Health may succumb to grief reaction

A severe form of bereavement increases the likelihood of suffering from a host of physical and mental ailments up to 2 years after a partner's death, according to a new study. A surviving spouse's long-standing insecurities regarding intimate relationships presages such a grief response, the researchers propose.

 This virulent strain of bereavement, dubbed traumatic grief by psychologist Holly G. Prigerson of Yale University School of Medicine and her colleagues, may diminish in response to psychotherapy. Without treatment, the condition appears to promote sleep disturbances, wrenching anguish, and suicidal thoughts, as well as increased alcohol, tobacco, and food consumption, high blood pressure, heart trouble, and perhaps even cancer, Prigerson's group reports in the May American Journal of Psychiatry.

"We find that individuals exhibiting traumatic grief tend to have relied on their departed spouses as a Band-Aid for an underlying insecurity in close relationships that often got its start in childhood," Prigerson holds.

 It is not unusual for grief to trigger feelings of depression, personal worthlessness, and despair, for which clinicians typically offer treatment. Traumatic grief, says the Yale scientist, represents a distinct form of bereavement characterized by searching and yearning for the deceased, disbelief that a dead partner is really gone, avoidance of reminders of the spouse, bitterness and guilt over the death, and hallucinations of seeing or hearing the lost loved one.

 These symptoms may represent a form of post-traumatic stress disorder, Prigerson theorizes.

 She and her coworkers studied 150 widows and widowers, first contacted when their spouses were hospitalized for serious illnesses. Interviews were conducted 6 months later, by which time all of the volunteers had been bereaved, and again 1 year and 2 years after the initial hospitalization.

 The 92 women and 58 men who had lost their spouses averaged 62 years old. Most of them were white and had been married for at least 20 years.

 Over the 2-year period of the study, new instances of a variety of health problems occurred much more frequently in the 33 participants who had been diagnosed with traumatic grief at the 6-month interview. Four of the 33 were diagnosed with cancer during the study period, whereas none of the other volunteers was. Larger studies are needed to explore possible influences of traumatic grief on cancer, Prigerson says.

 In a subsequent study of 20 similarly bereaved adults suffering from traumatic grief, Prigerson has found substantially greater drops in immune cell function than those already reported for major depression.

 Prior studies have linked physical and mental ailments to bereavement, but none has examined differences between individuals who did or did not develop traumatic grief, she adds.

 In the upcoming July American Journal of Psychiatry, Prigerson's group describes the successful treatment of a woman suffering from traumatic grief. Psychotherapy sessions addressed serious disturbances in her sense of security and trust in her parents and others that extended back to her childhood.

"Traumatic grief is probably a valid condition that may lead to serious health problems," says psychiatrist Sidney Zisook of the University of California, San Diego School of Medicine. "But we need to know more about how it works."

 For instance, he notes, traumatic grief symptoms seen after a spouse's gradual death from disease may differ from those appearing after an accidental death or suicide.