# A nurse is assessing a 65-year-old client who lost their sibling to a sudden accident 12 months ago. Which assessment finding would indicate the client is experiencing complicated grief?

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> subject: Mental Health

## 문제

A nurse is assessing a 65-year-old client who lost their sibling to a sudden accident 12 months ago. Which assessment finding would indicate the client is experiencing complicated grief?

## 보기

1. The client reports occasional crying episodes when reminded of their spouse
2. The client has returned to work but mentions feeling less motivated than before
3. The client avoids going to places they used to visit together and reports feeling like life has no meaning **✔ 정답**
4. The client talks about their spouse in past tense and acknowledges the reality of the loss

**정답: 3**

## 해설

Avoidance of places and feelings of meaninglessness indicate complicated grief with functional impairment. Other options represent normal grief responses or mild symptoms.

## 심화 해설

Understanding Complicated Grief

The question focuses on distinguishing normal grief from complicated grief, which is now formally recognized as Prolonged Grief Disorder (PGD) in the DSM-5-TR and ICD-11. While most bereaved individuals adapt over time, a subset develops a chronic, debilitating condition. Research indicates that PGD affects approximately 3-10% of bereaved individuals, with prevalence rates in some populations ranging between 4.7–5.4% [3,4]. The core of PGD is not simply intense sadness, but a persistent, pervasive, and maladaptive grief response that impairs function long after the loss.

Analysis of the Correct Answer (Option 3)

The client’s behavior—avoiding places they used to visit together and reporting that “life has no meaning”—is a hallmark presentation of complicated grief. This reflects a state of yearning/longing coupled with a profound sense of meaninglessness, which are central symptoms of PGD. The avoidance is a maladaptive coping mechanism to prevent triggering the intense emotional pain of the loss. A latent profile analysis of bereaved parents from the Sewol ferry disaster found that individuals in the most severe grief and PTSD profiles exhibited significant functional impairment and a lower quality of life, directly linking such pervasive symptoms to poor outcomes [2]. This persistent disruption, lasting over 12 months in this case, signifies a failure to integrate the loss and move forward adaptively.

Why the Other Options are Incorrect

Option 1: Reporting occasional crying episodes when reminded of the deceased is a normal grief reaction. Grief is not a linear process, and acute pangs of sadness triggered by memories can occur for years. This represents the normal oscillation between loss-oriented and restoration-oriented coping, not the pervasive, debilitating state of PGD.

Option 2: Returning to work but feeling less motivated is a common feature of normal, uncomplicated grief. The ability to resume daily activities, even with reduced enthusiasm, indicates functional progression. In contrast, PGD is characterized by a more profound functional impairment and a sense of identity disruption that makes resuming normal roles extremely difficult [3].

Option 4: Talking about the deceased in the past tense and acknowledging the reality of the loss is a critical sign of healthy grieving. This demonstrates that the cognitive processing of the loss has occurred. A key feature of PGD is a persistent disbelief or difficulty accepting the death, which this client is clearly not exhibiting [3]. A systematic review on young individuals bereaved by cancer found that a subset develops persistent grief symptoms, but acknowledging the reality of the loss is a protective factor, not a symptom .References (research sources)

- [2]Traumatic Loss After the Sewol Ferry Disaster: Latent Profiles of Grief and Posttraumatic Stress Disorder and Their Links to Social Stress, Growth, and Quality of Life.Research articleLee JS, Lee YR, Hyun J, Sohn S, Kang K, Huh HJ. (2026) · DOI: 10.30773/pi.2025.0126

- [3]Prolonged grief disorder in later life: advancing our understanding of biopsychosocial mechanisms to guide future personalized interventions.Research articleGoveas JS, Hwang G, Blair NP, Stein EA, Reynolds CF. (2026) · DOI: 10.1038/s41386-026-02329-x

## 임상 시나리오

Identifying Prolonged Grief DisorderBeyond Normal Bereavement
Normal grief integrates over time. Prolonged Grief Disorder (PGD) is diagnosed when symptoms persist for at least 12 months (adults) and cause significant functional impairment.

Key indicators include intense yearning/longing, a sense of meaninglessness, identity disruption, and maladaptive avoidance of reminders of the loss.

CautionDo not mistake PGD for normal grief. Occasional crying, reduced motivation, or acknowledging the loss are expected. PGD is marked by pervasive, debilitating symptoms that fail to improve.

## 핵심 개념

- **Complicated Grief** — A persistent, pervasive, and maladaptive grief response, formally recognized as Prolonged Grief Disorder (PGD), causing significant functional impairment lasting beyond cultural norms (e.g., >12 months).
- **Prolonged Grief Disorder (PGD)** — The DSM-5-TR diagnosis for complicated grief, characterized by intense yearning/longing, preoccupation with the deceased, identity disruption, disbelief, avoidance, and intense emotional pain causing clinically significant distress or impairment.
- **Maladaptive Coping** — Coping strategies, such as persistent avoidance of reminders, that prevent an individual from adapting to a stressor and integrating an experience, ultimately impairing daily function.

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