From love to pain: is oxytocin the key to grief complications?

While most adults confronted with the death of a loved one manage to grieve, about 10-20% of individuals develop complicated grief, characterized by persistent distress and impaired social skills, or pathological grief, defined by the onset or decompensation of a psychiatric disorder. Little is known about the biological causes of these grief complications. Recent work suggests that oxytocin, a major neuroendocrine hormone regulating many neurocognitive mechanisms, may be involved in this process. Oxytocin is widely studied and well known for its impact on the mother-child bond and hormonal and brain systems related to attachment and social interactions. In this article, we propose a neurocognitive model of grief complications based on existing data on the role of oxytocin in interpersonal attachment and its impact on brain activity. We suggest that complicated grief is associated with dysfunctional cerebral oxytocinergic signaling and persistent hyperactivation of the nucleus accumbens. This mechanism is involved in limiting the reduction of interpersonal attachment to the deceased during acute phases and in searching for new interpersonal relationships during the recovery phase. We show how the exploration of cerebral oxytocinergic signaling would improve the understanding of physiological grief mechanisms in the general population and could allow the development of new therapeutic perspectives against the complications of grief.

Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review.

PURPOSE: Prolonged Grief Disorder (PGD) is a condition recently introduced in international classifications of mental disorders. Although PGD is associated with significant distress and impairment that may have developmental consequences, to date, little is known about its prevalence and associated factors in children and adolescents. The present systematic review registered in PROSPERO (CRD42021236026) aimed to: (i) review existing data on the prevalence of PGD in bereaved children and adolescents; and (ii) identify factors associated with PGD in this population. METHODS: Six electronic databases, grey literature and a manually searched journal identified 1,716 articles with no backward limit to September 2021. Epidemiological studies were included if they reported the prevalence of PGD in bereaved children and adolescents. Study characteristics, diagnostic and assessment tools, population, loss-related characteristics and prevalence of PGD were reviewed. RESULTS: Five studies met our inclusion criteria. The reported prevalences of PGD ranged from 10.4% to 32%. Female gender, cognitive avoidance, chronic stressors such as economic hardship, exposure to trauma or other losses appear to be associated with more severe symptoms or even a higher risk of PGD. Conversely, data suggest social support may be protective. CONCLUSION: This first systematic review found a relatively high prevalence of PGD in bereaved children and adolescents. While further large epidemiological studies are needed, this review highlights the importance of evaluating PGD in current clinical practice and suggests that further research into diagnostic and therapeutic approaches targeting this disorder is warranted.

[The subjective experience of contact with the deceased or necrophany: a widespread and little-known phenomenon]. / Le vécu subjectif de contact avec un défunt ou nécrophanie : un phénomène répandu et peu connu.

The subjective experience of contact with the deceased (VSCD), spontaneous and direct, by people most often in mourning, is neither rare nor new. It's even considered a universal and timeless phenomenon. Yet this psychological and sensory manifestation, which can manifest itself through sight, hearing, smell or touch, remains little known to the general public and health professionals alike. This article is an opportunity for many to discover this phenomenon, also known as necrophany.

[Crossed views on depressive symptomatology with suicidal expression in the elderly]. / Regards croisés sur la symptomatologie dépressive à expression suicidaire du sujet âgé.

Presentation of the clinical situation of Mrs. M. The mobile psychiatric team of the Marchant hospital in Toulouse (31) is requested by the coordinating physician of an establishment for dependent elderly people for an evaluation of the mood with suicidal risk in this 92 year old patient who has recently entered the structure.

[Psychotherapy of traumatic grief in exiled patients]. / Psychothérapie du deuil traumatique chez les patients exilés.

After a presentation of the clinical speci-ficities of complex traumas in exiled patients, the psychotherapeutic issues and processes at work in the treatment of traumatic mourning are detailed through a clinical case. Emphasis is placed on the articulation and interface between the private and collective dimensions of grief.

[Loving to death or the pain of the first love breakup]. / Aimer à en mourir ou la douleur de la première rupture amoureuse.

A break-up in love can be understood as a mourning, that of a relationship in which many hopes had been founded. This notion is questioned, more particularly in the light of our clinical experience with adolescents, who were seen in consultation following their first losses of love objects. Each love mourning process is unique, evolving according to its own temporality and trajectory, linked in large part to characteristics inherent to the subject, but also to the context of the loss or the relationship maintained with the object of the loss. Despite this, This work participates in the construction of new affective investments and in the construction of the adult subject.

[The work of mourning, getting through the loss]. / Le travail du deuil, traverser la perte.

Pain, mourning translate, in their indeterminacy of the affective experience, the suffering, the guilt, the anguish when the individuals are confronted with the death, the loss or the separation from the object. It doesn't matter if this object is a loved one or an abstraction... These different experiences each sign in their own way the human way of reacting to the inescapable encounter with this reality. To seize and overcome the experience of the affective experience makes it possible to understand and to put in form the significant mechanisms which underlie the processes of mourning. It also helps to apprehend its necessary and obligatory scope, given the attachment and identification that characterize the link between humans.

[From the cultural cradle to the empty cradle, accompanying perinatal mourning]. / Du berceau culturel au berceau vide : accompagner le deuil périnatal.

In all societies, births and deaths are important moments that call upon the intimate and collective representations of each person. When death occurs during the perinatal period, bereaved couples may feel the need to refer to the cultural representations they have internalized, and thus re-affiliate themselves with a group to which they belong, likely to accompany them in making sense of what they have experienced. A clinical situation allows us to understand the psychological support of couples from elsewhere who are confronted with perinatal mourning.

[Migration loss and grief among immigrants with little education in Quebec]. / Pertes et deuils migratoires chez les immigrants peu scolarisés au Québec.

Qualitative research conducted in Quebec aims to trace the psychosocial profile of immigrants in a vulnerable situation due to their migratory journey and to identify the challenges of the actors involved in their integration process. The participants in the research are enrolled in a francization program specific to Quebec for immigrants with low literacy skills (Foreign Investment Promotion and Protection Agreement). The results raise several issues related to the grief and loss experienced by the most fragile immigrants. Indeed, the challenges of post-migration life and integration into the host society are added to the many migratory losses and the suffering of ongoing grief.

[Acceptance, mourning of delusions and recovery]. / Acceptation, deuil des idées délirantes et rétablissement.

Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental resources. This involves adapting and managing certain symptoms better, in order to be able to rebuild oneself psychologically. This may be the case for delusions, which need to be distanced and accepted in order to develop this new life stage in. In this perspective, the notions of mourning for the self and mourning for delusional beliefs seem to be necessary steps in the reconstruction of a self that is favourable to recovery.

[Together in the face of extreme violence: accompanying families after a traumatic event]. / Accompagner les familles après un événement traumatique.

After a traumatic event, families can also be impacted at different levels and require post-immediate or longer-term care. The adaptation of these family care procedures carried out following the attacks of 2015-2016 in France, based on existing clinical arrangements, in a child psychiatry service associated with a medical-psychological emergency unit, is discussed via two clinical examples. These different modalities of follow-up, a family debriefing and a situation of mourning associated with a trauma insist on the necessity to consider the temporality of the follow-up, the use of different theoretical tools, as well as the importance given to rituals and family skills hard hit by the traumatic event.

[How grief moved from culture to psychiatry]. / Comment le deuil est passé de la culture à la psychiatrie.

Bereavement has been debated among psychiatric experts since 2000. In addition to its precise manifestations, its duration is discussed: six months for the ICD-1, one year for the DSM-5-TR. Grief is not an illness but a process that can be blocked in the announcement phase of the death or in the depression phase following the absence. In all cases, acceptance of the loss is impossible. Psychiatric treatment can define a bereaved person who is suffering too much, and can reduce his or her suffering, but it cannot accelerate the process of remembering and then resuming a life without the loved one. Social rituals and psychosocial support have had this place for millennia in cultures throughout humanity.

[Accompanying caregivers facing bereavement in an institutional clinic]. / Accompagner des soignants confrontés au deuil en clinique institutionnelle.

In view of the major psychological issues that characterize the mourning process, a system has been working for about ten years in a group of health and medico-social institutions to support caregivers. The institutional intervention unit, composed of specially trained psychologists, offers discussion groups for these teams who have been confronted with the sometimes very brutal experience of loss and accompanies them towards the resumption of a mourning process. Based on group psychodynamic approaches, the reasons that can hinder the stages of mourning in these groups and the effects of the proposed discussion groups are explored.

[Specificities of antenatal grief]. / Spécificités du deuil anténatal.

Taking into account the pain of antenatal bereavement is relatively recent. If the stages of elaboration of this mourning are identical compared to those of other close persons, nevertheless it has some particularities. The status of the fetus is singular, an integral part of the mother's body, but without legal existence. The psychological context in which the mourning takes place is marked by a profound psychic transformation. Finally, the impact on parental narcissism must be taken into account.

Bereavement and reactions of grief among children and adolescents: Present data and perspectives.

Losing a loved one is among the most common and stressful traumatic events that a child or and adolescent can experience and can be associated with mental health and somatic disorders, as well as a range of life issues and potentially negative outcomes that may impact longitudinal development. Complicated grief, a disorder that has been studied primarily among adults, has received increasing recognition among children and adolescents in recent years. The demonstration of the distinctive character of grief reactions in relation to major depressive disorder and posttraumatic stress disorder has resulted in the inclusion of "persistent complex bereavement disorder" in an annex section of DSM-5 and of "prolonged grief disorder" in ICD-11. The grieving process in children and adolescents is not linear and is often characterised by periods of regression. Developmental phases should be taken into account to understand and clinically describe grief reactions occurring during childhood and adolescence. There are currently numerous interventions for bereaved children and adolescents, but little evidence to support them. More research focusing on the understanding of the underlying mechanisms and the risk factors for complicated grief among children and adolescents, as well as the implementation of evidence-based interventions, is definitely warranted.

L'irruption de la maladie et le deuil du corps bien portant.

Illness and grieving the loss of a healthy body. Grief is a phenomenon which is part of the normal and the pathological. In the case of illness, it is felt for a body which is lost, different, becoming something other. This article studies the notions of grief, body schema and body image.

[A pregnancy after perinatal bereavement]. / Une grossesse après un deuil périnatal.

A pregnancy following a perinatal bereavement has a rather particular dimension to it. It requires attentive support and monitoring in order to enable the future baby to take its place within the family. An interview with Marie-José Soubieux, child psychiatrist and psychoanalyst.

[The infant faced with the loss of a parent]. / L'enfant face au deuil d'un parent.

Bereavement in an infant constitutes a complex process with a distinct temporality. It is closely linked to family bereavement. Based on a clinical example, it is possible to detail the necessary stages as well as the difficulties to take into account during this very specific ordeal which the sudden loss of a parent represents.

[Perinatal bereavement and support for siblings]. / Deuil périnatal et soutien de la fratrie.

When the premature death of a baby occurs in a family, brothers and sisters need support. Their silence, their absence of questions or reactions must set off alarm bells. The parents, beyond their own bereavement, have a key role to play in enabling their children to integrate this loss into their lives.

[The care of stillborn babies and their family]. / La prise en charge d'un enfant né sans vie et de sa famille.

Practices around the care of stillborn babies have evolved considerably over the last 15 years. Perinatal bereavement care requires a team approach to support the parents experiencing this ordeal. The place of rituals is important as is the personalisation of the care. The humanity which surrounds such moments constitutes the foundation on which the future equilibrium of these bereaved families will be based.