Öz
Grief is a normal process that occurs following the irreversible loss of a loved one. This process, characterized by painful experiences, varies widely and is influenced by numerous factors, including the identity of the deceased, the circumstances of their death, the individual characteristics of the bereaved, and the availability of support systems. The suddenness and violence of a loss can disrupt the normal grieving process, leading to the manifestation of traumatic symptoms. This phenomenon, referred to as “traumatic grief” in the literature, is associated with an increased risk of various psychiatric disorders, including major depression, anxiety disorders, and post-traumatic stress disorder. The death of a parent represents a profound loss for an adolescent, complicating their coping mechanisms and significantly impacting their psychological well-being. Parental loss alone is a significant risk factor for suicidal behavior in adolescents. When a parent’s death is traumatic, it can further exacerbate this risk, leading to suicidal thoughts and behaviors by disrupting the normal grief process, even in adolescents who were previously mentally healthy. This article presents the diagnosis and treatment of a 17-year-old girl who exhibited active suicidal thoughts and behaviors after her father was killed with a firearm. The objective of this case report is to explore the atypical grief symptoms that can follow traumatic losses during adolescence and to assess the effectiveness of holistic approaches that combine supportive psychotherapy with pharmacotherapy in treating such cases.
Anahtar Kelimeler
Etik Beyan
Written informed consent for the presentation and publication of the case was obtained from the patient and her parent on the condition that the patient anonymity must be preserved.
Kaynakça
- 1. Freud S. Mourning and melancholia. The standard edition of the complete psychological works of Sigmund Freud,1917, 237-258.
- 2. Lindemann E. Symptomatology and management of acute grief. Am J Psychiatry. 1944; 101: 141-148.
- 3. Engel GL. Is grief a disease? A challenge for medical research. Psychosom. Med. 1960; 22:18-25.
- 4. Bowlby J, Parkes C. Separation and Loss within the Family. In Anthony EJ (ed.) The Child in His Family. New York: Whiley, 1970.
- 5. Volkan V. Normal and pathological grief reactions—a guide for the family physician. Virginia Med. 1966;93: 651–656.
- 6. Kübler-Ross E. On Death and Dying. Collier Books Macmillan Publishing, 1969.
- 7. Worden W. Grief counselling and grief therapy: A handbook for the mental health practitioner. New York, Brunner-Routlege, 2001.
- 8. Çevik A, Öncü B. Normal ve patolojik yas kliniğinin çok boyutlu incelenmesi ve tedavi ilkeleri. Psikiyatri Bülteni.1995;3(3):109-14. (Turkish article).
- 9. Lindemann E. Symptomatology and management of acute grief. Pastoral Psychology. 1963; 14(6): 8-18.
- 10. Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH. Diagnostic criteria for complicated grief disorder. Am J Psychiatry. 1997; 154: 904-910.
- 11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision. Washington: American Psychiatric Association, 2022.
- 12. Prigerson HG, Shear MK, Jacobs SC, et al. Consensus criteria for Traumatic Grief: A preliminary empirical test. Br J Psychiatry. 1999;174: 67–73. https://doi.org/ 10.1192/bjp.174.1.67.
- 13. Jacobs S, Mazure C, Prigerson H. Diagnostic criteria for traumatic grief. Death Stud.2000; 24(3): 185–199. https://doi.org/10.1080/074811800200531.
- 14. Parkes CM. A historical overview of the scientific study of bereavement. In: Stroebe MS, Hansson RO, Stroebe W, Schut H (eds.). Handbook for bereavement research: Consequences, coping, and care. Washington, DC. APA, 2001.
- 15. Prigerson HG, Bierhals AJ, Kasl SV et al. Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry. 1997; 154: 616-623.
- 16. Hensley PL (2006). Treatment of bereavement-related depression and traumatic grief. J Affect Disord. 2006; 92(1): 117-124. https://doi.org/10.1016/j.jad.2005.12.041.
- 17. Melhem NM, Day N, Shear MK, Day R, Reynolds III CF, Brent D. Traumatic grief among adolescents exposed to a peer’s suicide. Am J Psychiatry. 2004; 161(8): 1411-1416. https://doi.org/10.1176/appi.ajp.161.8.1411.
- 18. Keyes KM, Pratt C, Galea S, McLaughlin KA, Koenen KC, Shear MK. The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry. 2014;171(8); 864–871. https://doi.org/10.1176/appi.ajp.2014.13081132.
- 19. Simon NM, Shear MK, Reynolds CF et al. Commentary on evidence in support of a grief‐related condition as a DSM diagnosis. Depression and Anxiety. 2020;37(1):9-16. https://doi.org/10.1002/da.22985.
- 20. Prigerson HG, Horowitz MJ, Jacobs SC et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM‐V and ICD‐11. PLoS Med. 2009;6(8): e1000121. https://doi.org/10.1371/journal.pmed.1000121.
- 21. Baker AW, Keshaviah A, Horenstein A et al. The role of avoidance in complicated grief: A detailed examination of the grief‐related avoidance questionnaire (GRAQ) in a large sample of individuals with complicated grief. J Loss Trauma. 2016; 21(6): 533–547. https://doi.org/10.1080/15325024. 2016.1157412.
- 22. Jacobs S. Traumatic grief: Diagnosis, treatment, and prevention. Routledge, 2016.
- 23. Mannarino AP, Cohen JA. Traumatic loss in children and adolescents. J Child Adolesc Trauma. 2011; 4:22-33. https://doi.org/10.1080/19361521.2011.545048.
Öz
Yas, sevilen birinin geri dönüşümsüz kaybı sonrasında yaşanan normal bir süreçtir. Acı deneyimler içeren bu süreç, ölen kişinin kimliği, ölüm şekli, kayıp yaşayan kişinin bireysel özellikleri, destek sistemleri gibi birçok etmenle ilişkili olarak farklı biçimlerde yaşantılanabilir. Kayıp şeklinin ani ve şiddet içeren şekilde olması, olağan yas sürecini etkileyerek bireyin kayıp sürecinde travmatik belirti ve bulgular yaşamasına neden olabilir. Literatürde “travmatik yas” olarak tanımlanan bu süreç, major depresyon, anksiyete bozuklukları, posttravmatik stres bozukluğu başta olmak üzere birçok psikiyatrik hastalık açısından risk teşkil etmektedir. Ebeveynin ölümü ergen için benliğin baş etmesini zorlayan ağır bir kayıptır. Tek başına ebeveyn kaybı, ergenlerde intihar davranışı için önemli risk faktörüdür. Ebeveynin travmatik kaybı, ruhsal açıdan sağlıklı bir ergende dahi olağan yas sürecini bozarak ebeveyn ölümü sonrası intihar düşünce ve davranışlarına neden olabilir. Bu yazıda, babasının ateşli silahla öldürülmesi sonrasında aktif suicidal düşünce ve davranışlar ile çocuk ve ergen psikiyatri polikliniğine başvuran 17 yaşında bir kız hastanın tanı ve tedavi süreci anlatılacaktır. Bu olgu sunumunun amacı, ergenlik dönemindeki travmatik kayıplar sonrası olağan dışı yas bulgularının gözden geçirilmesi ve tedavide farmakoterapinin yanı sıra destekleyici psikoterapinin uygulandığı bütüncül yaklaşımların etkinliğinin değerlendirilmesidir.
Anahtar Kelimeler
Kaynakça
- 1. Freud S. Mourning and melancholia. The standard edition of the complete psychological works of Sigmund Freud,1917, 237-258.
- 2. Lindemann E. Symptomatology and management of acute grief. Am J Psychiatry. 1944; 101: 141-148.
- 3. Engel GL. Is grief a disease? A challenge for medical research. Psychosom. Med. 1960; 22:18-25.
- 4. Bowlby J, Parkes C. Separation and Loss within the Family. In Anthony EJ (ed.) The Child in His Family. New York: Whiley, 1970.
- 5. Volkan V. Normal and pathological grief reactions—a guide for the family physician. Virginia Med. 1966;93: 651–656.
- 6. Kübler-Ross E. On Death and Dying. Collier Books Macmillan Publishing, 1969.
- 7. Worden W. Grief counselling and grief therapy: A handbook for the mental health practitioner. New York, Brunner-Routlege, 2001.
- 8. Çevik A, Öncü B. Normal ve patolojik yas kliniğinin çok boyutlu incelenmesi ve tedavi ilkeleri. Psikiyatri Bülteni.1995;3(3):109-14. (Turkish article).
- 9. Lindemann E. Symptomatology and management of acute grief. Pastoral Psychology. 1963; 14(6): 8-18.
- 10. Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH. Diagnostic criteria for complicated grief disorder. Am J Psychiatry. 1997; 154: 904-910.
- 11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision. Washington: American Psychiatric Association, 2022.
- 12. Prigerson HG, Shear MK, Jacobs SC, et al. Consensus criteria for Traumatic Grief: A preliminary empirical test. Br J Psychiatry. 1999;174: 67–73. https://doi.org/ 10.1192/bjp.174.1.67.
- 13. Jacobs S, Mazure C, Prigerson H. Diagnostic criteria for traumatic grief. Death Stud.2000; 24(3): 185–199. https://doi.org/10.1080/074811800200531.
- 14. Parkes CM. A historical overview of the scientific study of bereavement. In: Stroebe MS, Hansson RO, Stroebe W, Schut H (eds.). Handbook for bereavement research: Consequences, coping, and care. Washington, DC. APA, 2001.
- 15. Prigerson HG, Bierhals AJ, Kasl SV et al. Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry. 1997; 154: 616-623.
- 16. Hensley PL (2006). Treatment of bereavement-related depression and traumatic grief. J Affect Disord. 2006; 92(1): 117-124. https://doi.org/10.1016/j.jad.2005.12.041.
- 17. Melhem NM, Day N, Shear MK, Day R, Reynolds III CF, Brent D. Traumatic grief among adolescents exposed to a peer’s suicide. Am J Psychiatry. 2004; 161(8): 1411-1416. https://doi.org/10.1176/appi.ajp.161.8.1411.
- 18. Keyes KM, Pratt C, Galea S, McLaughlin KA, Koenen KC, Shear MK. The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry. 2014;171(8); 864–871. https://doi.org/10.1176/appi.ajp.2014.13081132.
- 19. Simon NM, Shear MK, Reynolds CF et al. Commentary on evidence in support of a grief‐related condition as a DSM diagnosis. Depression and Anxiety. 2020;37(1):9-16. https://doi.org/10.1002/da.22985.
- 20. Prigerson HG, Horowitz MJ, Jacobs SC et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM‐V and ICD‐11. PLoS Med. 2009;6(8): e1000121. https://doi.org/10.1371/journal.pmed.1000121.
- 21. Baker AW, Keshaviah A, Horenstein A et al. The role of avoidance in complicated grief: A detailed examination of the grief‐related avoidance questionnaire (GRAQ) in a large sample of individuals with complicated grief. J Loss Trauma. 2016; 21(6): 533–547. https://doi.org/10.1080/15325024. 2016.1157412.
- 22. Jacobs S. Traumatic grief: Diagnosis, treatment, and prevention. Routledge, 2016.
- 23. Mannarino AP, Cohen JA. Traumatic loss in children and adolescents. J Child Adolesc Trauma. 2011; 4:22-33. https://doi.org/10.1080/19361521.2011.545048.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ruh Sağlığı Hizmetleri |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2024 |
| Gönderilme Tarihi | 10 Haziran 2024 |
| Kabul Tarihi | 30 Temmuz 2024 |
| Yayımlandığı Sayı | Yıl 2024 |