When it comes to grief, how long is too long? After debate that lasted well over a decade, the American Psychiatric Association’s diagnostic manual, known as the DSM-5, recently added a controversial new diagnosis: prolonged grief disorder.
The definition is anguish over the death of a loved one lasting more than a year. But according to experts like clinical psychologist Zakieh Bigio Klurfeld, prolonged grief disorder can affect people going through divorce as well.
Klurfeld is the lead author of a fascinating study called “Comparing the Nature of Grief and Growth in Bereaved, Divorced, and Unemployed Individuals,” published in the Journal of Affective Disorders. I was excited to talk with her about her findings, especially around divorce.
What was your reaction to prolonged grief disorder being added to the DSM-5?
I’m pleased! Some people are having an understandable negative reaction to the word “disorder,” which implies the pathologizing of a normal human experience. However, what they may be missing in their analysis is the cost of not including grief in the DSM-5. Up until now, healthcare providers have not been as attuned to grief — how to accurately screen for it, how to effectively treat it — because it’s not in the same handbook as other common issues. As a result, including grief means we can all be on the same page about what to look out for and how to help aid recovery.
Why do you think it’s taken 10 years to get it added?
I imagine there are some politics and economics that I can’t weigh in on. What I can say is there needs to be enough evidence that a condition is valid and distinct from other conditions. (In this case, that grief is distinct from anxiety, depression, and PTSD.) There also needs to be compelling rationale for why including it will be helpful to people.
I’ve read several reports on the addition to the DSM-5, and none of them — including one from the APA — mentioned divorce. Why do you think that is?
This is an excellent question. People still narrowly think of grief in terms of bereavement. My work and the work of some other psychologists is to broaden this definition to include varied losses, including role losses.
Is there a belief that prolonged grief is understandable for death, but not divorce or other types of loss?
I think so. There isn’t a deep acknowledgement of grief as an outcome for role losses such as divorce or job loss. You don’t hear people continuously checking on someone after a divorce the way they may attend to someone after a death. I’m not suggesting that death and divorce are the same. However, when people are strongly identified with a specific role and they lose it, then they are likely to experience some grief. This is because our roles are very important in everyday life; they form our sense of who we are and our characteristic patterns in the world. I believe it’s important to stop narrowly defining grief in terms of bereavement and to expand it to other role losses for this reason.
How does your work differ from earlier studies?
I found that alongside grief, many people also experience post-traumatic growth, which is an experience of growing specifically from the loss itself. Some people felt stronger in themselves, more appreciative of life, more in touch with new possibilities, more connected to others, and even more spiritual from working through the disruption.
Do divorced people experience the same types of loss responses (prolonged grief, major depression, post-traumatic stress) as those who’ve dealt with a death? Is it different in any way?
A subset of divorced people experience prolonged grief, just like a subset of bereaved people and people who have experienced job loss do. My study found that the bereaved group reported significantly higher prolonged grief symptoms than the job loss group but not the divorced group, suggesting that role losses in the context of close attachment relationships are more impactful and disruptive.
Can a prolonged fight over custody or support add to feelings of grief?
I have not researched this, but it’s an important guiding question for future research. My guess is that prolonged processes complicate the practical task at hand and the feelings around it. Toxic dispute may amplify grief (if it disrupts your sense of your partner and yourself), whereas healthy and collaborative dispute may alleviate grief (if it affirms your sense of your partner and yourself). Some loss is inevitable either way. Because life is short, any rupture that can be settled more efficiently and more collaboratively is ideal, when possible, especially when children are involved.
Is there any advice you’d give people going through a divorce?
I want to be clear that I’m not an expert on divorce specifically. Here’s some advice regarding varied losses, divorce being one of them.
From an educational standpoint, everyone is different. Not everyone is equally identified with their relationships and roles or experiences the same magnitude of loss. That being said, divorce involves some level of role loss, and it’s helpful to know that both grief and growth can come from it. Grief is a normal human experience. It involves an adaptive biobehavioral response that prompts us to slow down and regroup in order to mitigate more loss. Allowing that process to unfold (instead of suppressing it or rushing it) while knowing we’re also wired to be resilient and move forward is important.
Some people who have experienced a death or divorce report that they no longer know who they are outside of the context of their relationship. Continuing some pre-divorce patterns of functioning may be helpful. Engaging in activities that strengthen your sense of self and the other roles in your life is helpful so that you can think of yourself as flexible and multi-faceted and not just unitary or fixed. Constructively thinking about your ability to cope with stressful life events can also make a big difference, and building on your natural resilience to do so with an experienced mental health professional can be transformative.
If it’s difficult to return to your normal level of functioning after an extended period, seeking professional help from providers who are attuned to life disruptions and the mix of feelings and practical issues that can come with it is advised. Finally, accepting social support from loved ones and meeting others who are going through comparable experiences can make a huge difference in feeling less isolated.
Thanks again to Zakieh Bigio Klurfeld for this insightful interview. You can read more of her work at Medium.