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~ Acute Grief Response ~

Grief can be defined as an adaptation response to loss through the death of or separation from an object of love, be it a person, a body part of a body function. When a person experiences a loss he/she is likely to also experience an acute grief response to that loss. These responses are normal responses that occur after experiencing a loss. The diagnosis of Acute Grief Response is likely to be made by a person's Primary Care Provider, frequently after extensive medical evaluations are conducted to rule out major physiological medical problems. Many of the symptoms experienced in acute grief are presenting symptoms of major medical emergencies. If there is any doubt as to whether the symptoms you or a loved one might be feeling in the aftermath of the tragedy are physical or psychological seek professional treatment.

Acute grief is a definite syndrome characterized by psychological and somatic symptoms:

1. Sensations of somatic distress that occur in waves lasting for 20 minutes to an hour characterized by:
    • Tightness in the throat
    • Choking
    • Shortness of breath
    • Sighing
    • An empty feeling in the stomach
    • Lack of muscular strength
    • Intense subjective distress described as tension or pain

    •  
    2. Intense preoccupation with the image of the deceased, as in waking dreams, accompanied by feelings of vagueness and unreality.
    3. Guilt feelings; the survivor reviews behavior before the death for evidence of negligence and failure.
    4. Emotional distancing in relationships with others, accompanied by erratic responses of irritability, hostility and anger.
    5. Disoriented behavior such as restlessness, insomnia, absentmindedness and an inability to concentrate or to initiate and maintain normal daily activities.
Potential Symptoms of the Acute Grief Response

Physical Symptoms:  Acute Grief Response

Fatigue
Trouble initiating or maintaining sleep
Chest heaviness or pain
Shortness of breath
Tightness in the throat
Palpitations
Nausea
Diarrhea
Constipation
Abdominal, stomach pain
Back pain
Headache
Lightheaded
Dizziness
Change in appetite increased or decreased
Weight change
Hair Loss
Crying, sighing
Restlessness

Emotional Symptoms:  Acute Grief Response

Sadness
Anger
Irritability
Relief
Anxiety
Panic
Meaninglessness
Apathy
Numbness
Abandonment
Helplessness
Emotionally labile
Vulnerability
Self Blame
Fear
Guilt
Longing
Loneliness
Apathy
Disbelief
Denial

Social Symptoms:  Acute Grief Response

Overly sensitive
Dependent
Withdrawn
Avoid others
Lack of initiative
Lack of interest
Hyperactive
Underactive
Relationship difficulties
Lowered self esteem

Behavioral Symptoms:  Acute Grief Response

Forgetfulness
Difficulty concentrating
Slowed thinking
Sense of Unreality
Wandering aimlessly
Feeling trance-like
Feelings of unreality
Feelings of emptiness
Dreams of the deceased
Searching for the deceased
Sense the loved one's presence
Hallucinations of the deceased, sensing their presence (visual or auditory)
Assuming mannerisms or traits of the loved one 
Needing to retell the story of the loved one's death
Preoccupied with one's own death
Avoiding talking about loss so others won't feel uncomfortable

Resources
Bertmen SL, Sumpter HK, Greene HL. Bereavement and Grief. Chapter 219 in Greene HL (ed.) Clinical Medicine 2nd ed. St. Louis, MO: Mosby Year Book, Inc. 1996, pp. 856-8.
Casarett D, Kutner JS, Abrahm J. Life after Death: A Practical Approach to Grief and Bereavement. Ann Intern Med 2001;134:208-215. Available at: http://www.annals.org/issues/v134n3/full/200102060-00012.html Leaving Site
Kutner JS. Grief and Bereavement: Physical, Psychological, and Behavioral Aspects. ACP Annual Meeting 2000. Available at: http://www.acponline.org/vas2000/sessions/grief.htm Leaving Site
Hughes M. Bereavement and Support. Taylor & Francis, 1995.
Saindon C. Grief: A Normal and Natural Response to Loss. Self Help Magazine. April 15, 1998. Available at: http://www.shpm.com/articles/trauma/grief.html Leaving Site
Fitzgerald H. The Mourning Handbook. New York, N. Y.: A Fireside Book, 1994, p. 37.


The acute responses to loss are not unhealthy or maladaptive responses.
Rather they are normal responses to an abnormal event.

Kirsti A. Dyer, MD, MS

See the Emergency 911 Page for links to immediate resources
if you are feeling helpless, hopeless, overwhelmingly depressed, or suicidal.

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Last update Sept. 11, 2002