Christina Zampitella, Psy.D.

Grief is disenfranchised when a person is denied the right to grieve, does not have the social support essential to adapting to his or her loss, and is deprived of the social validation in order to heal. When the griever is disenfranchised, he or she may withdrawal from others or question his or her own grieving process, may not acknowledge the reality of the loss and its implications, or adapt to the loss in healthy ways. As a result, their grieving process remains private, intensifying the grieving process, which increases the risk of complicated grief. Disenfranchisement comes from several sources, including one’s cultural expectations, expectations of others, professionals who serve in “expert” roles, and even from the griever himself. Since every mental health professional will work with bereaved clients, it is essential that he or she know how to recognize disenfranchisement, understand the impact of disenfranchisement on the griever’s mourning process, learn how to reduce the chance of disenfranchising his or her clients, and provide guidance and interventions for disenfranchised grievers as they navigate through the social interactions that may include unhelpful expectations and judgments. Attendees will engage in didactic lecture, case studies, and videos to meet these goals. 

A review of the DSM across the decades reveals a complicated history of the inclusion and exclusion of grief-related emotional difficulties for bereft clients. Starting with the DSM-III, uncomplicated bereavement was introduced as a condition that may be the focus of clinical attention. As research on complicated grief progressed, changes in subsequent DSMs has led to controversy, extended research, and, eventually, the inclusion of prolonged grief disorder in the upcoming release of the DSM-5-TR in mid-2021. This 3 hour presentation explores the history of how bereavement has been addressed in previous and current DSMs and the ICD, an examination of the bereavement exclusion in major depressive disorder and adjustment disorder, the development and inclusion of persistent complex bereavement disorder in the DSM-5, and the diagnostic criteria for prolonged grief disorder in the DSM-5-TR and the ICD-11. Additionally, the presentation will explore differential diagnosing so the practitioner will be skilled in making sound clinical judgment in treatment planning. 

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Mental health and healthcare professionals are faced with the often misunderstood and misdiagnosed symptoms of uncomplicated and complicated grief. Formal education rarely, if ever, provides extensive enough training to accurately identify and treat those who are grieving. Often grieving clients present with other diagnoses because symptoms can mimic uncomplicated or complicated grief. The grieving process is often pathologized, or misdiagnosed, resulting in potential exacerbation of the presenting issues because inappropriate interventions are utilized. As a result, those who are grieving are often are inadvertently disenfranchised by providers, which can make the professional support they sought to reconstruct their previously shattered identities and worldviews ineffective. It is essential to be versed in identifying grief related constructs that may underlie, or even cause, mental health difficulties. 

This presentation aims to provide current information on the grieving process, clarify misconceptions of outdated theories, and differentiate between uncomplicated and complicated grief, and also examines the changes in conceptualization, differential diagnosing, treatment planning, and interventions used with grieving individuals. Attendees will leave with an improved clinical skill set they can immediately use to identify and treat their clients.