For a small percentage of people, loss doesn’t soften with time. New research reveals how prolonged grief disorder disrupts the brain’s reward systems—and how treatment can help.
For a small percentage of people, loss doesn’t soften with time. New research reveals how prolonged grief disorder disrupts the brain’s reward systems—and how treatment can help. A woman attends a candlelight vigil for victims of the Half Moon Bay shootings in California in 2023.
Scientists are investigating how brain systems involved in attachment and reward may continue to signal the presence of a lost loved one. A woman attends a candlelight vigil for victims of the shootings in Half Moon Bay in California, the United States, Jan. 27, 2023.Grief can bring waves of heartache, anger, or numbness—but for most people, those feelings gradually shift over time. For some, they don’t. The loss remains intense, persistent, and difficult to reconcile with daily life. in 2022. It describes a form of grief that doesn’t ease with time and interferes with a person’s ability to adapt to loss. “There’s something interfering with their ability to finally say, ‘OK, I know it’s something I can’t do anything about. I have to accept this,’” saysResearchers are now beginning to understand why. Rather than reflecting overwhelming sadness alone, PGD may involve disruptions in the brain systems that govern attachment and reward, according to aIn people with prolonged grief, those systems may continue to signal that the lost loved one is still expected or “reachable,” creating a mismatch between memory and reality. Over time, that unresolved signal may make it harder for the brain to update and accept the loss. “Because prolonged grief is a new kid on the block when it comes to diagnosis, in terms of understanding the neurobiology of it, we have a much smaller evidence base,” saysIt’s typically marked by persistent yearning for the lost loved one, feeling emotionally numb or detached, a shaken identity or sense of self, and not accepting the reality of the loss, she adds.. However, with acute grief, “there’s less yearning and more acceptance as time goes on,” she explains. “We’re not seeing change over time in people who have prolonged grief.” Even though the PGD diagnostic criteria specify that symptoms are related to a person’s death, Bryant says, “There's no doubt that we see prolonged grief symptoms in all sorts of loss,” such as a relationship or deceased pet.The brain activity associated with PGD hasn’t been studied as extensively as depression or post-traumatic stress disorder, Bryant says.and struggle to regulate emotions, he explains. Regions involved in reward and motivation—including the orbitofrontal cortex, striatum, and nucleus accumbens—appear to remain active in ways that suggest the brain is still expecting the presence of the lost loved one. “What seems to be the case is that people with severe grief are still showing that reward expectation of their loved one, when they see a cute photo, for example,” O’Connor says.For those without PGD, a photo may activate the memory and emotion-related areas of the brain, but not the reward-expectation response “that they’re going to walk through the door again,” she explains.published in 2020 and co-authored by Prigerson also found that PGD, compared to “normative grief,” involves different activity patterns in the amygdala and orbitofrontal cortex, which work together to process emotions and make reward-based decisions. may work differently in people with PGD, Prigerson says, but researchers aren’t sure why.An estimated 4 percent of people develop PGD after a loss, Prigerson says. Researchers are still working to understand why, but certain patterns are emerging.is higher after the death of a child or spouse, or among people with a history of depression, who’ve experienced multiple deaths, who have a lack of social support, or who are emotionally dependent on the person who died, according to the American Psychiatric Association.Prolonged grief disorder doesn’t just affect emotional well-being—it can have wide-ranging effects on physical health. It often occurs alongside conditions such asScientists are still working to understand why. One leading explanation is that prolonged grief keeps the body in a sustained stress response.—activate in response to a threat and then return to baseline. But in prolonged grief, that system may remain chronically engaged. Elevated levels of stress hormones like cortisol can, over time, strain the cardiovascular system, disrupt sleep, and interfere with immune function., but over time it has been linked to a range of diseases, including heart disease, metabolic disorders, autoimmune conditions, and gastrointestinal issues, says O’Connor.Prolonged grief disorder does not typically respond to antidepressants, interpersonal psychotherapy, or other approaches used to treat depression, Prigerson says., which involves 16 sessions and working through “healing milestones,” Shear says. These include understanding and accepting grief, imagining a promising future, strengthening relationships, narrating a story of the death, living reminders of the loss, and connecting with memories of the deceased. “The treatment really focuses on helping people accept the reality of the loss and restore their capacity for well-being, to thrive in their lives,” Shear explains. The recognition of PGD as a formal diagnosis in the DSM-5 has also made it easier for the likelihood of detection, accurate diagnoses, and effective treatment (andThis is crucial, O’Connor says, as “prolonged grief is this disabling and unbending experience.” And, people need time and support to heal, Shear adds.
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