Grief is a normal part of life, but for some of us it lasts months or years longer than is typical. Scientists are beginning to figure out why.
UNSW scientists have revealed new insights into a relatively new psychiatric disorder that sees patients get ‘stuck’ in their grieving process.
“Everybody knows what grief is,” says Scientia Professor Richard Bryant from the UNSW School of Psychology.
“There's great sadness and emotional pain associated with missing the person and wishing they were back.
“For most people that very intense pain eases over time.”
It’s a natural part of being a person, which is why for many years peak psychiatry bodies were reluctant to designate it a condition on its own, which the American Psychiatric Association did in 2022.
For about 5% of us, though, that intense pain doesn’t ease.
The symptoms linger for months and years, leading to something called “Prolonged Grief Disorder” (PGD).
“It's defined by missing the person very much, having a lot of sadness, feeling that life is meaningless,” says Prof. Bryant.
“There's a sense that part of themself has died.”
The bereaved mightn’t be able to accept their loved one has died, might continue to cook for them every night, or never throw out any of their belongings.
If they are “stuck” in their grief for more than six to twelve months, they might have PGD.
PGD is a relatively new area of study, but scientists are zeroing in on the part of the brain that might be driving the condition.
Prolonged Grief Disorder is the new kid on the block when it comes to psychiatric diagnoses.
The neurobiology of prolonged grief
In a recent article in Trends in Neurosciences, Richard Bryant and colleagues from the Westmead Institute for Medical Research suggest that Prolonged Grief Disorder may stem from misfires in the brain’s reward system.
They examined dozens of neuroimaging studies in which researchers provoke grief in participants and then analyse brain scans.
Participants are placed inside an MRI scanner, shown images of the person they’ve lost, and their brain activity is measured in real time.
Across multiple studies, Prof. Bryant says, a consistent pattern has emerged: the circuits most active in people with prolonged grief are those involved in reward, motivation and attachment.
Grief, at its core, is the brain registering the absence of someone that once brought reward.
In most people, that system gradually recalibrates after a death.
In prolonged grief disorder, it may not.
“What we see is that grief is very much driven by a more reward or goal-oriented function, your brain is saying ‘I want to be with that deceased person again’,” Professor Bryant says.
This is opposed to other mental health conditions, like anxiety or depression, which are driven by an aversion to something, and stem from a different part of the brain.
While evidence consistently points to the brain’s reward centre as the culprit for PGD, the researchers argue that there isn’t enough data right now to be certain.
They also point out that while some evidence supports a focus on the reward centre of the brain, other evidence suggests other potential avenues.
“Prolonged Grief Disorder is the new kid on the block when it comes to psychiatric diagnoses,” Professor Bryant says.
“So we don't have as much evidence, because it's only been researched in more recent times.”
Ultimately, Bryant and his colleagues say that clearer answers require larger samples, standardisation in what is a relatively new field of research, and longitudinal studies that directly test the mechanisms thought to keep grief stuck.
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Tom Melville, UNSW Science Media
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Email: tom.melville@unsw.edu.au
