Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T04:39:11.121Z Has data issue: false hasContentIssue false
  • English
  • Français

The special case of complicated grief in women at high risk for breast cancer

Published online by Cambridge University Press:  18 February 2010

David K. Wellisch  and
Marie M. Cohen
David K. Wellisch*
Affiliation:
Department of Psychiatry, UCLA School of Medicine, Los Angeles, California
Marie M. Cohen
Affiliation:
Department of Psychiatry, UCLA School of Medicine, Los Angeles, California
*
Address correspondence and reprint requests to: David K. Wellisch, Department of Psychiatry, UCLA School of Medicine, Neuropsychiatric Institute and Hospital, Center for the Health Sciences, 760 Westwood Plaza, Los Angeles, CA 90024-1759. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Exploration of complicated grief focusing on the relationship of post-traumatic stress disorder (PTSD) and complicated grief in a population of women at high risk for developing breast cancer. Special reference is made to women who have experienced a material death.

Method:

We reflected on the clinical attributes of the Revlon UCLA High Risk Clinic population in terms of their own perceived risk of developing breast cancer. For part of our population, their perceived risk was coupled with their reactions to the loss of their mothers to breast cancer. We compared and contrasted this pattern of reactions to those described by Licihtenthal et al. (2004) in their developmental review of complicated grief as a distinct disorder.

Results:

We concluded that our population of women differed from Lichtenthal et al.'s (2004) model for complicated grief. Lichtenthal's group postulated that the key element of complicated grief involves the protracted nature of separation anxiety and distress and excludes PTSD. In our populations, the daughter with complicated grief experiences a combination of separation anxiety and a type of PTSD involving anxiety over the perceived certainty of her own future diagnosis of breast cancer. It was noteworthy that Lichtenthal's model population was composed of individuals caring for terminally ill spouses. Significantly, the spousal caretakers did not have an ongoing genetic link to their partners whereas our population is genetically linked. We postulate that this accounts for the unique presentation of complicated grief and PTSD in our population.

Significance of results:

We submit that this combination of complicated grief and PTSD requires a cognitive reframing of thier perceived inevitability of developing breast cancer and desensitization techniques to help high risk women pursue preventative health care rather than avoiding it.

Keywords

Complicate griefPTSDHigh-riskBreast cancer
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 1 , March 2010 , pp. 7 - 15
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bowlby, J. (1963). Pathological mourning and childhood mourning. Journal of the American Psychoanalytic Association, 11, 500–541.CrossRefGoogle ScholarPubMed
Bowlby, J. (1973). Attachment & Loss: Separation. New York: Basic Books.Google Scholar
Bowlby, J. (1980). Attachment and Loss, Vol. 3. Loss: Sadness and Depression. New York: Basic Books.Google Scholar
Brain, K., Norman, P., Gray, J., et al. (1999). Anxiety and adherence to breast self-examation in women with a family history of breast cancer. Psychosomatic Medicine, 61, 181–187.CrossRefGoogle ScholarPubMed
Braithwaite, D., Emery, J., Walter, F., et al. (2004). Psychological impact of genetic counseling for familial cancer: A systematic review of meta-analysis. Journal of the National Cancer Institute, 96, 122–133.CrossRefGoogle ScholarPubMed
Butow, P., Meiser, B., Price, M., et al. (2005). Psychological morbidity in women at increased risk of developing breast cancer: A controlled study. Psycho-Oncology, 14, 196–203.CrossRefGoogle ScholarPubMed
Clayton, P.G., Desmarais, L., & Winokur, G.A. (1968). A study of normal bereavement. American Journal of Psychiatry, 125, 168–178.CrossRefGoogle ScholarPubMed
Clayton, P.G., Hirjanic, M., & Murphy, G.E. (1974). Mourning and depression. Canadian Journal of Psychiatry, 19, 309–312.Google ScholarPubMed
Coyne, J.C., Benazon, N.R., Gaba, C.G., et al. (2000). Distress and psychiatric morbidity among women from high-risk breast and ovarian cancer families. Journal of Consulting and Clinical Psychology, 68, 864–874.CrossRefGoogle ScholarPubMed
Erblich, J., Bovbjerg, D.H., & Valdimorsdottir, H.B. (2000). Looking forward and back: Distress among women at familial risk for breast cancer. Annals of Behavioral Medicine, 22, 53–59.CrossRefGoogle ScholarPubMed
Gail, M.H., Brinton, L.A., Byar, D.P. et al. (1989). Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. Journal of National Cancer Institute, 81, 1879–1886CrossRefGoogle ScholarPubMed
Goldberg, D. & Williams, P. (1988). User's guide to the General Health Questionnaire. NFER-Nelson: E. Windsor Berks.Google Scholar
Hamann, H.A., Somers, T.J., Smith, A.W., et al. (2005). Postraumatic stress associated with cancer and BRCA 1&2 genetic testing. Psychosomatic Medicine, 67, 766–772.CrossRefGoogle Scholar
Horowitz, M.J., Siegal, B., Holen, A., et al. (1997). Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry, 154, 904–910.Google ScholarPubMed
Kash, K.M., Holland, J.C., Halper, M.S., et al. (1991). Psychological distress and surveillance behaviors of women with a family history of breast cancer. Journal of National Cancer Institute, 84, 24–30.CrossRefGoogle Scholar
Kash, K.M., Holland, J.C., Holger, M.S., et al. (1992). Psychological distress of surveillance behaviors of women with a family history of breast cancer. Journal of the National Cancer Institute, 84, 24–30.CrossRefGoogle ScholarPubMed
Katapodi, M.C., Lee, K.A., Facione, N.C., et al. (2004). Predictors of perceived breast cancer risk and the relation between perceived risk of breast cancer screening: A meta-analytic review. Preventive Medicine, 38, 388–402.CrossRefGoogle ScholarPubMed
Kelly, B., Edwards, P., Synott, R., et al. (1999). Predictors of bereavement outcome for family careers of cancer patients. Psycho-Oncology, 8, 237–249.3.0.CO;2-C>CrossRefGoogle Scholar
Lerman, C.L. & Schwartz, M. (1993). Adherence and psychological adjustment among women at high risk for breast cancer. Breast Cancer Research and Treatment, 28, 145–155.CrossRefGoogle ScholarPubMed
Lichtenthal, W., Cruess, D., & Prigerson, H.G. (2004). A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clinical Psychology Review, 24, 637–662.CrossRefGoogle ScholarPubMed
Meiser, B. & Holliday, J.D. (2002). What is the impact of genetic counseling in women at increased risk of developing hereditary breast cancer? A meta-analytic review. Social Science and Medicine, 54, 1463–1470.CrossRefGoogle ScholarPubMed
Neimeyer, R.A. (2001). Reauthoring life narratives: Grief therapy as meaning reconstruction. Israeli Journal of Psychiatry and Related Sciences, 38, 171–183.Google ScholarPubMed
Neimeyer, R.A., Prigerson, H.G., & Davies, B. (2002). Mourning and meaning. American Behavioral Scientist, 46, 235–251.CrossRefGoogle Scholar
Prigerson, H.G., Bierhals, A.J., Kasl, S.V., et al. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, 616–623.Google ScholarPubMed
Prigerson, H.G. & Jacobs, S.C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary emperical test. In Handbook of Bereavement Research: Consequences, coping, and care, Strobe, M.S. & Harrison, R.O. (eds.), pp. 613–645. Washington, D.C.: American Psychological Association.CrossRefGoogle Scholar
Shear, M.K., Frank, E., Foa, E., et al. (2001). Traumatic grief treatment: A pilot study. American Journal of Psychiatry, 158, 1506–1508.CrossRefGoogle ScholarPubMed
Spielberger, C.D. (1983). Manuel for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Trask, P.C., Patterson, A.G., Wang, C., et al. (2001). Cancer-specfic worry interference in women attending a breast and ovarian cancer risk evaluation program: Impact on emotional distress and health functioning. Psycho-Oncology, 10, 349–360.CrossRefGoogle ScholarPubMed
Van Doorn, C., Kasl, S.V., Beery, L.C., et al. (1998). The influence of marital quality and attachment styles on traumatic grief and depressive symptoms. Journal of Nervous and Mental Disease, 186, 566–573.CrossRefGoogle ScholarPubMed
Van Dooren, S., Rijnsburger, A.J., Seynaeve, C., et al. (2003). Psychological distress and breast self-examination frequency in women at increased risk for hereditary or familial breast cancer. Community Genetics, 6, 235–241.Google ScholarPubMed
Watson, E.K., Henderson, B.J., Brett, J., et al. (2005). The psychological impact of mammographic screening on women with a family history of breast cancer. A systematic review. Psycho-Oncology, 14, 939–941.CrossRefGoogle ScholarPubMed
Wellisch, D.K., Hoffman, A., Goldman, S., et al. (1999). Depression and anxiety symptoms in women at high risk for breast cancer: Pilot study of a group intervention. American Journal of Psychiatry, 156, 1644–1645.CrossRefGoogle ScholarPubMed