A call to the field: complicated grief in the DSM-5.

While complicated grief has been addressed in part through some recommendations for modifications in the upcoming fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there remain reasons for substantial concern about its scope therein and within clinical practice. The authors issue a call to the field, reiterating that complicated grief is complicated and cannot be confined to just one syndrome or disorder. Continued research is urged, and specific caveats are identified for exploring the complex dimensions of loss and grief. The authors advocate for ongoing dialogue about and investigation of various potential forms of complicated grief.

Can individuals who are specialists in death, dying, and bereavement contribute to the prevention and/or mitigation of armed conflicts and cycles of violence?

Specialists in death, dying, and bereavement and their consequences for individuals, families, and communities have experience and research findings that are relevant to an understanding of the reactions of individuals faced by deadly violence. At such times, powerful emotions and ingrained patterns of thought and behavior can given rise to disproportionate responses that may feed into cycles of violence. An extended table shows how professionals helping individuals and families faced with violent death share common aims with those aiming to help larger social units faced with armed attacks. It follows that these professionals should work together to improve death education, to prepare people for possible deadly violence and, where possible, to suggest alternatives, to create secure places and relationships in which communication becomes possible, bad news can be broken and understood, feelings examined, differences reconciled, and people can redirect anger into the prevention of escalation rather than its perpetuation. All of these activities hold out hope that cycles of deadly violence can be broken as well as mitigating the consequences when they are not. The undoubted success of the worldwide palliative care movement resulted from the recognition of serious deficiencies in existing services, the provision of an inclusive, holistic, program that extends across medical, social psychological, and spiritual realms of discourse, providing care for patients and their families, irrespective of wealth, race, religion, and political persuasion, by dedicated leaders and teams backed by education and information services and organized across geographical boundaries. It is argued here that the time is ripe for a similar commitment to bring to an end the scandal of armed conflict by a similarly multidisciplinary, multicultural effort to relieve the suffering that both causes and results from armed conflict. This must remain independent of race, religion, political persuasion, and opposing sides and could build upon the leadership, educational models, information services, and international organizations that already exist for the provision of palliative and bereavement care.

An exploration of associations between separation anxiety in childhood and complicated grief in later life.

Recent studies have suggested that the vulnerability to complicated grief (CG) may be rooted in insecure attachment styles developed in childhood. The aim of this study was to examine the etiologic relevance of childhood separation anxiety (CSA) to the onset of CG relative to major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder in bereaved individuals. The Structured Clinical Interview for the DSM-IV, Inventory of Complicated Grief-Revised, and CSA items from the Panic Agoraphobic Spectrum Questionnaire were administered to 283 recently bereaved community-dwelling residents at an average of 10.6 months postloss. CSA was significantly associated with CG (OR = 3.2; 95% CI, 1.2-8.9), adjusting for sex, level of education, kinship relationship to the deceased, prior history of psychiatric disorder, and history of childhood abuse. CSA was not significantly associated with major depressive disorder, posttraumatic stress disorder, or generalized anxiety disorder.

Breaking the cycles of violence.

Violence begets violence and it is important to understand how cycles of violence are perpetuated if we are to find solutions to the global problems they present. A multi-disciplinary group of The International Work Group on Death, Dying and Bereavement has developed a model of the cyclical events that perpetuate violence at all levels including the family, community, nation, and world. This includes the Violent Act(s), the Perception of the Violent Act(s), the Immediate Response, Legitimising Authority, Destructive Codes, and Inflammatory/Polarising Strategies. It is possible at each point to break the cycle, examples are given and recommendations made.

Grief: lessons from the past, visions for the future.

Over the last millennium, patterns of mortality have changed and have determined who grieves and how. At all times grief has been recognized as a threat to physical and mental health. More recently the scientific study of bereavement has enabled us to quantify such effects and to develop theoretical explanations for them. This article reviews our evolving understanding of grief, focusing especially on the developments in research, theory, and practice that have come about in the last century. Wars and similar conflicts are associated with repression of grief, but methods of helping by facilitating its expression that developed during the 2 World Wars are less needed and effective at other times. In recent years more attention has been paid to the social context in which grief arises and, particularly, to the nature of the attachments that precede and influence the reaction to bereavement and to other traumatic life events. At the same time a range of caring resources has become available and acceptable to bereaved people and the results of scientific evaluation of these gives promise that we are moving toward an era in which more sensitive and appropriate care will be provided to the bereaved by both voluntary and professional caregivers.