انواع تجربه سوگ و داغداری

Abstract The bereavement literature has yet to show consensus on a clear definition of normal and abnormal or complicated grief reactions. According to DSM-IV, bereavement is a stressor event that warrants a clinical diagnosis only in extreme cases when other DSM categories of psychopathology (e.g., Major Depression) are evident. In contrast, bereavement theorists have proposed a number of different types of abnormal grief reactions, including those in which grief is masked or delayed. In this article, we review empirical evidence on the longitudinal course, phenomenological features, and possible diagnostic relevance of grief reactions. This evidence was generally consistent with the DSM-IV's view of bereavement and provided little support for more complicated taxonomies. Most bereaved individuals showed moderate disruptions in functioning during the first year after a loss, while more chronic symptoms were evidenced by a relatively small minority. Further, those individuals showing chronic grief reactions can be relatively easily accommodated by existing diagnostic categories. Finally, we found no evidence to support the proposed delayed grief category. We close by suggesting directions for subsequent research.

Introduction Grief is a painful, but unfortunately common experience. Most people at different points in their lives are confronted with the death of a close friend or relative. There are, however, marked individual differences in how intensely and how long people grieve. Some grieve openly and deeply for years, and only slowly return to a semblance of their normal level of functioning. Others suffer intensely, but for a relatively more proscribed period of time. Still others appear to get over their losses almost immediately, and to move on to new challenges and new relationships with such ease as to raise doubts among their friends and relatives as to whether they may be hiding something or running away from their pain. The extent that grief varies across individuals suggests important questions about what constitutes normal or common grief, and when, if at all, too much or too little grief might be considered abnormal, or even pathological. Unfortunately, the bereavement literature has yet to agree on a clear, empirically defensible definition of grief, or its normal and abnormal course and manifestations Bonanno, 1998 and Hansson et al., 1993. The present review was motivated by this deficiency. First, we review competing formulations of normal and complicated grieving found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association, 1994) and in the bereavement literature. According to the DSM-IV, bereavement is a stressor that produces relatively normal and expectable distress. DSM-IV does not offer a complicated grief diagnosis, and allows for bereavement-related diagnoses only in extreme cases when existing diagnostic categories (e.g., Major Depression) may be relevant. In contrast, bereavement theorists have argued for the clinical necessity of a complicated grief diagnosis, and have proposed a number of different types of complicated grief. In an effort to reconcile these competing positions, we review the available empirical evidence on grieving. Specifically, we examine three kinds of evidence: longitudinal studies of grief outcome, descriptive studies of the phenomenological features of grieving, and diagnostic studies that focus on the distinction between normal and pathological or complicated variants. Our analysis is generally supportive of the DSM-IV's conception of grief as a normal reaction to an enduring stressor, and reveals little in the way of empirical evidence to support the complex taxonomies of grief outcome developed in the bereavement literature. We summarize the available evidence into a working definition of grief course patterns, and close by suggesting several avenues for future bereavement research.

.