion for grief from the definition of Major Depressive Disorder. That would result in more people who have severe symptoms as a result of grief getting treatment under the Depression code. I suspect that in practice most clinicians after a while go ahead and give the diagnosis of depression, grief or no, after the client has had problems for a while.

But there is another problem with all this increasing of treatment for grieving people. A specialty is growing up of practitioners who say they specialize in “grief counseling.” The research has not been kind to some of those “Grief counselors.” Some grief counseling seems to do more harm than good. 

Personally I am all for helping people who need help but the idea that we might evolve a sub specialty of counselors who are doing harm not good worries me. Complex grief is not the only area where we have a risk of doing more harm than good. 

Some of the treatments for PTSD and other trauma counseling have the potential to make the victim relive the experience… rather than allowing them to heal. The repeated exposure to the trauma may retraumatize the client and (make) them worse.

Not everyone who experiences the loss of a loved one has symptoms we might call complex grief. People with a past history of Major Depression are more likely to become depressed again if someone close to them dies. So is this a new disorder “complex grief” or is this a reemergence of Major Depression? Add a second stressor like financial problems, divorce, alcoholism or addiction and the loss of a loved one is more likely to affect peoples functioning.

People with multiple losses are more at risk and so are people who have a loss in early life and then experience a loss again. If you lose a parent as a child, are you more likely to feel sad when someone else dies in your life? Does that make the second loss a mental illness?

Men and women differ in they way they show grief, so do people of different cultures. We would want to avoid creating a mental illness that only one sex or culture gets diagnosed with. But then we already have several that are more likely to be given to (women) than men.  Does that mean that there is a difference in the mental health of one sex or the other or only that we are defining the emotions of women and ways they express them as a mental illness.

Professionals don’t all agree on this.

So what do I think will happen? Wish my crystal ball was clearer. My guess is that we will not add complex grief as a new disorder. The APA looks poised to soften the criteria for Major Depression and let some people who are suffering from depression as a result of a traumatic loss get more help.

I also expect to see more peer and self-help groups with or without professional assistance.

So what do you think? 

Is complex different than normal grief? 

Should it be a separate diagnosed mental illness or is it a normal human emotion?

~~~

This post was featured in “Best of Blog – May 2012” 

For more about David Joel Miller and my work in the areas of mental health, substance abuse and co-occurring disorders see the "about the author page." about the author page. For information about my other writing work beyond this blog there is also a Facebook authors page, in its infancy, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Thanks to all who read this blog.

~~~

This post came out over a year ago. We know now that this writer's prediction did not prevail. He had said, "My guess is that we will not add complex grief as a new disorder." To the contrary, this very month, May, 2013, the new DSM comes out, the "DSM V," and it does indeed add "Complicated Grief" as a "disorder."  

Tommy and I, both trained in counseling psychology, and both grieving parents, are concerned with this added "diagnosis" as we know ~as child-loss parents- that what is being termed "Complicated Grief," and added as a diagnostic "disorder," is, in fact, the NORM for Child-Loss Grief and Trauma.  

Life-long grief is to be expected and adapted to, and should therefore not be coined as a "disorder," adding to the further pathologizing of Child-Loss Grievers that this culture already tends to do when we are struggling with our very normal grief...

~~~

Pictures, thanks to ~The Compassionate Friends of Atlanta Siblings Group  

Article from CounselorsSoapbox.com

http://counselorssoapbox.com/2012/04/22/is-it-complex-grief-depression-or-bereavement/

Thursday's Therapy - "Good Grief" ~The New York Times

Thursday's Therapy

"Good Grief"

Just a reminder, there is a flip side to the opinion shared by the psychologist from last week's Thursday's Therapy, so we wanted to share this vantage point this week so that you can decide where your thoughts more closely align...

Opinion

OP-ED CONTRIBUTOR

The New York Times

Good Grief

By ALLEN FRANCES

Published: August 14, 2010

Coronado, Calif.

Cyprian Koscielniak

A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem.

Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can’t sleep well and don’t feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder.

This would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have. It is also a safe bet that the drug companies would quickly and greedily pounce on the opportunity to mount a marketing blitz targeted to the bereaved and a campaign to “teach” physicians how to treat mourning with a magic pill.

It is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions. Researchers point out that, during bereavement, some people develop an enduring case of major depression, and clinicians hope that by identifying such cases early they could reduce the burdens of illness with treatment.

This approach could help those grievers who have severe and potentially dangerous symptoms — for example, delusional guilt over things done to or not done for the deceased, suicidal desires to join the lost loved one, morbid preoccupation with worthlessness, restless agitation, drastic weight loss or a complete inability to function. When things get this bad, the need for a quick diagnosis and immediate treatment is obvious. But people with such symptoms are rare, and their condition can be diagnosed using the criteria for major depression provided in the current manual, the D.S.M. IV.

What is proposed for the D.S.M. 5 is a radical expansion of the boundary for mental illness that would cause psychiatry to intrude in the realm of normal grief. Why is this such a bad idea? First, it would give mentally healthy people the ominous-sounding diagnosis of a major depressive disorder, which in turn could make it harder for them to get a job or health insurance.

Then there would be the expense and the potentially harmful side effects of unnecessary medical treatment. Because almost everyone recovers from grief, given time and support, this treatment would undoubtedly have the highest placebo response rate in medical history. After recovering while taking a useless pill, people would assume it was the drug that made them better and would be reluctant to stop taking it. Consequently, many normal grievers would stay on a useless medication for the long haul, even though it would likely cause them more harm than good.

The bereaved would also lose the benefits that accrue from letting grief take its natural course. What might these be? No one can say exactly. But grieving is an unavoidable part of life — the necessary price we all pay for having the ability to love other people. Our lives consist of a series of attachments and inevitable losses, and evolution has given us the emotional tools to handle both.

In this we are not unique. Chimpanzees, elephants and other mammals have their own ways of mourning. Humans have developed complicated and culturally determined grieving rituals that no doubt date from at least as far back as the Neanderthal burial pits that were consecrated tens of thousands of years ago. It is essential, not unhealthy, for us to grieve when confronted by the death of someone we love.

Turning bereavement into major depression would substitute a shallow, Johnny-come-lately medical ritual for the sacred mourning rites that have survived for millenniums. To slap on a diagnosis and prescribe a pill would be to reduce the dignity of the life lost and the broken heart left behind. Psychiatry should instead tread lightly and only when it is on solid footing.

There is still time to keep the suggested change from entering the D.S.M. 5, which will not be published until May 2013. The task force preparing the new manual could adopt a more cautious and modest estimation of the reach of psychiatry and its appropriate grasp.

For the few bereaved who are severely impaired or at risk of suicide, doctors can already apply the diagnosis of major depression. But don’t change the rules for everyone else. Let us experience the grief we need to feel without being called sick.

Allen Frances, an emeritus professor and former chairman of psychiatry at Duke University, was the chairman of the task force that created the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Article: http://www.nytimes.com/2010/08/15/opinion/15frances.html?_r=1&emc=tnt&tntemail1=y

Thursday's Therapy - Does the Grief After a Child's Traumatic Death Ever End? ~Dr. Ursula Weide, Grief Expert, Says No

~Journey of the Survivor

What Not to Say to a Grieving Parent

Don't tell me to go on with my life.

Don't tell me to be strong.

Don't tell me my child was sick, that I knew it was coming.

Don't tell me my child is in a better place.

Don't tell me to stop crying.

Don't tell me you know how I feel.

Don't tell me I need to get over it.

Don't compare my child's death to your animals.

Don't tell me I need closure.

Do say I am here, just take my hand

and, cry all you need to!

~~~

Thursday's Therapy

Does the Grief After a Child's 

Traumatic Death Ever End?

Dr. Weide, Grief Expert, Says No

Nine years after the murder of their daughter and at the beginning of the suspect's trial on October 18 Chandra Levy's parents continue to suffer the symptoms of complicated or traumatic grief. According to Dr. Ursula Weide, such suffering is a major yet unrecognized public health problem which affects millions each year. The current efforts on the part of mental health experts to make complicated grief an officially recognized diagnosis will compel society to develop a better understanding of the pain of the survivors and to pave the way for more helpful treatment.

Washington, DC (PRWEB) 

October 22, 2010

Chandra Levy’s parents, their daughter murdered in 2001 in
Washington, D.C., continue to experience the typical symptoms
of complicated grief, as the Washington Post reported on October
18. The case received national attention because Levy, a federal
intern, had an affair with Congressman Condit from California
at the time. 

Since Levy’s body was found one year after her disappearance,
many questions will remain unanswered. Now that the trial of the
suspect is beginning, the parents still wonder what they could have
done to prevent the violent death of their child in Washington,
D.C., thousands of miles away from their own home.

~~~~~

Dr. Ursula Weide, a Licensed Psychologist and Fellow of
Thanatology with offices in Maryland and Virginia, who
developed a novel approach to complicated grief years after the
traumatic death of her young husband, says that it is natural for
the “what ifs”, anger, guilt, tension between the parents, and the
agony of the questions without answers – why did it happen to
our daughter? – to continue for extended periods of time.

Complicated grief after a traumatic – such as an untimely or violent - 

death of a child, spouse, partner, sibling or parent, fundamentally 

changes a person’s life and takes many years to integrate into a different 

way of living. As reported in numerous research papers, 10% to15% of all 

the bereaved – close to 2 million new traumatized grievers each year - 

experience complicated grief, different from adaptive grief after, for 

example, the death of an aging parent or a friend.

Adaptive grief, which initially can involve symptoms similar to 

complicated grief, subsides within a few weeks or months, says Weide. 

Complicated grief, such as the Levy family’s natural reaction to their 

child’s death, continues. Society’s lack of understanding of the difference 

and of the lasting impact of a traumatic death make it even harder for the 

survivors to eventually learn to live better with what happened, the best 

outcome possible.

Society wants survivors to 

"Move on, Get over it, Get a life” 

and has a time frame of about 3 to 5 months. Since the survivors are 

painfully aware that none of this often well-intended advice is helpful 

and that the trauma continues way beyond the first several months, they 

often feel that they are “going crazy” or that something is wrong with them, 

says Weide. A great sense of hopelessness and isolation from friends and 

family often follows. Studies have also shown that the risk of illness and 

death on the part of the survivors exceeds the national averages.

After their daughter’s disappearance and death, the Levys went public
with their grief, educating society and drawing attention to a degree of
suffering most would prefer to ignore. Fortunately, major efforts are
currently under way to have the diagnosis of Complicated Grief added
to the upcoming fifth edition of the Diagnostic and Statistical Manual
of the American Psychiatric Association, as summarized in two articles
in the Journal of Clinical Psychiatry (July and August 2010). Two articles
in the New York Times shed additional light on some of the more
controversial aspects of these efforts.

According to Dr. Weide, once the new Complicated Grief diagnosis will
be official, society and health care practitioners will have no choice but to 

acquire more accurate information about the plight of traumatized
survivors and learn how to support them in a more appropriate fashion.

~~~~~

Readers’ Comment:

Do not advise them 

to "move on."  

That is simply cruel.

~Janice Badger Nelson, Hospice Nurse

Park City, Utah from Boston

Article: http://www.prweb.com/releases/2010/10/prweb4684754.htm

Thursday's Therapy - How Is Your PostTraumatic Growth?

Thursday's Therapy

How Is Your PostTraumatic Growth?

Click here to take the Post Traumatic Growth Inventory

Managing traumatic stress: Tips for recovering from disasters and other traumatic events

Disasters are often unexpected, sudden and overwhelming. In some cases, there are no outwardly visible signs of physical injury, but there is nonetheless a serious emotional toll. It is common for people who have experienced traumatic situations to have very strong emotional reactions. Understanding normal responses to these abnormal events can aid you in coping effectively with your feelings, thoughts and behaviors, and help you along the path to recovery.

What happens to people after a disaster or other traumatic event?

Shock and denial are typical responses to traumatic events and disasters, especially shortly after the event. Both shock and denial are normal protective reactions.

Shock is a sudden and often intense disturbance of your emotional state that may leave you feeling stunned or dazed. Denial involves not acknowledging that something very stressful has happened, or not experiencing fully the intensity of the event. You may temporarily feel numb or disconnected from life.

As the initial shock subsides, reactions vary from one person to another. The following, however, are normal responses to a traumatic event:

• Feelings become intense and sometimes are unpredictable. You may become more irritable than usual, and your mood may change back and forth dramatically. You might be especially anxious or nervous, or even become depressed.
• Thoughts and behavior patterns are affected by the trauma. You might have repeated and vivid memories of the event. These flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. You may find it difficult to concentrate or make decisions, or become more easily confused. Sleep and eating patterns also may be disrupted.
• Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, can trigger upsetting memories of the traumatic experience. These "triggers" may be accompanied by fears that the stressful event will be repeated.
• Interpersonal relationships often become strained. Greater conflict, such as more frequent arguments with family members and coworkers, is common. On the other hand, you might become withdrawn and isolated and avoid your usual activities.
• Physical symptoms may accompany the extreme stress. For example, headaches, nausea and chest pain may result and may require medical attention. Pre-existing medical conditions may worsen due to the stress.

How do people respond differently over time?

It is important for you to realize that there is not one "standard" pattern of reaction to the extreme stress of traumatic experiences. Some people respond immediately, while others have delayed reactions — sometimes months or even years later. Some have adverse effects for a long period of time, while others recover rather quickly.

And reactions can change over time. Some who have suffered from trauma are energized initially by the event to help them with the challenge of coping, only to later become discouraged or depressed.

A number of factors tend to affect the length of time required for recovery, including:

• The degree of intensity and loss. Events that last longer and pose a greater threat, and where loss of life or substantial loss of property is involved, often take longer to resolve.
• A person's general ability to cope with emotionally challenging situations. Individuals who have handled other difficult, stressful circumstances well may find it easier to cope with the trauma.
• Other stressful events preceding the traumatic experience. Individuals faced with other emotionally challenging situations, such as serious health problems or family-related difficulties, may have more intense reactions to the new stressful event and need more time to recover.

How should I help myself and my family?

There are a number of steps you can take to help restore emotional well-being and a sense of control following a disaster or other traumatic experience, including the following:

• Give yourself time to adjust. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state.
• Ask for support from people who care about you and who will listen and empathize with your situation. But keep in mind that your typical support system may be weakened if those who are close to you also have experienced or witnessed the trauma.
• Communicate your experience. In whatever ways feel comfortable to you — such as by talking with family or close friends, or keeping a diary.
• Find out about local support groups that often are available. Such as for those who have suffered from natural disasters or other traumatic events. These can be especially helpful for people with limited personal support systems.
• Try to find groups led by appropriately trained and experienced professionals. Group discussion can help people realize that other individuals in the same circumstances often have similar reactions and emotions.
• Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs.
• Establish or reestablish routines such as eating meals at regular times and following an exercise program. Take some time off from the demands of daily life by pursuing hobbies or other enjoyable activities.
• Avoid major life decisions such as switching careers or jobs if possible. These activities tend to be highly stressful.

When should I seek professional help?

Some people are able to cope effectively with the emotional and physical demands brought about by traumatic events by using their own support systems. It is not unusual, however, to find that serious problems persist and continue to interfere with daily living. For example, some may feel overwhelming nervousness or lingering sadness that adversely affects job performance and interpersonal relationships.

Individuals with prolonged reactions that disrupt their daily functioning should consult with a trained and experienced mental health professional. Psychologists and other appropriate mental health providers help educate people about normal responses to extreme stress. These professionals work with individuals affected by trauma to help them find constructive ways of dealing with the emotional impact.

With children, continual and aggressive emotional outbursts, serious problems at school, preoccupation with the traumatic event, continued and extreme withdrawal, and other signs of intense anxiety or emotional difficulties all point to the need for professional assistance. A qualified mental health professional can help such children and their parents understand and deal with thoughts, feelings and behaviors that result from trauma.

Click here to take the Post Traumatic Growth Inventory.

Updated August 2011

~American Psychological Association

~Graphic, thanks to Grieving Mother, ~Vicki Warrington Davis via ~Just Feelin' Good
PostTraumatic Growth Inventory: http://cust-cf.apa.org/ptgi/
Article: http://www.apa.org/helpcenter/recovering-disasters.aspx

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Thursday's Thursday - Is Grief an Illness?

Thursday's Thursday

Is Grief an Illness?

HealthDay News

Is Grief an Illness? The Debate Heats Up

Psychiatric experts torn on whether bereavement should be included in new diagnostic manual.

By Alan Mozes, HealthDay Reporter

THURSDAY, Feb. 16, 2012 (HealthDay News) — The loss of a loved one can trigger deep emotional turmoil, but is the grief that follows a normal part of being human or is it a form of mental illness in need of diagnosis and treatment?

That's the gist of a "major debate" now unfolding in the world of psychiatry, as the American Psychiatric Association (APA) prepares to issue the fifth edition of its seminal reference guide to mental disease, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The issue: For the first time, the manual — a touchstone for mental health professionals across the United States — may not exclude the concept of " bereavement" from the constellation of behaviors and experiences that it deems worthy of consideration when clinicians set out to diagnose a major depressive disorder.

What does this mean? That feelings or outbursts accompanying the passing of a family member or close friend — such as crying, insomnia, fatigue, confusion and profound sadness — may now be viewed as a treatable illness rather than as a normal reaction to life's most shattering moments.

Needless to say, not everyone agrees with this shift in thinking.

"To me, grief is a normal condition, not to be tagged with a diagnostic code and to be treated," stressed Dr. T. Byram Karasu, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine and psychiatrist-in-chief at Montefiore Medical Center in New York City. "Everyone loses someone in their lives at some point. So, this would be classifying everyone at some point. No one would be immune to this."

"And that does not make sense, because grief is a normal and very healthy behavior," 

said Karasu, who also chairs the APA's National Task Force on the treatment of depression. 

"One has to feel joy as well as pain and depression, otherwise life is not worth living. And one should not interrupt the grieving by medication or psychotherapy. You have to feel the loss, and only by feeling the loss and recovering from it will the person become a better person. Interrupted grief will remain unfinished business."

Karasu's stance is in line with those expressed by the editorial board of the British medical journal The Lancet, which lays out its opposition to the new clinical approach in its Feb. 18 issue.

"Grief is not an illness," 

the journal's editors argue, noting that a diagnostic change in the APA's forthcoming manual would empower clinicians to interpret any post-loss despair that endures beyond a two-week window as a troubling sign of sickness rather than a standard sign of coping.

The Lancet team suggests that, instead, an intense but normal bout of grief can last six months to a year, depending on the very individualized nature of the particular relationship that has been severed by death. 

{Or as we Child-Loss Grievers know, our grief will normally last a life-time!}

"Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed," the authors noted.

They acknowledged, however, that sometimes grief can morph into something much more complicated, longer lasting and "pathological." In such instances, true clinical depression may ensue along the lines of a so-called "prolonged grief disorder," a potentially new designation now under consideration by the World Health Organization. And such patients, the board agreed, might stand to benefit from some form of mental health intervention.

The concern over exactly when normal grief becomes a condition that perhaps requires treatment is what's driving the notion of inclusion in the DSM, said University of California, San Diego, psychiatry professor Dr. Sidney Zisook.

"It is well recognized that the death of a loved one, just like any other serious stressor, [such as the] loss of a job, diagnosis of a fatal illness, divorce can trigger a clinical depression,” he said. "The ensuing depressive syndromes are no less severe or debilitating when brought on by bereavement as they are after any other life event or, indeed, when the depression seems to occur out of the blue." {Well, now, that concept is debatable! Child-Loss Grief does feel quite severe and debilitating, but it does allow us breathers between the grief-bursts which clinical depression is not as likely to do.}

"Acknowledging that bereavement can be a severe stressor that may trigger a clinical depression in a vulnerable person does not medicalize or pathologize grief," he suggested. "Rather, it prevents clinical depression from being overlooked or ignored, and facilitates the possibility of appropriate treatment."

"This acknowledgment," Zisook cautioned, "does not mean that we think acute grief should end in days, weeks or even months. For some, it may last for years, {or in Child-Loss Grief, a life-time,} whether or not there is also a clinical depression. But, acknowledging that clinical depression may also be present in some bereaved individuals may go a long way towards helping those individuals get on with their lives."

For University of Michigan Medical School psychiatry professor Dr. Randolph M. Nesse, the debate boils down to a tug-of-war between basic common sense on the one hand and science's search for diagnostic consistency on the other.

"Everyone knows that grief is something that happens to everybody," he noted. "And just because an emotion feels bad doesn't mean it's wrong or unhealthy. Most often it's a common-sense response to a real problem."

"So, my take is that it would be senseless to eliminate the grief exclusion [from the DSM]," said Nesse, who is also a professor of psychology at UM's College of Literature, Science and the Arts. "But, because it can be so damn hard to figure out when an emotion is normal or not normal without really knowing what is going on in a person's life, there are undeniable advantages to having a neat, clean, simple check-box kind of classification system for diagnosing depression. It makes it easier. So, you include grief as a box to tick, whether or not there is a real problem to be diagnosed."

"But that is what is so troubling," 

he added. 

"Because when someone gets a diagnosis of depression it then encourages giving that person treatment. And the getting of that treatment then pushes the person being treated into believing they do indeed have a problem that needs treatment to begin with. And that can be very unhelpful in many, many cases in which grief is really a normal and healthy response to a life event."

{Add to that, that many times, so-called Grief "Treatment" has been known to do more harm than good under psychotherapists who do not understand the multi-dimensional, long-term, and enduring aspects of Child-Loss Grief!}

Last Updated: 02/17/2012

Highlights, mine, and {Comments, mine}

~~~~~~~~~~

Moral of the Story when Grieving your Child:

{Also, pictures/graphics, mine}








Pictures/Graphics, thanks to ~ihaveaspecialangel My Special Angel: For Loved Ones Lost, and Grieving Mother, Jill Compton

Article: http://www.everydayhealth.com/emotional-health/0217/is-grief-an-illness-the-debate-heats-up.aspx?xid=tw_heartdiseases_20120222_grief