What is an indication of an abnormal grief reaction in this patient? A 47-year-old woman presents to her family practitioner because of depression of 1 month’s duration. Approximately 1.5 years ago her husband died of pancreatic cancer after a rapidly deteriorating course. She says she returned to work 2 weeks after his death and felt little emotional difficulty at that time.During the past month she has noted near constant sadness and frequent episodes of crying. She also notes new onset of frequent tension headaches, particularly during times of stress. She feels guilty that she is alive while he is dead. Her physical examination is unremarkable except that she weighs about 1.3 kg (2.9 lb) less than she did 2 months previously.

Delayed grief

The correct answer is A. Pathologic grief includes excessive, intense, or prolonged grief as well as grief that is delayed, inhibited, or denied. The patients quick return to work and lack of emotional impact at the time of death, combined with her grief symptoms 1.5 years after her husbands death, most likely reflect a delayed grief reaction. This patient is at higher risk for an abnormal grieving process given the rapid course of her husbands illness and death Answer B is incorrect. Although denied grief is a pathologic entity, no symptoms of denial are elicited here Answer C is incorrect. Guilty feelings are a normal part of the grieving process. They are abnormal if the feelings are intense and include feelings of worthlessness Answer D is incorrect. Somatic symptoms such as headaches may be part of the normal bereavement process Answer E is incorrect. Weight loss of 1.3 kg (2.9 lb) or less is not worrisome. A weight loss of 3.6 kg (8.0 lb) or more would be worrisome for pathologic grief.