Showing posts with label grief. Show all posts
Showing posts with label grief. Show all posts

Wednesday, October 30, 2019

Coping with the Death of a Parent


The Death of a Parent Affects Even Grown Children Psychologically and Physically

Grief is both real and measurable. Scientists now know that losing a parent changes us forever.

By Joshua A. Krisch
Updated Oct 16 2019, 11:00 AM

The death of a parent is one of the most emotional and universal human experiences. If a person doesn’t know what it’s like suffer the loss of a father or mother, they most likely will one day. But just because the passing of a parent happens to almost everyone doesn’t make it any easier. The death of a parent is traumatic, yes, but it also informs and changes their children biologically and psychologically. It can even make them sick.

The death of a parent can trigger emotional and physical stress. Click here to learn more.

“In the best-case scenario, the death of a parent is anticipated and there’s time for families to prepare, say their goodbyes, and surround themselves with support,” psychiatrist Dr. Nikole Benders-Hadi says. “In cases where a death is unexpected, such as with an acute illness or traumatic accident, adult children may remain in the denial and anger phases of the loss for extended periods of time … [leading to] diagnosis of major depressive disorder or even PTSD, if trauma is involved.”

There’s no amount of data that can capture how distinctly painful and powerful this grief is. That said, there are a number of psychological and brain-imaging studies that demonstrate the magnitude of this loss. The posterior cingulate cortex, frontal cortex, and cerebellum are all brain regions mobilized during grief processing, research shows. These regions are involved in storing memories and dwelling on the past, but they’re also involved in regulating sleep and appetite.

In the short term, neurology assures us that loss will trigger physical distress. In the long-term, grief puts the entire body at risk. A handful of studies have found links between unresolved grief and hypertension, cardiac events, immune disorders, and even cancer. It is unclear why grief would trigger such dire physical conditions, but one theory is that a perpetually activated sympathetic nervous system (fight or flight response) can cause long-term genetic changes. These changes — less pre-programmed cell death, dampened immune responses — may be ideal when a bear is chasing you through the forest and you need all the healthy cells you can get. But this sort of cellular dysregulation is also how cancerous cells metastasize, unchecked. 

While the physical symptoms are relatively consistent, the psychological impacts are all but unpredictable. In the 12 months following the loss of a parent, the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders considers it healthy for adults who have lost their parents to experience a range of contradictory emotions, including sadness, anger, rage, anxiety, numbness, emptiness, guilt, remorse, and regret. It is normal to withdraw from friends and activities; it is normal to throw oneself into work.

As ever, context matters. Sudden, violent death puts survivors at higher risk of developing a grief disorder, and when an adult child has a fractured relationship with a parent, the death can be doubly painful — even if the bereaved shuts down and pretends not to feel the loss. “Coping is less stressful when adult children have time to anticipate parental death,” Omojola says. “Not being able to say goodbye contributes to feeling depressed and angry.” This may explain why studies have shown that young adults are more affected by parental loss than middle-aged adults. Presumably, their parents died unexpectedly, or at least earlier than average.

Gender, of both the parent and child, can especially influence the contours of the grief response.


Studies suggest that daughters have more intense grief responses than sons, but men who lose their parents may be slower to move on. “Males tend to show emotions less and compartmentalize more,” Carla Marie Manly, a clinical psychologist and author, told Fatherly.


At the same time, the differences between losing a father and a mother represent relatively weak trends. “Complicated bereavement can exist no matter which parent is lost,” Benders-Hadi says. “More often, it is dependent on the relationship and bond that existed with the parent.”

Grief becomes pathological, according to the DSM, when the bereaved are so overcome that they are unable to carry on with their lives. Preliminary studies suggest this occurs in about 1 percent of the healthy population, and about 10 percent of the population that had previously been diagnosed with a stress disorder. “A diagnosis of adjustment disorder is made within three months of the death if there is a ‘persistence of grief reactions’ exceeding what’s normal for the culture and the religion,” Omojola says. “In this situation, the grieving adult has severe challenges meeting social, occupational, and other expected, important life functions.” Even adults who are able to go to work and put on a brave face may be suffering a clinical condition if they remain preoccupied with the death, deny that their parent has died, or actively avoid reminders of their parents, indefinitely. This condition, known as persistent complex bereavement disorder, is a trickier diagnosis to pin down (the DSM labeled it a “condition for further study”).

Elisabeth Goldberg works with grieving adults as a relationship therapist in New York City, and she has seen the toll that long-term grieving can take on a marriage. Specifically, Goldberg suggests a (somewhat Freudian) link between losing a parent and cheating on a spouse. “I see many affairs as manifestations of unresolved grief about losing a parent,” Goldberg says. “The adult child stays in a state of disbelief, and rejects reality in many ways in order to feed the delusion that the parent is still alive. The grieving child needs a new attachment figure, that’s the psyche trying to reconcile the denial and grief. 

In more concrete — and dire — terms, unresolved grief can spiral into anxiety and depression. This is especially true when the parent dies by suicide, according to Lyn Morris, a licensed therapist and VP at Didi Hirsch Mental Health Services. “Adults who lose a parent to suicide often struggle with complex emotions such as guilt, anger, and feelings of abandonment and vulnerability,” she told Fatherly. Indeed a 2010 study out of Johns Hopkins University confirmed that losing a parent to suicide makes children more likely to die by suicide themselves.

How to cope in a healthy way remains an active area of scientific inquiry. Ross Grossman, a licensed therapist who specializes in adult grief, has identified several “main distorted thoughts” that infect our minds when we face adversity. 

On the opposite extreme, patients sometimes blame their deceased parents for not treating them properly, and never making amends. This is similarly unhealthy. “The usual result of this is deep resentment, anger, rage,” Grossman says. “They may have genuine, legitimate reasons to feel mistreated or abused. In these situations, it’s not always the death of the parent but the death of the possibility of reconciliation, of rapprochement and apology from the offending parent.”

“The possibility has died along with the person.”
The death of a parent can trigger emotional and physical stress. Click here to learn more.

In extreme cases, therapy may be the only way to get a grieving son or daughter back on his or her feet. But time, and an understanding spouse, can go a long way toward helping adults get through this unpleasant, yet ubiquitous, chapter in their lives. “Husbands can best support their wives by listening,” Manly says. “Men often feel helpless in the face of their wives’ emotions, and they want to fix the situation. A husband can do far more good by sitting with his wife, listening to her, holding her hand, taking her for walks, and — if she desires — visiting the burial site.”

Tuesday, May 15, 2018

Suicide in America: Know the Signs

Suicide in America: Frequently Asked Questions.

Suicide is a major public health problem and a leading cause of death in the United States. The effects of suicide go beyond the person who acts to take his or her life: it can have a lasting effect on family, friends, and communities. 

Learn about the brain in health and illness. Click here.

National Institute of Mental Health (NIMH), can help you, a friend, or a family member learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention.

If You Know Someone in Crisis: Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1–800–273–TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the NSPL’s website. The Crisis Text Line is another resource available 24 hours a day, 7 days a week. Text “HOME” to 741741.


What Is Suicide?
Suicide is when people direct violence at themselves with the intent to end their lives, and they die because of their actions. It’s best to avoid the use of terms like “committing suicide” or a “successful suicide” when referring to a death by suicide as these terms often carry negative connotations.
suicide attempt is when people harm themselves with the intent to end their lives, but they do not die because of their actions.

Who Is at Risk for Suicide?

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk.
The main risk factors for suicide are:
  • A prior suicide attempt
  • Depression and other mental health disorders
  • Substance abuse disorder
  • Family history of a mental health or substance abuse disorder
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Being in prison or jail
  • Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
  • Medical illness
  • Being between the ages of 15 and 24 years or over age 60 
Even among people who have risk factors for suicide, most do not attempt suicide. It remains difficult to predict who will act on suicidal thoughts.

Are certain groups of people at higher risk than others?

According to the Centers for Disease Control and Prevention (CDC), men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use more lethal methods, such as firearms or suffocation. Women are more likely than men to attempt suicide by poisoning.
Also per the CDC, certain demographic subgroups are at higher risk. For example, American Indian and Alaska Native youth and middle-aged persons have the highest rate of suicide, followed by non-Hispanic White middle-aged and older adult males. African Americans have the lowest suicide rate, while Hispanics have the second lowest rate. The exception to this is younger children. African American children under the age of 12 have a higher rate of suicide than White children. While younger preteens and teens have a lower rate of suicide than older adolescents, there has been a significant rise in the suicide rate among youth ages 10 to 14. Suicide ranks as the second leading cause of death for this age group, accounting for 425 deaths per year and surpassing the death rate for traffic accidents, which is the most common cause of death for young people.
Looking for more data and statistics? For the most recent statistics on suicide and more information about risk, please visit the CDC website at www.cdc.gov/ViolencePrevention/suicide/index.html.

Why do some people become suicidal while others with similar risk factors do not?

Most people who have the risk factors for suicide will not kill themselves. However, the risk for suicidal behavior is complex. Research suggests that people who attempt suicide may react to events, think, and make decisions differently than those who do not attempt suicide. These differences happen more often if a person also has a disorder such as depressionsubstance abuseanxietyborderline personality disorder, and psychosis. Risk factors are important to keep in mind; however, someone who has warning signs of suicide may be in more danger and require immediate attention.

What Are the Warning Signs of Suicide?

The behaviors listed below may be signs that someone is thinking about suicide.
  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty, hopeless, or having no reason to live
  • Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
  • Talking about great guilt or shame
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable pain, both physical or emotional
  • Talking about being a burden to others
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Withdrawing from family and friends
  • Changing eating and/or sleeping habits
  • Showing rage or talking about seeking revenge
  • Taking risks that could lead to death, such as reckless driving
  • Talking or thinking about death often
  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, making a will

Do People Threaten Suicide to Get Attention?

Suicidal thoughts or actions are a sign of extreme distress and an alert that someone needs help. Any warning sign or symptom of suicide should not be ignored. All talk of suicide should be taken seriously and requires attention. Threatening to die by suicide is not a normal response to stress and should not be taken lightly.

If You Ask Someone About Suicide, Does It Put the Idea Into Their Head?

Asking someone about suicide is not harmful. There is a common myth that asking someone about suicide can put the idea into their head. This is not true. Several studies examining this concern have demonstrated that asking people about suicidal thoughts and behavior does not induce or increase such thoughts and experiences. In fact, asking someone directly, “Are you thinking of killing yourself,” can be the best way to identify someone at risk for suicide.

What Should I Do if I Am in Crisis or Someone I Know Is Considering Suicide?

If you or someone you know has warning signs or symptoms of suicide, particularly if there is a change in the behavior or a new behavior, get help as soon as possible.
Often, family and friends are the first to recognize the warning signs of suicide and can take the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions. If someone is telling you that they are going to kill themselves, do not leave them alone. Do not promise anyone that you will keep their suicidal thoughts a secret. Make sure to tell a trusted friend or family member, or if you are a student, an adult with whom you feel comfortable. You can also contact the resources noted below.
How can doctors and other health care providers play a role in suicide prevention?
Health care providers can help prevent suicide when they understand the risk factors and use evidence-based treatments and therapies. In addition, The Joint Commission recommends screening all patients in all medical settings for suicide risk using validated, population and setting-specific tools.
Clinicians should be advised that it is no longer acceptable to “contract for safety” with patients. Safety planning for managing future suicidal thoughts and means restriction (removing or ensuring safe storage of potentially lethal items) have been proven to be effective ways of preventing suicide. Health care providers can find educational resources on the Zero Suicide website and news about the latest research on the NIMH website at www.nimh.nih.gov.

What if Someone Is Posting Suicidal Messages on Social Media?

Knowing how to get help for a friend posting suicidal messages on social media can save a life. Many social media sites have a process to report suicidal content and get help for the person posting the message. In addition, many of the social media sites use their analytic capabilities to identify and help report suicidal posts. Each offers different options on how to respond if you see concerning posts about suicide. For example:
  • Facebook Suicide Prevention webpage can be found at www.facebook.com/help/594991777257121/[use the search term “suicide” or “suicide prevention”].
  • Instagram uses automated tools in the app to provide resources, which can also be found online at https://help.instagram.com [use the search term, “suicide,” self-injury,” or “suicide prevention”]
  • Snapchat’s Support provides guidance at https://support.snapchat.com [use the search term, “suicide” or “suicide prevention”]  
  • Tumblr Counseling and Prevention Resources webpage can be found at https://tumblr.zendesk.com[use the search term “counseling” or “prevention,” then click on “Counseling and prevention resources”].
  • Twitter’s Best Practices in Dealing With Self-Harm and Suicide at https://support.twitter.com [use the search term “suicide,” “self-harm,” or “suicide prevention”].
  • YouTube’s Safety Center webpage can be found at https://support.google.com/youtube [use the search term “suicide and self injury”].
If you see messages or live streaming suicidal behavior on social media, call 911 or contact the toll-free National Suicide Prevention Lifeline at 1–800–273–TALK (8255), or text the Crisis Text Line (text HOME to 741741) available 24 hours a day, 7 days a week. Deaf and hard-of-hearing individuals can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential. This service is available to everyone. People—even strangers—have saved lives by being vigilant.

What Treatment Options and Therapies Are Available?

Effective suicide intervention practices are based on research findings and tested to see how various programs benefit various specific groups of people. For example, research has shown that borderline personality disorder is a risk factor for suicidal behavior, and there are programs that are effective in reducing suicide attempts.
Among its research on suicide, the National Institute of Mental Health (NIMH) has supported research on strategies that have worked well for those who have mental health conditions related to suicide such as depression and anxiety. These mainly include types of psychotherapies (such as cognitive behavior therapy or dialectical behavioral therapy). NIMH also conducts research on suicide risk screening tools for health care clinicians to use as a guide for screening patients for suicide risk.
For basic information about psychotherapies and medications, visit the NIMH website (www.nimh.nih.gov/health). For the most up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration (FDA) website.
Looking for a mental health provider in your area?
For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1–800–662–HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location.

Talking to Your Doctor

Suicide is often not discussed in medical visits where physical symptoms are more of the focus. If you have thoughts of suicide, tell your health care provider. Asking questions and providing information to your doctor or health care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at www.ahrq.gov/patients-consumers.
Source: NIMH