Symptoms:
- identity disruption
- marked sense of disbelief about death
- avoidance of reminders that the person is dead
- intense emotional pain
- difficulty with reintegration 
- emotional numbness
- feeling that life is meaningless 
- intense loneliness
- grief period lasts longer than expected

Symptoms of Prolonged Grief Disorder

Studies suggest that grief symptoms can improve after a psychedelic experience. This can be evaluated in terms of the modulation produced by psychedelics that have the capacity to trigger emotional breakthroughs that can better symptoms in certain disorders. 

Improvement of grief disorder symptoms by use of psychedelics

Untreated prolonged grief disorder can lead to a number of issues including substance abuse, suicidal thoughts, trouble sleeping, and compromised immune function. This compromised immune function can result in cancer and other severe health issues. Additionally, about 5-10% of adolescents will experience post-traumatic stress disorder and depression along with prolonged grief disorder following the loss. Prolonged grief disorder can play a significant role in triggering other psychiatric disorders. A sample was taken in which it was found that major depressive disorder had a prevalence of 55%, 48% with PTSD,  and 62% with anxiety disorders (Szuhany). In summary, prolonged grief disorder can create a higher risk of mortality as a result of many of the aforementioned effects.

Physical and Emotional Effects of Prolonged Grief Disorder

- older adults
- female gender
- those with a history of depression
- those with a history of bipolar disorder 
- caregivers
- those who experience the loss of a loved one very suddenly or traumatically
- those who feel the loss is unjust
- lower socioeconomic status
- those with childhood hardships

Risk Factors for Developing Prolonged Grief Disorder

Collection of references for prolonged grief disorder

References for Prolonged Grief Disorder

When the DSM-5 was published in 2013, it did not include Prolonged Grief Disorder as a diagnosable mental disorder. Instead, it was referred to as Persistent Complex Bereavement Disorder in the appendix and noted that it was in need of further study. After much debate, it was finally added to the DSM-5 TR in 2022. Despite its inclusion in the DSM, there is still much debate about whether or not it should be included. 

Prolonged Grief Disorder (PGD) and The DSM-5

The rate at which individual's present symptoms of  PGD and the intensity of their symptoms appear to be related to:
- Relationship with the deceased 
 - Cause of death 

Rates of Prolonged Grief Disorder (PGD)

Using functional magnetic resonance imaging, (fMRI), research has shown neural differences between those with and without prolonged grief disorder. In those with prolonged grief disorder, there is a higher level of activation in the nucleus accumbens meaning a higher activation in the reward centers of the brain. This activation in the reward center is associated with the deceased which suggests a cause for impaired judgement following the loss. Additionally, prefrontal regions, whole brain volume and cognitive function can differ in those with prolonged grief disorder versus those without.

Neurobiology of Prolonged Grief Disorder

Prolonged grief disorder occurs when a person experiences grief that persists longer and is more intense than typical grief. The grief can become severe enough to interfere with the person's day-to-day life, often affecting work, home, friendships and other important areas of life. 

New York University

The DSM-5-TR separates Trauma-and Stressor-Related Disorders into the following specific disorders:
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Posttraumatic Stress Disorder (PTSD)
- Acute Stress Disorder
- Adjustment Disorders
- Prolonged Grief Disorder
- Other Specified Trauma- and Stressor-Related Disorder
- Unspecified Trauma- and Stressor-Related Disorder


[DSM-5-TR] List of Trauma- and Stressor-Related Disorders

Refers to the sorrow felt after a major loss, such as the death of a loved one. Severe grief can become life-threatening by weakening the immune system, leading to self-neglect, and causing suicidal thoughts.

Grief

Prolonged grief disorder. Psychiatry.org - Prolonged Grief Disorder. (2022, May). https://www.psychiatry.org/patients-families/prolonged-grief-disorder 

Prolonged Grief Disorder - American Psychiatric Association

When an individual has significant difficulty in forming healthy emotional relationships, often following abuse. Individual might struggle with affect regulation, engage in aggressive/disruptive behavior, be socially withdrawn, and have an aversion to touch/physical affection. 

Reactive Attachment Disorder (RAD)

This disorder is diagnosed among children older than nine months, who willingly approach and engage with adults they don’t know. This is due to inadequate care, limiting the child’s opportunity to form a stable bond with a main caregiver.

Disinhibited Social Engagement Disorder

Acute stress disorder is a kind of trauma and stress related disorder. It is a mental health disorder which occurs within the first month (3 days to 1 month following exposure) of experiencing trauma, or one or more traumatic events. However, once the symptoms occur longer than one month, acute stress disorder becomes post traumatic stress disorder.

Acute Stress Disorder

Prolonged Grief Disorder

Although not classified as a specific disorder, some researchers have begun to see that global warming is causing mental health problems for many people, especially those most affected by environmental destruction. This idea has been referred to as "climate grief." Climate grief most often manifests as some form of depression or anxiety.

Climate Grief

A model by Elizabeth Kübler-Ross proposing five stages an individual may face when confronting their own death: denial, anger, bargaining, depression, and acceptance. However, this model is not universal; not all individuals experience every stage, the order can vary, and some may not experience the negative emotions described in the model at all.

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