Horowitz M J, Bonanno G A, Holen A
Langley Porter Psychiatric Institute, University of California, San Francisco.
Psychosom Med. 1993 May-Jun;55(3):260-73. doi: 10.1097/00006842-199305000-00004.
Pathological grief deserves a place in the diagnostic nomenclature. Because posttraumatic stress disorder requires an event beyond the range of usual experience and bereavement is virtually a universal experience, a new diagnosis of signs and symptoms precipitated by a loss event is needed. Many varieties of pathological grief have been noted in clinical research studies, and multiple diagnoses of pathological grief would make research difficult. The authors advance a solution in a personality-based explanation of abnormal responses to loss events; this allows for a single diagnosis of pathological grief. The authors also present a predictive model to partially explain pathological grief by antecedent trait combinations. The hypothesis is that persons with a preloss combination of both contradictions in relational schemas about the deceased and tendencies toward excessive control to stifle unwanted affect will tend to have unsuccessful processes of mourning. Types of contradictions and overcontrol may vary, yielding personality-based varieties of response within a single diagnostic category.
病理性哀伤在诊断术语中应占有一席之地。由于创伤后应激障碍需要一个超出正常经历范围的事件,而丧亲之痛几乎是一种普遍经历,因此需要一个由丧失事件引发的新的症状诊断。临床研究已经注意到多种病理性哀伤,而对病理性哀伤进行多种诊断会使研究变得困难。作者们提出了一种基于人格的解释,以说明对丧失事件的异常反应,这使得对病理性哀伤可以进行单一诊断。作者们还提出了一个预测模型,通过先前的特质组合来部分解释病理性哀伤。其假设是,在与逝者的关系模式中存在矛盾且有过度控制以抑制不必要情感倾向的人,在丧亲前就有这种组合的人,往往会有不成功的哀悼过程。矛盾和过度控制的类型可能各不相同,在单一诊断类别中产生基于人格的不同反应类型。