• Martha ZimmermannEmail author
  • Anthony Papa


The loss of a loved one is an inevitable part of the human experience. Normal grieving may be characterized by an acute, time-limited experience of yearning, emotional distress, and intrusive thoughts related to the deceased that tends to remit within 4–6 months of the loss (Bonanno, 2005). Normal grieving may be also characterized by brief, transient distress, continuing to experience and express positive emotion, and a quick return to functioning (Bonanno et al., 2002; Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). Regardless of level of intensity, grief is typically a transitory experience in which a person either continues to function or returns to previous function after a period of time. Despite a return to functioning, many individuals still report sadness when reminded of the deceased throughout the lifetime. As such, categorizing grief as a mental disorder has often been considered controversial for fear of pathologizing a normal human phenomenon. While most bereaved individuals experience a wide range of responses that are considered healthy and normal, research suggests that for a certain group of individuals, the experience of losing a loved one can result in significant levels of unrelenting distress and impairment that may benefit from clinical intervention. These reactions can include a number of issues that require clinical evaluation and monitoring including pathological grief (see below), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), poor sleep, substance abuse, suicidal ideation, physical disease, poor health behaviors, underutilization of mental health services, and an overall reduction in quality of life and social isolation (e.g., Lannen, Wolfe, Prigerson, Onelov, & Kreicbergs, 2008; Lee, 2015; Lichtenthal et al., 2011; Papa, Lancaster, & Kahler, 2013; Prigerson et al., 1995; Simon et al., 2007; Stahl & Schulz, 2014). These risks indicate an important need for clinical intervention given the considerable impact they may have on quality of life, health behaviors, and functional impairment in important domains such as social relationships and occupational functioning. However, interventions for grief when pathological grief is not present have been shown to be ineffective and potentially iatrogenic (Schut & Stroebe, 2005). Thus, effectively distinguishing normal reactions to loss from those that require treatment is imperative in an integrated care setting.


Grief Bereavement Treatment Screening Comorbidity Differential diagnosis Primary care 


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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of Nevada, RenoRenoUSA

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