Clinical features of bereavement and normal grief

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Although the terms bereavement, grief, and mourning are often used interchangeably, the Committee on Health Consequences of the Stress of Bereavement suggests the following definitions.

• Bereavement is the loss of a loved person through death (coded in ICD-10 as Z63.4 and in DSM-IV as V62.82).

• Mourning is the voluntary social expression of that loss.

• Grief is the involuntary emotional and related behavioural reaction to that loss.

Women are not only more at risk of bereavement than men, but they also appear to suffer from its psychiatric complications more often. Men show less acceptance of their loss and turn to other romantic relationships sooner.

Grief is an individual process in which many symptoms occur.(22) No symptom is pathognomonic of normal or abnormal grief. The reactions to bereavement were described in detail by Lindemann(23> who suggested that the characteristics of normal grief were as follows:

• somatic symptoms

• preoccupation with the image of the deceased

• guilt and self-blame

• hostility (irritability and anger)

• functional disorganization.

Other components of the normal grief reaction have since been recognized. Bowlby(24) and others have placed these symptoms into three (or four) distinct phases (Table 1). Recent authors emphasize that this approach should not be taken to imply that a bereaved person must go through fixed steps in the grieving process.

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Table 1 Proposed phases of normal grief

Less acknowledged are the positive aspects of the bereavement experience, which include a sense of making the most of the time remaining, increased independence, and improved flexibility.

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