By Julie Axelrod
~ 4 min read

The 5 Stages of Grief & Loss

The 5 Stages of Grief & Loss
The 5 stages of grief and loss are: 1. Denial and isolation; 2. Anger; 3. Bargaining; 4. Depression; 5. Acceptance. People who are grieving do not necessarily go through the stages in the same order or experience all of them.

The stages of grief and mourning are universal and are experienced by people from all walks of life, across many cultures. Mourning occurs in response to an individual’s own terminal illness, the loss of a close relationship, or to the death of a valued being, human or animal. There are five stages of grief that were first proposed by Elisabeth Kübler-Ross in her 1969 book On Death and Dying.

In our bereavement, we spend different lengths of time working through each step and express each stage with different levels of intensity. The five stages of loss do not necessarily occur in any specific order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief.

The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges: As long as there is life, there is hope. As long as there is hope, there is life.

Many people do not experience the stages of grief in the order listed below, which is perfectly okay and normal. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.

All, keep in mind — all people grieve differently. Some people will wear their emotions on their sleeve and be outwardly emotional. Others will experience their grief more internally, and may not cry. You should try and not judge how a person experiences their grief, as each person will experience it differently.

1. Denial & Isolation

The first reaction to learning about the terminal illness, loss, or death of a cherished loved one is to deny the reality of the situation. “This isn’t happening, this can’t be happening,” people often think. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock of the loss. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

2. Anger

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.
The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.

3. Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control–

If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…
Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

4. Depression

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words.

The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.

5. Acceptance

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.

Coping with loss is ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.

By DrEmmaBasch in psychcentral

~ 2 min read

Your Emotions After Miscarriage

Your Emotions After Miscarriage

Now that we’ve discussed some of the facts about miscarriage and why it occurs, I wanted to devote some time to exploring common emotional reactions to miscarriage

There is no one way you are supposed to feel (or not feel) following a miscarriage. I’ve seen women in my private practice express a range of emotions from numbness and disbelief, to despair, to anger, to those that experience their feelings somatically. Over the years of working with women who have lost pregnancies, I have been humbled to learn from their journeys of grief and loss. Below are reflections from my work with them that I hope will support those who are grieving and healing.

1. There is no normal, there is no supposed to, there is no right way to feel. Grief is very personal in this way. Some women experience significant distress following a loss, while some are less affected. Some experience despair right away and some women come to me for help years after a miscarriage finding that some new experience such as a subsequent pregnancy or a new loss has triggered them.
2. Grieving takes time. There is no roadmap for how long you “should” be grieving, and the feelings you experience may shift and change from day to day. This is expected and part of the process. How long you grieve for and what that grief feels like is not dependent on how far along you were in your pregnancy.
3. Many women experience significant guilt. Sometimes this is experienced as blaming oneself for the loss. Some women feel guilt for grieving at all. Some women feel guilt for having moments during the day where they are happy or are not focused on their loss.
4. Many women express a sense of anger or betrayal at their own bodies following a loss. I’ve had many clients describe feeling disconnected or dissociated from their bodies after a miscarriage.
5. Some women find themselves going into a “solving” or “doing mode,” where they fixate on some specific task or responsibility that feels very separate from the loss. I’ve had some clients throw themselves into work and some who become obsessed with physical fitness. These are normal attempts to distract and distance from the pain of loss, and to try and gain a sense of control following an experience that has felt very out of control.
6. Many women experience difficulties in their relationships with their spouse/partner following loss. Losing a pregnancy can be a very different experience for the mom then for the partner/spouse who did not share the physical connection to the pregnancy. The grief is often experienced and expressed differently.
7. It is normal to be triggered in both expected and unexpected ways. Many women feel triggered seeing pregnant women or babies, or looking at baby items. Some get triggered going back to their doctor’s office.
8. There are significant hormonal changes that occur after a pregnancy loss which can impact you physically and emotionally.
9. You may feel distant from friends and family, especially if you had not disclosed your pregnancy. You may find that some people find it difficult to offer appropriate support due to their own discomfort and unease. You may find that those you care about say profoundly hurtful and unhelpful things in attempts to be helpful.
10. While grief is a normal and expected process, some women find that they are unable to move through it, and that their grief morphs into intense feelings of depression and anxiety. This is especially true for those who have experienced multiple losses or who have a history of mental health concerns.

January 10, 2011 • Contributed by Janie Lacy, LMHC, NCC, CSAS, Sex Addiction Topic Expert Contributor

Married to Someone with Sex Addiction: Is Divorce the Only Option?

 

 Married to Someone with Sex Addiction: Is Divorce the Only Option?

Reported on ScienceDaily.com: “In a study, teens rarely talked to their parents about potentially risky online experiences. Parents and children often have much different perceptions of and reactions to the same online situations. Some of these situations may include cyberbullying, sexual exchanges and viewing inappropriate content online.”

“When you asked why teens didn’t talk to their parents, a lot of times they mention risky situations, which they didn’t think were a big deal, but they add that if they told their parents, they would just freak out and make things worse.” (Pamela Wisniewski, the lead researcher of the study.) (Italics are mine.)

The Parental Freak Out

In America at least, teens have been fearing parental freak outs since teenage-hood first became a recognized phenomenon. It seems to have begun in the 20th century, with a real recognition in the 1950s, the Rebel-Without-A-Cause-era. Previously, entertainment, parties, music and so on, though often geared towards “the young,” were not necessarily exclusively focused on adolescents. Families spent more time together in those days. Multi-generational parties were common. Then movies, television, and finally the internet came along, contributing to an increase in social and physical isolation from other family members.

Do Teenagers Exist?

There is an ongoing debate about whether or not teenagerhood is a cultural phenomenon or whether it is a description of a transformation that occurs mentally and emotionally during adolescence. (Some cultures don’t experience adolescence in the same, intense way we do in America, except primarily for the obvious physical changes.)

Whatever the cause of teenagerhood, the parental freak out doesn’t help bridge the parent-teenager divide and may be making it wider.

Another Step On Life’s Journey

Building an open and honest relationship takes time, effort, and, I believe, a commitment to staying as positive as possible. Double, for parent-child relationships. Learning parenting strategies before having children, or at least when they are little – not when your children are teenagers – is the truly effective option.

Adolescence in America is often assumed to be a time of rebellion, difficulties with parents, and negative, even risky behavior. While it is true that adolescence is a time children develop more autonomy, in truth, all of childhood is about developing a separate self from parents. Adolescence appears to be an acceleration of this development. Perhaps it seems so because the changes can be startling. Also, teens begin to form stronger relationship with peers, as they sort out who they want to “hang out with,” which is code for, “who I want to be.”

It can be helpful to view childhood, adolescence, and adulthood as points along a spectrum, rather than semi-pathologizing the admittedly often bewildering behaviors of teenagers.

Don’t Freak Out, Get Help

If you’re the parent of young children, start getting parenting guidance now. If you have strong and healthy parental role models, ask them for their advice. Remember, they’ve been through the ups and downs of parenting.

If you’re clashing with your adolescent child, get parenting help now, too. Even belated changes to your communication style can make a difference.

If your teenager is engaging in risky behaviors online, in person, or on their phones, do not freak out. Again, get help now.

If possible, get advice and even direct involvement from clergy, therapists, and wise, loving and supportive family members. Do what you can to express your concern and love to your child in as positive a fashion as possible. Tell kid of any age how much you love them, how your job as a parent is (in part) to help them learn how to be safe, and how to take care of themselves.

It’s not an unhealthy guilt trip to let them know how devastated you would be if they were harmed in any way. Judicious use of sincere discussions will do a lot more than rehashing old scenes involving yelling and screaming. (The key is judicious, too much, and it’s get stale, fast.)

Try ending every conversation with a loving statement–a genuine loving statement. After all, that’s really why you’re tempted to freak out in the first place.

Anxiety & Bipolar Disorder: Part II

By LaRae LaBouff
~ 2 min read

This article is Part II of “Anxiety & Bipolar Disorder.” You can read part one here.

Anxiety disorders are highly prevalent in those with bipolar disorder. Over 50% of patients have at least one. That means a person may not only be dealing with bipolar disorder but also generalized anxiety disorder and panic disorder, for example. Those that have both anxiety disorders and bipolar disorder tend to fare worse than those with bipolar disorder alone, so receiving the correct treatment is imperative.

What does anxiety look like in bipolar disorder?

Even outside having a co-occurring (comorbid) anxiety disorder, people with bipolar disorder can still experience debilitating anxiety. There are a couple of ways this can happen. The first is that bipolar disorder patients are still people. They can experience anxiety just like anyone else, even without having an anxiety disorder.

The other is having a bipolar episode with the specifier “with anxious distress.” Specifiers are basically extensions of the diagnosis. They help add clarification and specificity to the patient’s current mood state. Anxious distress can occur during any episode whether mania, hypomania or depression.

The diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) classifies a patient as having anxious distress if two of the following symptoms are experienced throughout an episode:

1 Feeling keyed up or tense.
2 Feeling unusually restless.
3 Difficulty concentrating because of worry.
4 Fear that something awful may happen.
5 Feeling that the individual might lose control of himself or herself.

The severity of the anxious distress is defined as:
Mild: Two symptoms.
Moderate: Three symptoms.
Moderate-severe: Four or five symptoms.
Severe: Four or five symptoms with motor agitation.

What impact does anxiety have on people with bipolar disorder?

People with comorbid anxiety and bipolar disorders tend to fare worse than those with bipolar disorder alone. Here are more ways bipolar disorder is impacted by anxiety:

People with both anxiety and bipolar disorders have longer episodes.
There is less time between episodes when both disorders are present.
Social phobias tend to proceed hypomanic episodes.
Nearly one-third of panic attacks are experienced in hypomania.
Those with both disorders begin having symptoms at a younger age.
Those with both disorders don’t respond as well to treatment.
Comorbid anxiety and bipolar disorders lead to worse functioning and lower quality of life.
People with both anxiety and bipolar disorders have a higher suicide rate.
What treatments for anxiety are available?

Treating an anxiety disorder in addition to bipolar disorder is tricky. The standard treatments for anxiety disorders are antidepressants and benzodiazepines. However, these medications can cause problems in people with bipolar disorder.

Antidepressants can induce manic or hypomanic symptoms in some people with bipolar disorder. They can also worsen symptoms over time and possibly trigger rapid cycling, in which the patient experiences more than four episodes in a single year.

Benzodiazepines are effective for acute anxiety but come with the risk of abuse and addiction. More than half of bipolar disorder patients also experience substance use disorder at some point in their lives.

When treating bipolar disorder and anxiety, bipolar disorder should be considered the primary illness and treated before an anxiety disorder. There is some evidence that treatments for bipolar disorder also treat anxiety. Mood stabilizers like gabapentin and divalproex have shown anti-anxiety effects. There is also limited evidence that atypical antipsychotics like risperidone may have anti-anxiety effects as well.

Any treatment plan should be constructed with a mental healthcare professional. Anxiety with bipolar disorder is especially complicated and must be treated according to the individual. Some may not need additional treatment other than those medications for bipolar disorder. Others may be able to tolerate antidepressants or benzodiazepines. Whatever the treatment plan, it must be followed and closely monitored so that the person with bipolar disorder can receive the best treatment possible in order to achieve a better quality of life.

Anxiety & Bipolar Disorder: Part I

By LaRae LaBouff
~ 2 min read
Anxiety & Bipolar Disorder: Part I Anxiety is a big factor in bipolar disorder. It can range from worrying about symptoms to full blown panic disorder. More than half of the people with bipolar disorder also have at least one type of anxiety disorder. With this knowledge, it is imperative that both professionals and patients educate themselves on the impact anxiety has on people with bipolar disorder. It is a serious illness that comes in many forms. Being able to recognize and treat anxiety in bipolar disorder can have a great impact on the livelihood of people suffering from both disorders.

What is anxiety?

Anxiety is basically a disproportional amount of worry. It is persistent and negatively impacts a person’s daily life. According the the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), apart from everyday anxiety or short-term anxiety, anxiety disorders typically last at least six months. In anxiety disorders, people will overestimate the danger or impact of a situation. Anxiety disorders typically develop during childhood and are more common in women than in men.

When a patient first seeks help for anxiety from a mental health professional, they may be given a survey to determine the severity of their anxiety. The patient rates seven statements on a scale of 1-5 referring to their symptoms over the past week. After the survey is completed, the mental health professional will determine the score to help determine whether or not the person may be dealing with an anxiety disorder. Note that this is not the only factor in determining whether or not a person has an anxiety disorder, it’s just the start.

The statements presented are:
1 I felt fearful
2 I felt anxious
3 I felt worried
4 I found it hard to focus on anything other than my anxiety.
5 I felt nervous
6 I felt uneasy
7 I felt tense

If a patient scores highly on the survey, the next step would be to try to determine if they have a diagnosable anxiety disorder and which type that may be.

What are the different types of anxiety disorders?

There are many types of anxiety disorders as anxiety can manifest in different ways. The most common anxiety disorders are:

Separation Anxiety Disorder– Typically occurring in children, the patient fears harm coming to loved ones. They may also have frequent nightmares.
Social Anxiety Disorder-The patient is anxious about or avoidant of social interaction in fear of scrutiny. This occurs especially in unfamiliar circumstances.
Panic Disorder-In panic disorder, patients will have sudden, intense feelings of anxiety and fear, known as a panic attack. Panic attacks are also accompanied by physical symptoms like heart palpitations, shaking, sweating and shortness of breath. Patients may become avoidant of specific circumstances in fear of having more panic attacks.
Agoraphobia-People with agoraphobia tend to be afraid of being in open or closed spaces or being in a crowd. The fear is typically that they will not be able to escape. They often develop panic-like symptoms and may avoid circumstances that trigger their fears.
Generalized Anxiety Disorder-People with generalized anxiety disorder have an intense anxiety over numerous aspects of life including work, school and relationships. It can be accompanied by symptoms such as restlessness, feeling keyed up, fatigue, difficulty concentrating, irritability, muscle tension and sleep problems.

Being familiar with anxiety is an important part of understanding some aspects of bipolar disorder, since anxiety disorders are so common in conjunction with bipolar disorder. Part II discusses the effects of anxiety disorders on bipolar disorder and the difficulties in treatment.