ABSTRACT
Grief is a natural response to loss, typically resolving over time. However, in some individuals, grief becomes persistent and debilitating, leading to a diagnosis of Prolonged Grief Disorder (PGD).
Prolonged Grief Disorder (PGD) is a recently recognized mental health condition characterized by persistent and intense grief that disrupts daily functioning. This review explores PGD, its etiology, diagnostic criteria, pathophysiology, treatment options, and the potential role of homeopathy in alleviating its symptoms based on existing literature and clinical evidence.
INTRODUCTION
PGD is a mental condition characterized by a particular set of symptoms following the loss of a family member or close friend (bereavement). People with PGD struggle with grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms such as depression, emotional pain, emotional numbness, loneliness, identity disruption, and difficulty managing interpersonal relationships. Accepting the loss is also difficult, which can manifest as rumination about the death, a strong wish to reunite with the deceased, or skepticism that the death occurred. PGD is estimated to affect approximately 10% of bereaved survivors, while rates vary significantly according on the populations sampled and classifications employed.
Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)[1] and the International Classification of Diseases, 11th Revision (ICD-11) under code 6B42 as a distinct mental health condition. [2]
ETIOLOGY
The development of PGD is multifactorial, influenced by biological, psychological, and social factors:
- Genetic and Biological Factors : Some individuals may have a genetic predisposition to emotional dysregulation, increasing their susceptibility to prolonged grief.
- Neurobiological Dysregulation: Altered brain activity in regions such as the amygdala, prefrontal cortex, and nucleus accumbens contributes to emotional processing difficulties.
- Personality Traits: Individuals with high levels of neuroticism, attachment insecurity, or perfectionism may be more prone to PGD.
- Pre-existing Mental Health Conditions: A history of anxiety, depression, or trauma can increase vulnerability to PGD.
- Nature of the Loss: Sudden, unexpected, or traumatic losses, as well as the death of a child or spouse, significantly raise the risk of PGD.
- Social Factors : Limited emotional or social support can hinder the natural grieving process, leading to prolonged distress.
- Cultural and Religious Factors: Beliefs surrounding death and mourning can influence the expression and duration of grief.
DIAGNOSTIC CRITERIA FOR PGD
According to the DSM-5-TR, PGD is diagnosed when an individual experiences:
– Intense and persistent yearning or preoccupation with the deceased.
– At least three of the following symptoms for 12 months or more:
- Identity disruption due to the loss.
- Marked difficulty in accepting the death.
- Avoidance of reminders of the deceased.
- Intense emotional pain related to the loss.
- Difficulty reintegrating into life after the loss.
- Emotional numbness.
- Feeling that life is meaningless.
- Intense loneliness.[4]
In the ICD-11, PGD is diagnosed if the symptoms persist for at least six months and cause significant distress, with a preoccupation with the deceased interfering with daily functioning.[5]
PATHOPHYSIOLOGY OF PGD
involves complex neurobiological and psychological mechanisms, including:
- Dysregulated Stress Response:* Prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis leads to increased cortisol levels, impacting emotional regulation and increasing susceptibility to depression and anxiety.
- Altered Brain Networks: Neuroimaging studies suggest that individuals with PGD show hyperactivity in the nucleus accumbens (associated with reward processing) and hypoactivity in the prefrontal cortex (responsible for emotional regulation and cognitive control).
- Neurotransmitter Imbalance: PGD has been linked to imbalances in serotonin and dopamine pathways, contributing to persistent rumination and an inability to move forward after loss.
- Inflammatory Processes: Chronic stress and grief have been associated with increased inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), which may play a role in mood disturbances and cognitive dysfunction.[6]
TREATMENT FOR PGD
Treatment for PGD includes both conventional and complementary approaches:
Psychotherapy:
- Complicated Grief Therapy (CGT):* A structured therapy designed specifically for PGD, helping individuals process grief and rebuild their lives.
- Cognitive Behavioral Therapy (CBT):* Aids in identifying and modifying maladaptive thoughts related to grief.
- Interpersonal Therapy (IPT):* Focuses on addressing interpersonal difficulties resulting from grief.
Pharmacotherapy:
– Selective Serotonin Reuptake Inhibitors (SSRIs), such as sertraline and paroxetine, may help alleviate symptoms of grief-related depression.
– Benzodiazepines may be prescribed temporarily for severe anxiety and sleep disturbances but are not recommended for long-term use.
Complementary and Alternative Therapies:
– Mindfulness-Based Interventions: Yoga, meditation, and mindfulness techniques can help reduce stress and emotional distress.
HOMOEOPATHY AND PROLONGED GRIEF DISORDERS
Homeopathy and Its Application in Mental Health
A state of whole physical, mental, and social well-being is called health; it goes beyond simply being free from illness or disability . By this definition, homoeopathy is the only medical system that takes an integrated approach to comprehending the role of the mind in health and disease. Its founder, Samuel Hahnemann, was arguably the first to not only emphasize the role of the mind in the disease process but also to assert that disease originates in the mind.
Homeopathy, a Rationale system of medicine developed by Samuel Hahnemann, is based on the principles of “like cures like” and potentization. It has been traditionally used for emotional and psychological disturbances, including grief, anxiety, and depression. Homeopathic remedies are believed to work by stimulating the body’s self-healing mechanisms and restoring emotional balance.
Some Homeopathic Remedies for Grief and PGD
Ignatia amara – Frequently used for acute grief, sudden emotional shock, and inconsolable weeping. An ignatia state can be felt by anyone who suffers from loss of loved one or on separation from a loved one.
The ignatia person after a loss will go into spasms, will become hysteric, unable to thunk or talk. Can’t cry at moment of shock, in front of others, they will go inside shut the door, and cry afterward. Passes out while sobbing or wailing. Continue brooding over the grief. She or he has a weeping spell a headache, trembles, sleepless anxious. [7]
Natrum muriaticum – Indicated for long-standing grief, suppressed emotions, and withdrawal from social interactions.
Natrum mur. People do not cry easily, for example, when suffering a grief. They may be quite serious in their demeanour. However, when nervous or under stress, they tend to laugh over serious matters, then to giggle hysterically; as the giggling becomes uncontrollable, it dissolves into hysterical weeping.
A daughter may have a deep feeling for her father without anyone else realizing it. Then the father dies. The daughter grieves silently, locking herself in her room and crying in her pillow. To the surprise of everyone around who did not realise the deapth of her affection, she becomes very introverted, desiring only to be alone with books and her music. This continues till she finally breaks down. Then there is uncontrolled, hysterical sobbing with massive shaking of the body, spasms, twitching. Such an outburst usually lasts just a short time, and she quickly regains control and composure.
Phosphoric acid– As the patient is affected deeper by the grief, the emotional level becomes completely “frozen down”; there is no emotional movement whatsoever. Such a profound stillness occurs on the emotional plane that the patient is incapable of response: it is as if stimuli are not received by the organism at all. The phosphoric acid patient himself knows he is devoid of emotional responsiveness, even if this is not yet apparent to others around him. Just as there is stillness and coldness physically, there is no movement at all emotionally.[8]
Aurum metallicum – Suitable for grief accompanied by depression, self-reproach, and suicidal thoughts.
Causticum – Recommended for individuals experiencing deep sorrow with a sense of injustice and hopelessness.
CONCLUSION
Prolonged Grief Disorder is a severe mental health condition with significant emotional and functional consequences. Every person is different from other and have different reaction to a stimuli, so individualistic approach should be applied in each case, which can only be possible in homoeopathy. Hence in such cases homoeopathy should be taken in account to improve mankind.
Bibliography
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Rev.). APA.
- Eisma MC, Rosener R, Comtese H. ICD- 11 Prolonged Grief Disorder Criteria: Turning challenges into opportunities with multiverse analyses, 2020 Aug 7;11;752
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Rev.). APA.
- World Health Organization. (2019). International Classification of Diseases, 11th Revision (ICD-11).
- Karkala SE, Roger’s KE, The neurobiological reward system in Prolonged Grief Disorder. A systemic Review, 2020 sep 30:
- Vithoulkas , George, Essence Of Materia Medica, 2nd revises edition, 2020.
- Vithoulkas , George, Essence Of Materia Medica, 2nd revises edition, 2020.
Author:
Dr. Farheen Khan – BHMS, MD(HOM) GHMC BHOPAL
Co Author
Dr. Shobhana Shukla – HOD and Professor of department of homoeopathic materia medica ghmc bhopal
