Ep #197: Prolonged Grief Disorder

Welcome to The Widowed Mom Podcast, episode 197, Prolonged Grief Disorder.

Welcome to The Widowed Mom Podcast, the only podcast that offers a proven process to help you work through your grief, to grow, evolve, and create a future you can truly look forward to. Here’s your host, Master Certified life coach, grief expert, widow, and mom, Krista St-Germain.

Hey there, welcome to another episode of the podcast. Have you registered for the Dating for Widows Masterclass yet? If not, you should go do that. You should just pause this episode and you should go register, coachingwithkrista.com/datingmasterclass. It’s going to be free. You can upgrade if you want to do the VIP package but the basic package is totally free. It includes three days of teaching. It will be live but then recorded so don’t worry if you can’t make it live. I just want to make dating easier for you.

There’s so much drama in our brains around dating. And it just doesn’t have to be that way. It’s not that bad. So this masterclass is designed to help. So for three days I’m going to teach you three concepts that will make dating so much easier for you, things that I personally have used for myself, that I have helped my clients with and it’s going to be good. And then also I just recorded actually six different tapping exercises for dating related drama and sent them to the folks who edit my podcast and they’re going to put them to music and they’re going to be lovely.

So if you upgrade to the VIP package, that’s one of the things that’s waiting for you is some tapping exercises that I have designed specifically to help reduce the intensity of emotion and make you feel better whether you’re already dating, someday you want to date, doesn’t really matter. But go register for that, coachingwithkrista.com/datingmasterclass.

And then not a whole heck of a lot to report in terms of what’s going on in my life. I am very excited though because I booked a trip to see my daughter in Spain. If you’ve been listening to the podcast you know she’s doing a study abroad semester over there. And originally I was planning to go out in May because I have a lot of coaching friends as one does. And some of them travel together regularly and they invited me to go stay in Greece with them. They rented a Vrbo and they invited me to go stay there, most of them are based in Europe in different countries.

And so they rented this beautiful Vrbo and they’re going to have some fun and also do some work on their coaching businesses. And so I was going to try to wrap a trip in around that just because it obviously makes more sense to go to Europe once. It’s a long trip and it’s expensive. But that didn’t quite work out because the weekend before looks like she’s going to have a trip. And then the weekend after is her finals week. But I found a couple of weeks in April that work really, really well for my schedule and I booked the trip and bonus.

As soon as I booked it, she told me that she gets that week off, one of those weeks totally off for holy week which I never expected so I’m really excited. So I’m going to go there, get a hotel, hang with her, see the sites, do some coaching work from there in a very weird time zone adjustment and it’ll be amazing. So I have that to look forward to, really excited. And I’ve never been to Spain. I’ve only been to Europe once and that was 2014/15, something like that. So it’s been a minute, so I’m excited to go see Spain and to go see her.

And you know what I love? I love that I have a business that allows me to do that. I love that I have a business that allows me to have such a flexible schedule that I can make time with my kids and do that first. I want that for all of you too. Not that you have to become a coach but I want you to have a business that supports the lifestyle that you want, and I so love that about this business. Not only does it make my heart happy but it gives me the lifestyle that I want, which is such a gift.

Okay, let’s talk about prolonged grief disorder. I’ve been thinking about doing this podcast episode for a while and frankly, it’s just not a very exciting topic. So I keep kicking it down the road but it’s time. It’s time to talk about it. If you’ve never heard of prolonged grief disorder you’re not alone, many people haven’t. And there’s a lot of controversy surrounding the term and the diagnosis.

So I just want to give you the basic information and my hope is that if this term is new to you and even if it isn’t frankly, that you will come away from this podcast using the idea of prolonged grief disorder in the most constructive and loving way possible. And I’ll tell you a little bit more about what I mean as we go but let’s talk about what it is, how it came to be, the basics.

So prolonged grief disorder is the new name for what used to be called complicated grief in the last version of the DSM. The DSM if that is not a term you have ever heard, is the Diagnostic and Statistical Manual of Medical Disorders. It’s kind of a mouthful, isn’t it? Basically it’s the diagnostic book, the big book that clinicians and psychiatrists use to diagnose mental disorders. Now, I am not someone who uses this book. I am not in the business of diagnosing anything but I do get it in that field, having a diagnosis especially for insurance coding purposes is important.

So I understand why this book exists, it’s not something I use in the line of coaching work that I do. So I don’t want to act like I’m an expert on the DSM when I am not at all. But the DSM is the big book revised, with lots of opinions. To get something in a DSM revision is a big deal, meaning that it requires a lot of people, committees, public commentary in the field. It’s kind of a big deal. So the latest version of the DSM, the DSM 5 has been in work since 2012. It had been, I think, the version before it was published in 1994 and then they started talking about a revision.

And it’s obviously not just this one term that got revised. They revised a ton of diagnoses. But in that process I just want you to know that there was a lot of disagreement. People in the grief world view prolonged grief disorder, that term, they view the concept differently, not everybody can agree. So I think it’s important as a consumer of information, as advocates for our own mental wellbeing, that we understand that even when something appears in a book and it has an official title and psychiatrists use it, that doesn’t mean that everybody agrees. I think that’s important information to have.

So what is it? It used to be called in the last revision, complicated grief disorder. Now, I kind of like that term a little bit better. If you listened to the podcast interview I did with Mary Frances O’Connor, author of The Grieving Brain, and you might go back and listen to it if you haven’t. But I really like the lens that she sees this through. Now, I will remind you, the definition of grief that I use is that grief is the natural human response to a perceived loss. Grief is not a disorder. Grief is a natural human response to a perceived loss. We were built to grieve. We are supposed to grieve.

Grief is a normal part of being human. So that’s important. And sometimes though what happens as with anything is that it doesn’t always go in the best possible way. Sometimes things interfere with healing. And the example that Mary Frances O’Connor uses, which I really like is the example of a broken bone.

So if you break a bone, your body knows what to do with the broken bone. Your body knows to heal a broken bone but sometimes even if you get that bone set and you get it casted, sometimes something goes awry, there is an infection or something happens. And some assistance can help get that healing back on track. And I love this idea that it can just get complicated. And essentially that’s what complicated grief is. For most of us and I am really generalizing here, we have an early acute experience of grief where it feels like our world fell apart and everything feels chaotic in our minds.

Some of us have very intense grief fog and we can’t think or we’re numb, or we have really abrupt mood swings. We go through that period of knowing intellectually that it happened but not really understanding that it did and still expecting them to come home. There are different ways to describe grief but in early acute grief it can be really hard to function. It feels like your whole world just exploded sometimes.

For most people, 90 ish percent, they adjust, they adapt to grief, they integrate it into their lives. They don’t stop grieving in that the grief will always be a part of life because the loss always happened and they’re always going to have thoughts and feelings about that loss. And sometimes especially around death anniversaries or particularly meaningful days or holidays, they’re going to feel more emotion around that loss than at other times. But for the most part, they get back to living. And grief is no longer interfering on a daily basis because it gets integrated into life.

Well, the idea of complicated grief, now called prolonged grief disorder, is that for some people a year or more has passed for adults, six months for children and they aren’t able to live life without significant disruption. Here’s some symptoms of prolonged grief disorder according to the APA’s website. Identity disruption such as a feeling as though part of oneself has died. And remember this is at least six months for children and at least 12 months for adults, beyond death.

Marked sense of disbelief about the death. avoidance of reminders that the person is dead. Intense emotional pain such as anger, bitterness, sorrow related to the death. Difficulty with reintegration such as problems engaging with friends, pursuing interests, planning for the future. Emotional numbness, absence or marked reduction of emotional experience. Feeling that life is meaningless or intense loneliness, feeling alone or detached from others. In addition, the person’s bereavement might last longer than might be expected based on social, cultural or religious norms.

So that’s saying not in early acute grief, but a year now for an adult has passed, and some of those grief symptoms, and again I’m not in the business of diagnosing. So I’m not going to get into any more detail than that. But according to the APA’s website it’s at least three or more of those symptoms every day for at least the last month prior to the diagnosis.

Now, how do we use that information? Here is my hope. My hope is that if you relate to that you will hear that and you will go, “Oh, okay.” And you will be compassionate with yourself and you will seek support and you will not shame yourself or blame yourself. And you might feel a sense of relief knowing that there is a name for what you’re experiencing. Now, how I hope you won’t use this information is that, and you probably won’t because you’re listening to this podcast.

And if you’re listening to this podcast you probably have had a grief experience and it might be other people that tend to use this against you. We don’t want to take this and make it mean that grief in and of itself is a disorder. We want to take this information and say, “Okay, grief is very human and natural and normal and these are the kinds of things that happen in grief and it’s different for every person and there’s no end point and there’s no goal. And I’m not broken because I am thinking and feeling this way.

And I also don’t have to live a life where grief significantly impacts my quality of living. And if a year or more has gone by and that’s still happening to me then support is available.” That’s what I really want you to hear. But you can imagine that those of us who have been saying, “Grief is not a disorder, grief is natural, grief is normal, stop making it wrong. Stop telling us to get over it. Stop telling us to move on. That’s not how grief works. There is no endpoint.” If you’ve listened to the podcast, that’s the kind of thing you hear me say all the time.

You can imagine we’re a little conflicted around this idea of prolonged grief disorder because we can see how people misuse pathologizing but with anything it’s not black or white in my opinion. It’s nuanced. There’s some value in this diagnosis. There’s a way to use it for good. And there’s also a way that we can use it against people who are grieving or we can use it against ourselves. And so let’s live in the gray. Let’s live in the gray area.

Now, I have read different numbers but it seems to be that on average people can agree that it’s somewhere between 7-10% of adults will experience symptoms of prolonged grief disorder, somewhere around there. But I have read four. I have read five. I have read 10. I have read 12. I have read lots of different numbers. So I don’t think the numbers matter. Most people do not struggle with prolonged grief disorder, the majority of people don’t but some people do, a much smaller number.

I do think it’s also worth noting that a lot of people in the mental health field were trained to mistakenly believe that prolonged grief disorder was more prevalent in people who had complicated relationships. Meaning when it was complicated and they were alive there’s a higher likelihood of it being complicated when they died and that is not true. In fact the opposite is true. And most people who experience prolonged grief disorder actually had a very rewarding, very strong, very close connection to the person that died which makes a whole lot of sense when you think about it.

If you want to learn more my suggestion is you go to prolongedgrief.columbia.edu. And we’ll link in the show notes. And that is the Prolonged Grief Center. It used to be called the Complicated Grief Center or Center for Complicated Grief, which Dr. Kathy Shear is behind and her work is fantastic. I love her website for you because there is a section on it for both professionals and for the public. So if you want to learn more I highly recommend that you go to that website and you click on the for the public section.

Now, listen, you will find many times on this website the term ‘complicated grief’. Now, who knows when you’re listening to this but as this is being recorded right now if you go to the website you will see complicated grief everywhere. Give them a break. The work they’re doing is important and changing their website and updating it and making it current so that it says prolonged grief disorder is probably not super high on their list.

So don’t get confused when you see complicated grief, it’ll still say who has CG, it’s okay. They’re talking about prolonged grief disorder. They just probably haven’t updated their terminology yet. But what I love about this website is a couple of things. One is that when you click on the for the public section you will see a quiz that you can take, a self-assessment tool, brief grief questionnaire, very easy. You can take it and in literally just a couple of minutes you will know if you might be experiencing prolonged grief.

Another reason I love this is because not all mental health professionals have the same education as it relates to grief. And Dr. Shear has developed a very specific protocol for prolonged grief disorder treatment. And she has trained mental health professionals in her work at various levels.

But if you go to this website and you click on Find a Therapist and you’re looking for a therapist who understands prolonged grief disorder you can sort, you can search by location. You can tell the level of education that they have received as it relates to work they have done with the center. And that’s so empowering for you. The last thing you want is to show up in someone’s office, if you want a good licensed mental health professional who doesn’t understand grief, who doesn’t even know the term ‘prolonged grief disorder’.

So I like this for you as someone who can use this tool, find what they need. And there’s just a lot more information in there too that can help you gently, help you help others in your life understand a little more about what you might be going through if this describes your experience, so that they can better support you And I love that website for that reason.

So that’s what I wanted you to hear. We’re going to use this term for good and not evil. Grief is not a disorder. Grief is just the natural human response to loss but at a certain point if it is persistently interfering with the quality of your life we don’t have to settle for that. We don’t have to make ourselves feel bad about it. We just have to know that that is not what’s possible in grief.

And I’m talking about, when you hear me talk about posttraumatic growth, if you’re experiencing prolonged grief disorder you’re nowhere near posttraumatic growth. You’re not even back to the level of wellness that you were experiencing before the loss. So not only is posttraumatic growth possible but we don’t have to have a lower quality of life even after losing our person. And if a year or more has gone by and we are, intervention is possible. I hope that clarified some things for you.

And we’ll link to the show notes so that you can go to Columbia University’s Center for Prolonged Grief’s website and take advantage of all the resources that are there for you. I love you. You’ve got this. Take care and I’ll see you next week, bye bye.

If you like what you’ve been hearing on this podcast and want to create a future you can truly get excited about after the loss of your spouse, I invite you to join my Mom Goes On coaching program. It’s small group coaching just for widowed moms like you where I’ll help you figure out what’s holding you back and give you the tools and support you need so you can move forward with confidence.

Please don’t settle for a new normal that’s less than you deserve. Go to coachingwithkrista.com and click work with me for details and the next steps. I can’t wait to meet you.