It is widely understood that grief does not follow a straight path, but for a significant minority, it becomes an unending struggle. Approximately 10 percent of individuals who lose a loved one develop prolonged grief disorder (PGD), a psychiatric condition characterised by intense emotions like sadness or guilt persisting beyond six months.
Understanding Prolonged Grief Disorder
Formally classified by the World Health Organisation in 2018, PGD involves elevated levels of distress related to bereavement. According to NHS guidelines, those affected often spend excessive time dwelling on the deceased, struggle to accept the death, experience suicidal thoughts, and find it challenging to resume daily activities. They may feel that life has lost its meaning, part of their identity is missing, or they simply cannot come to terms with the loss, despite acknowledging its reality.
Risk Factors and Scientific Puzzles
People who have experienced a traumatic or sudden loss are more susceptible to PGD, yet not everyone in such situations develops the disorder, leaving researchers perplexed. In a recent review published in the medical journal Trends in Neurosciences, experts from the University of New South Wales in Australia delved into the neurobiology of PGD to uncover why it persists in some individuals.
Brain Patterns and Psychological Cravings
The research team argues that PGD shares brain patterns observed in patients with depression and anxiety, with additional activity in systems involved in reward and attachment. This suggests that individuals may be psychologically 'craving' the presence of their lost loved one, making it harder to move forward effectively.
Lead author Richard Bryant explained, 'Prolonged grief disorder is the new kid on the block in terms of psychiatric diagnoses. It's not that it's a different type of grief. It's just more that the person is stuck in the grief. It sort of gelled with this notion that grief is characterised by a craving or a longing for the deceased.'
Insights from Brain Imaging Studies
As PGD is a relatively new diagnosis, available data is limited, primarily consisting of functional MRI (fMRI) brain scans. These scans measure blood flow changes when individuals view photos of the deceased or engage in grief provocation tasks. Studies have repeatedly linked PGD to alterations in reward-related brain circuits, including regions like the nucleus accumbens and orbitofrontal cortex, which are involved in desire and motivation, as well as the amygdala and insula, key players in emotion processing.
Some of these brain patterns overlap with those seen in depression and post-traumatic stress disorder, conditions that share traits such as rumination and emotional distress. Bryant noted, 'It would be very strange if we didn't get that overlap,' highlighting the interconnected nature of these mental health issues.
Future Research and Treatment Implications
Bryant aims to expand his research by working with larger groups of bereaved individuals to monitor how brain activity evolves over time, whether they navigate through grief or become stuck. He emphasised the importance of awareness, stating, 'To actually deal with prolonged grief, we need to recognise it as a disorder. We do have treatments that can address it, but we can't do that if we can't identify these people.'
This ongoing investigation into the neurobiology of PGD not only sheds light on the mechanisms behind enduring sorrow but also underscores the need for targeted interventions to support those grappling with this challenging condition.
