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APA Offers Tips for Understanding Prolonged Grief Disorder
“Prolonged grief disorder was recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a volume published by the American Psychiatric Association (APA) that defines and classifies mental disorders. It can happen when someone close to the bereaved person has died within at least 6 months for children and adolescents, or within at least 12 months for adults.”
Washington, D.C., Sept. 23, 2021 – Americans are currently facing several ongoing disasters that have caused death and suffering, such as COVID-19, the wind-down in Afghanistan, floods, fires, hurricanes and gun violence. While many Americans are mourning, some may experience prolonged grief disorder, which is characterized by incapacitating feelings of grief.
Prolonged grief disorder was recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a volume published by the American Psychiatric Association (APA) that defines and classifies mental disorders. It can happen when someone close to the bereaved person has died within at least 6 months for children and adolescents, or within at least 12 months for adults.
In prolonged grief disorder, the bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.
“The circumstances in which we are living, with more than 675,000 deaths due to COVID, may make prolonged grief disorder more prevalent,” said APA President Vivian B. Pender, M.D. “If you’ve recently lost someone close to you, it’s very important to check in with yourself. Grief in these circumstances is normal, but not at certain levels and not most of the day, nearly every day for months. Help is available.”
Some of the symptoms of prolonged grief disorder are:
- Identity disruption (e.g., feeling as though part of oneself has died).
- Marked sense of disbelief about the death.
- Avoidance of reminders that the person is dead.
- Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
- Difficulty with reintegration (e.g., problems engaging with friends, pursuing interests, planning for the future).
- Emotional numbness.
- Feeling that life is meaningless.
- Intense loneliness (i.e., feeling alone or detached from others).
In the case of prolonged grief disorder, the duration of the person’s bereavement exceeds expected social, cultural or religious norms and the symptoms are not better explained by another mental disorder.
Prolonged grief disorder is the newest disorder to be added to the DSM. After studies dating back several decades suggested that many people were experiencing persistent difficulties associated with bereavement that are substantially prolonged beyond culturally normed expectations, and a two-year process of review and public comment, APA’s Board of Trustees and Assembly approved it last fall for inclusion in the DSM. It will be included in the new text revision of DSM-5 (DSM-5-TR), which is slated for release in March 2022.
“Including prolonged grief disorder in the DSM-5-TR will mean that mental health clinicians and patients and families alike share an understanding of what normal grief looks like and what might indicate a long-term problem,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Especially now, sharing information and increasing awareness about prolonged grief disorder is essential.”
COVID Caregivers and Grief Overload:
Coping with Too Much Loss
by Alan D. Wolfelt, Ph.D.
“For many caregivers, COVID-19 has been a nonstop wrecking ball. It has swung back and forth across the globe, decimating families and communities. And who’s there in the midst of the ongoing crisis, providing care to the hundreds of thousands of sick, dying, dead, and grieving people? The professional caregivers. The nurses, long-term care workers, doctors, funeral directors, hospice staff, social workers, EMTs, and other critical frontline workers whose vocations place them squarely in the wrecking ball’s path.
If you’re one of these caregivers, you don’t need me to tell you how extraordinarily difficult your work has been. You’ve been challenged with fatiguing physical labor and PPE protocols as well as work conditions that have placed your own health, and possibly your family’s health, in jeopardy. And some of you have borne witness to a staggering amount of loss—perhaps more loss in a few months that you might have otherwise experienced in an entire career.
If you feel you’ve been exposed to too much loss during the pandemic and find yourself struggling with your thoughts, feelings, ability to function day-to-day, and possibly the prospect of ongoing exposure to even more loss, this article is for you.
What is grief overload?
Grief overload is what you feel when you experience too much loss all at once or in a relatively short period of time.
As a caregiver, you probably understand and accept that death is a natural part of life. You are probably well-equipped and trained to handle everyday loss situations. But when you are forced to care for an unusually high number of patients and families, some in desperate circumstances, you will naturally feel heightened stress, anxiety, fear, depression, hopelessness, physical unwellness, and other symptoms.
Grief overload simply means you have been exposed to more loss than anyone could reasonably take in stride. Even if you have coped well with death and loss in the past, you may be finding that the COVID-19 losses happening around you are different. This time you may feel helpless and hopeless. This time you may feel like you’re struggling to survive.
What is secondary trauma?
Secondary trauma happens when you are exposed to the traumatic loss situations of others. During the COVID-19 pandemic, many caregivers have suffered not only grief overload but also secondary trauma.
Long-term care facility workers have been placed in the difficult position of caring for multiple dying patients at one time. Nurses and doctors have had to triage patients and, lacking adequate PPE and lifesaving equipment, have sometimes been forced to choose who will receive full care and who will not. Hospital and morgue workers have had to stack overflow bodies in refrigerated trucks. Funeral home staff have cared for more bodies and bewildered families in a month than they normally do in a year.
Secondary trauma symptoms often overlap with post-traumatic stress symptoms, including intrusive thoughts about what happened, avoidance of triggers and feelings related to the place or event, pervasive negative feelings, and pronounced anxiety.
What to do about grief overload and secondary trauma
The COVID-19 wrecking ball is leaving many grief-overloaded and traumatized caregivers behind in its wake. If you’re one of them, or know someone who may be, here are some guidelines for taking care of your own mental health in the weeks and months to come:
• Prioritize your own care.
You can’t be of much help to others if you’re not first taking care of yourself. If you’re struggling, it’s time to make yourself the top priority. Take a day or two or three off work to recuperate and get an assessment.
• Get an assessment.
See your primary care provider as well as a professional counselor. The goal is to create a plan to shore up your mental health and get you the intensive help you may need for a period of weeks or months to restore and rebalance.
• Look into company resources.
Many healthcare organizations and workplaces with frontline caregivers have protocols and mental-health resources for trauma training, debriefing, reflective supervision, therapy, and more. Contact your HR department or benefits coordinator. Be sure you know what resources are available to you and how to access them.
• Take sick leave or FMLA to buy yourself downtime.
If you are emotionally unwell, both sick leave and FMLA time can be used to give yourself an essential respite. What you may need most of all is some time away from COVID-19 losses and trauma. Again, talk to your supervisor or HR department to activate the benefits you have earned.
• Focus on good basic self-care.
If you’ve been too busy or distracted to take good care of yourself, it’s time to make time. Now more than ever you need adequate high-quality sleep, regular exercise, a healthy diet, and good hydration. Mindfulness practices like meditation and yoga can also be transformative. Use your time away from work to embark on a self-care makeover. Ask for friends and family to help you with this new lifesaving focus.
Throughout the COVID crisis, we’ve been applauding caregivers like you. We’ve been calling you heroes, putting up banners to thank you, and dropping off food to keep you sustained. Yet you and I know that claps and cookies are not enough. You deserve to be well cared for, including comprehensive mental-health benefits and adequate time away from work, to renew yourself and to be able to return to work whole and healthy.”
If you think you may be suffering from grief overload and/or secondary trauma, Please reach out for support today at Emma’s Place 347.850.2322
During the COVID-19 crisis and this challenging time, we have been faced with losses, experiences, and difficulties that none of us could have foreseen, or even imagined. While this period has been daunting, stressful, and traumatic, we can still find ways to cope, grow, and build strength throughout all this adversity.
One of these ways is to develop our resilience. Resilience is the ability to accept and adapt to traumatic and stressful events. When building our resilience, we don’t deny any difficult feelings or emotions that come up for us, but find ways to deal with these emotions in a helpful way.
Below are some concrete ways you can change your behaviors to build resilience. Remember building certain qualities within ourselves is much like building our muscles. It takes practice and work. Things that may seem difficult at first, become easier the more we work at it, and you will soon see your resilience growing stronger and reap the benefits of becoming more resilient.
Focus on Physical Wellness
- Eat healthy – a portion of our emotional well-being is maintaining our physical well-being. Therefore, it is important to eat nutritious meals during times of trauma. It is also important to not drink too much alcohol. While you may temporarily feel better when drinking alcohol, it has effects on our physical system that leaves us feeling worse when the effects wear off.
- Exercise – Moving our body physically helps to relieve stress. Also, exercise release certain chemicals in our brains that help us feel good too.
- Drinking Water – hydrating throughout the day helps us feel better physically too and helps us to avoid dehydration which leads to feelings of tiredness among other things.
- Get plenty of sleep – Sleeping helps our body repair, improves our immune function, focus and concentration, and feelings of well-being.
Maintain a Schedule and Routine
- Set schedules – Often when we don’t have appointments, play dates, and other activities to attend to, we become lax with our schedules. However, even if you don’t need to be anywhere it’s best for your emotional and physical well-being to try to stick to a schedule and eat meals, go to bed, and wake up around the same time every day.
- Find a routine that works for you – It is sometimes helpful to have a set thing that you do at the same time each day. For example, taking a walk every morning, having family game time, or watching a favorite tv show with a friend on the telephone. The important thing is to find a routine that has meaning for you.
Have Compassion for Yourself and Others
During times of stress it is natural to sometimes feel more irritable, impatient, and critical. We tend to take these feelings out on ourselves and others. It is important to not expect too much of yourself, not be critical of yourself, and not compare yourself to others. Keep reminding yourself that you are doing the best you can, and forgive yourself for any mistakes or transgressions. It is also important to remember that if others are short or impatient with you, they are reacting to their difficult feelings and be compassionate and forgive them too rather than taking it personally and ruminating on how they may have offended you.
Focus on the Present Moment
- When going through a difficult time, we often project into the future and imagine more negative feelings and experiences. Just like we couldn’t have predicted this current pandemic, you have no way of knowing what the future will bring. The only thing we have and know for sure is the present moment. We can focus on the present moment by:
- Being Mindful – this means fully focusing on whatever we are doing in the present moment, no matter what the task. For example, if we are washing the dishes, focus on the feel of the water on your hands, watch the stream of water and the pattern it makes on the dishes you are washing.
- Meditating – When we meditate we focus our awareness on our breath, an object, or particular saying or mantra. This helps us to train ourselves to bring our awareness to the present moment and away from the chatter of thoughts in our mind.
- Focusing on our Breathing – Believe it or not, many times we are holding our breath or not breathing fully throughout the day. This leaves our body tense and constricted. When we focus on our breath we can release tension and also remain more present and grounded instead of letting our thoughts carry us away.
Maintain Social and Spiritual Connections
- Check in Frequently with Family and Friends – It is very difficult being apart from our loved ones and this often leads to feelings of isolation. We can still maintain meaningful and loving relationships through video chats, texts and phone calls.
- Join Virtual Classes and Groups – There are many groups, programs, and institutions that are offering classes on a variety of topics such as writing, drawing, cooking, philosophy, and exercise. These virtual groups are an excellent way of staying connected with people you do know, and also making new friends or starting a new hobby.
- Maintain a Connection with Lost Loved Ones – Many of us are dealing with the unexpected and sudden loss of loved ones. While grief is a life-long journey and process, it is helpful to remind ourselves that we can still maintain a connection with our loved ones even though they are not physically present. We can do this for example by writing letters to them, talking to their pictures, or developing certain rituals to honor them.
- Faith-based Spiritual Services – Many religious institutions are also offering virtual services that you can partake in.
Be Grateful and Positive
- Keep a Gratitude Journal – During the hardest of times we sometimes lose sight of the fact that there are also things to be grateful for. Each day write down at least one thing you are grateful for. Every so often read what you wrote to serve as a reminder of all there is to be grateful for.
- Maintain Positive Thinking – When we start thinking negatively about the future, we can remind ourselves that the future is an unknown. Since we don’t know anything yet about the future, we can have every reason to come up with positive ways of thinking about the future as negative ways.
We hope that you find this a useful guide to building resilience. Remember too, just like working out at the gym, everyone is starting from a different place, so be gentle with yourself as you build your resilience practice. Do what you can to start with, and then build a little more to your practice as you become comfortable with what you have been doing so far. And always know that Emma’s Place is here for you. (Stacey Cohen)
“Let everything happen to you. Beauty and terror. Just keep going. No feeling is final.” – Rainer Maria Rilke