Download Caitlin Vasquez

Therese A. Rando, Ph.D
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Caitlin Vasquez
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“Complicated” implies that although
something has gone wrong, it can
potentially be corrected
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Three main difficulties in defining complicated mourning
o First the terminology can be imprecise and inconsistent.
o Second knowing what criteria constitutes as complicated mourning.
o Third mourning is highly idiosyncratic; an appropriate response in one
situation for an individual mourner may be a highly irrational response for a
different mourner in another situation.

For these reasons it would be best to look at complications in the
mourning processes themselves rather than at particular
symptomatology.
*Symptomatology- study of relationship
between symptom and disease
*Thanatology- the study of the medical,
psychological, and sociological aspects of death
and the ways in which people deal with it
• Recognize
• React
• Recollect
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• Relinquish
• Readjust
• Reinvest
The six “R” processes of mourning are:
o Recognize the loss
• Acknowledge the death
• Understand the death
o React to the separation
• Experience the pain
• Feel, identify, accept, and give some form of expression to all the
psychological reactions to the loss
o Recollect and re-experience the deceased and the relationship
• Review and remember realistically
• Revive and re-experience the feelings
o Relinquish the old attachments to the deceased and the old assumptive world
o Readjust to move adaptively into the new world without forgetting the old
• Revise the old assumptive world
• Develop a new relationship with the deceased
• Adopt new ways of being in the world
• Form a new identity
o Reinvest

In all forms of complicated mourning, two things are
attempted and are what cause the complications in the “R”
processes of mourning:
o To deny, repress, or avoid aspects of the loss, its pain, and full
realization of its implications for the mourner
o To hold onto, and avoid relinquishing the lost loved one

Complicated mourning may take any one or combination of
these four forms:
o Symptoms
o Syndromes
o Mental or physical disorder
o Death

Refers to any
o Psychological symptom
o Behavioral symptom
o Social symptom
o Physical symptom
• Can be alone or in combination with
another form
• Which in context reveals some dimension of compromise,
distortion, or failure of one or more of the six “R” processes
of mourning.

Only if the symptoms comprising them meet the criteria for
the specific syndrome is there said to be a complicated
mourning syndrome present.

If only some of the symptoms are present, or there is a
combination of symptoms from several of the syndromes,
but the fail to meet the criteria for a particular complicated
mourning syndrome, then they are considered complicated
mourning symptoms.

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A diagnosable mental or physical disorder would include any
DSM-III-R3 diagnosis of a mental disorder or any recognized
physical disorder that results from or is associated with a
compromise, distortion or failure of one or more of the six
“R” processes of mourning.
Death may be consciously chosen (i.e., suicide) or it may
stem from the immediate results of a complicated mourning
reaction (i.e., an automobile crash resulting from the
complicated mourning symptom of driving at excessive
speed) or the long-term results of complicated mourning
reaction (i.e., cirrhosis of the liver secondary to mourningrelated alcoholism).
• A mental or physical disorder and death may or may not be sub-intentioned
on the part of the mourner.

Theses factors can predispose any individual into two categories:
o Factors associated with the specific death are known especially to
complicate mourning include:
•
•
•
•
A sudden death, especially when it’s traumatic, violent, mutilating, or random
Death from an overly-lengthy illness
Loss of a child
the mourner’s perception of preventability.
o Factors associated with antecedent and subsequent variables that tend to
complicate mourning include:
• Premorbid relationship with deceased which has been markedly angry or
ambivalent or markedly dependent
• The mourner’s prior or concurrent mental health problems and/or
accommodated losses and stresses
• The mourner’s perceived lack of social support.

Three main areas which have significantly increased the
prevalence of complicated mourning:
• the types of death occurring today
• the characteristics of personal relationships that are severed by today’s
deaths
• the personality and resources of today’s mourner

Social change, medical advances, and shifting political
realities have spawned the recent trends that have
complicated healthy grief and mourning.

Three types of death known to be at high risk for
complicated mourning:
o Sudden and unanticipated deaths, especially if they are traumatic
(i.e., characterized not only be suddenness and lack of anticipation,
but violence, mutilation, and destruction; preventability and/or
randomness; mutiple death; or the mourner’s personal encounter
with death
o Deaths that result from excessively lengthy chronic illnesses
o Deaths of children

Each of these deaths presents the survivors with issues
known to compromise the “R” processes of mourning.

There has been an increase in conflicted and dependent
relationships in our society.
o Both types are high-risk factors when they characterize the
mourner’s premorbid relationship with the deceased.
o With more of these types of relationships than ever before, there is
relative increase in the prevalence of complicated mourning, which
is predisposed to develop after the death of one with whom the
mourner has had this type of bond.

Personality and resources leave individuals compromised in
mourning for three reasons.
o The personalities and mental health of today’s mourners are often
impaired.
o The presence of more loss and stress in the life of today’s mourner
as compared to times in the past.
o The mourner’s resources.
• Disenfranchised mourning is on the rise
• the consequent perceived lack of social support