Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What are the signs, symptoms, and stages of grief?
Perhaps the most well-known model for understanding grief was developed by
Elisabeth Kübler-Ross, MD, in her 1969 book titled On Death and Dying. The five
stages of the grief cycle that she outlined are
She described the stage of denial as the bereaved having difficulty
believing what has happened, the anger phase as the survivor questioning the
fairness of the loss, the bargaining stage as wishing to make a deal with fate
to gain more time with the one who was lost, the depression stage as the period
when the bereaved person gets in touch with how very sad they are about losing
their loved one, and acceptance as feeling some resolution to their grief and
more ability to go on with their own life.
Kübler-Ross apparently felt these phases can be applied to any significant personal loss (for example, of a job, relationship, one's own health, anticipating one's own death), as well as the death of a loved one. It also seems that she believed these stages don't all have to occur, can take place in different order, and can reoccur many times as part of an individual's specific grief process. Other grief experts describe seven stages of grieving, specifically
shock or disbelief,
denial,
bargaining,
guilt,
anger,
depression,
acceptance/hope.
The shock or disbelief stage is understood as the numbness
often associated with initially receiving the news of the death of a loved one.
The guilt stage of grief refers to feelings of regret about difficult aspects of
the relationship with the deceased.
In addition to the emotional pain already discussed, symptoms of grief can be
physical, social, cultural, or religious in nature. Physical symptoms can range from mild
sleep or appetite problems to heart attack. Social symptoms of bereavement include isolation from
other loved ones and difficulty functioning at home, school, and/or at work.
For children and adolescents, reactions to the death of a parent or other
loved one tend to be consistent with their reaction to any severe stress. Such
reactions usually reflect the particular developmental stage of the child or
adolescent. For example, since infants up to about 2 years of age cannot
yet talk, their reaction to the loss of a loved one tends to involve crying and
being more irritable. They further show physical symptoms of sleep or appetite
problems, changes in activity level, and being more watchful of (vigilant
toward) their surroundings.
Since preschoolers from 3 to 5
years of age begin to be able to remember the one who died but have not yet
developed the ability to understand the permanence of death, they may believe
they somehow magically caused the death and can make the person come back. In
addition to showing signs of grief that are similar to infants, they may have
more difficulty separating from caregivers.
Early school-aged children, from 6
to 8 years of age, more likely understand that death is permanent compared to
younger children, often feel guilt about the death of the loved one, become
preoccupied with memories about the departed, and try to master the loss they
have suffered by talking about it frequently. While symptoms of grief in
school-aged children from 9 to 11 years of age are quite similar to those of early
school-aged children, this older group is more vulnerable to a decrease in self-esteem because they feel different from their peers if they have experienced the
loss of a loved one. They are also more prone to defend against their feelings
of loss by becoming engrossed in school, social, and/or extracurricular
activities.
In keeping with their budding need for independence, young
adolescents 12 to 14 years of age may experience mixed feelings about the
deceased individual and exhibit a wide range of emotions. They may avoid talking
about the loss. Older teens usually experience grief similarly to adults,
enduring sadness, anxiety, and anger. They tend to deny their
feelings of loss to parents but discuss them in detail with peers. For children,
adolescents, and adults, as with any major stress, grief may cause a person to
regress emotionally, in that they go back to former, often less mature ways of
thinking, behaving, and coping.
Symptoms of complicated grief include intense emotion and longings for the
deceased, severely intrusive thoughts about the lost loved one, extreme feelings
of isolation and emptiness, avoiding doing things that bring back memories of
the departed, new or worsened sleeping problems, and having no interest in
activities that the sufferer used to enjoy. Teens tend to react to the loss of a
loved one that died through suicide similarly to the ways in which adults
experience complicated grief.
Regardless of age, individuals who lose a loved one from suicide are more at
risk for becoming preoccupied with the reason for the suicide while wanting to
deny or hide the cause of death, wondering if they could have prevented it,
feeling blamed for the problems that preceded the suicide, feeling rejected by
their loved one, and stigmatized by others.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Smoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Advance directives are designed to outline a person's wishes and preferences in regard to medical treatments and interventions. Advance directives generally fall into three categories: living will, power of attorney, and health-care proxy.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
Teenagers recognize that they are developmentally between child and adult. Teen health prevention includes maintaining a healthy diet, exercising regularly, preventing injuries and screening annually for potential health conditions that could adversely affect teenage health.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Hospice is a service that offers support, resources, and assistance to terminally ill patients and their families. In such late stages of diseases, especially when there is "nothing left to do," hospice can offer help for patients and families. There are many aspects of a patient's well-being that can be addressed. Hospice can play a key role in managing physical symptoms of a disease (palliative care) and supporting patients and families emotionally and spiritually.
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