Understanding the Impact of Loss & Grief on our Patient’s Well Being: Learning How to Take a Loss History (2)
The Impact of Grief on a Person’s Well Being Health
is the optimal state of well being–being well physically, emotionally, spiritually and mentally. Wellness is considered to be the state in which the physical, emotional, mental, and spiritual dimensions are balanced so that energy is used effectively. Although grief and wellness seem unrelated, unrecognized acute loss or unresolved grief can mimic various medical conditions, lead to illness and a decline in wellness. A grieving person may experience a variety of somatic complaints: fatigue, insomnia, pain, gastro-intestinal symptoms, chest pressure, palpitations, stomach pains, backaches, panic attacks, increased anxiety or a generalized feeling of not being quite right. These symptoms may be due to a medical disorder or a grief response following a loss. Potentially serious medical complaints require a through evaluation to exclude serious medical disorders before a grief response or depression can be diagnosed.
Loss and the resulting grief response can impact a person’s mental and behavioral wellness. Repressed, unrecognized or unresolved grief can cause personal anguish, increased anxiety, multiple physical complaints, functional impairment, strained relationships, marital discord, disrupted sleep, impaired childhood, increased substance abuse—tobacco, alcohol, drugs, tranquilizers; clinical depression, and an increased mortality from heart disease and suicide. The death of a spouse has been shown to negatively impact the health of the surviving bereaved spouse, including increasing the risk of death. Studies have shown that bereavement—grief following a death–can also lead to an increased mortality from ischemic heart disease, the development of high blood pressure, depression of the immune system, and increased depressive and anxiety disorders including post traumatic stress disorder.
In order to enhance our patients’ well being, we need to recognize the role that loss and grief may play in a current medical diagnoses or conditions. We also should determine the patient’s past losses, life challenges or experiences, which can still impact the person’s health and affecting his or her overall wellness.
Distinguishing between Grief and Depression
During a normal grief response, a person may experience symptoms of distress or depression. This overlap between grief and depression makes it challenging for practitioners to determine if a person is experiencing a grief response or true clinical depression. The accompanying table summarizes the key characteristics of grief and depression to help you distinguish between these two related but distinctive conditions.
Failing to identify a grief response to loss may result in a poor response to therapy because the correct diagnosis (grief) was not make and underlying etiology for the patient’s symptoms was never identified. If the grief response is not identified, the patient may not receive the support needed to help him or her cope with the life changing events. Taking a loss history may help the practitioner to identify and correctly diagnosing a grief response. This in turn can help the practitioner to educate the patient that their symptoms may be related to the life challenge, which then helps the patient to process the change, integrate the loss, begin living again and restore balance, energy and well being.
Resource available on request.
Kirsti A. Dyer, MD, MS, FAAETS, FACW, NCBF, CWS Internal Medicine Physician – on Hiatus for Childcare Adult Medicine, Life Change and Wellness Specialist Nationally Certified Bereavement Facilitator Certified Wellness Specialist Journey of Hearts, The Violet Heart. Dr. Dyer can be reached at email@example.com