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An understanding of dysfunctional grieving begins with a clear definition of the normal or uncomplicated grieving process. Lindemann (1944) described the normal grieving process as a syndrome with a predictable course that includes distinctive reactions such as somatic distress, preoccupation with the image of behavior, and the actual taking on of the traits of the deceased individual. Such uncomplicated grief may last up to 1 year and is minimally disruptive to the individual's daily functioning (Lazare, 1989).
The experience of loss is framed by the individual's perception of that loss (Yeager, 1984). The grieving process varies from person to person in accordance with the individual's emotional, psychological, and cultural context for viewing object loss. This article is intended to provide the nurse practicing in a general setting with an understanding of the grieving process and the management of the patient experiencing dysfunctional grieving.
Dysfunctional grieving - the deviation of the grieving process from the norm - may occur in any setting. Although a review of the recent nursing and allied health literature reveals extensive information about the normal grieving process, little is written regarding diagnosis and treatment of dysfunctional grieving in the general, nonpsychiatric setting. Nurses in any specialty area need an increased knowledge about the difficulties arising for individuals who are experiencing complications in the grieving process.
In dysfunctional grieving, the patient becomes overwhelmed and resorts to maladaptive coping, which interferes with the individual's ability to function in the cognitive, behavioral, or developmental spheres. Movement toward assimilation of or accommodation to the loss is impeded, resulting in a progression toward social, emotional, and psychological dysfunction with the possibility of eventual physical complications. These individuals have also been observed to develop such disorders as anxiety and depressive disorders, substance abuse, and the physical sequelae associated with increased stress.
Literature Review
Dysfunctional grieving has been variously described as grief that is atypical, pathological, complicated, absent or totally lacking, abnormal, neurotic, and unresolved, as well as labeled depression of widowhood or grief-related facsimile illness. A number of authors have attempted to provide clinical approaches to identifying the characteristics and symptoms of and risk factors for this elusive disorder (Lazare, 1979; 1989; Lindemann, 1944; Kübler-Ross, 1970; Worder, 1982; Yeager, 1984; Zisook, 1987). This review begins with an identification...