Unrelenting Grief May Be Sign of Distinct Syndrome

After Janice Van Wagner's mother died of breast cancer two years ago, her sense of loss was overwhelming.

"I was devastated," said Van Wagner, 34, of Los Angeles. "I felt like a piece of me had gone missing. It was like I was split in two."

While most people grieve when someone close to them dies, the emotional intensity tends to recede with time. But for some, like Van Wagner, their pain persists, sometimes for months or even years, often making it impossible to resume a normal life.

"I was kind of stuck in a repetitive thinking about the suffering that she went through in the last month of her life and the last few weeks," Van Wagner said. "I just kept reliving that over and over again in my mind."

This unrelenting form of mourning, which affects an estimated 10 percent to 20 percent of people who have lost someone close, is gaining recognition as a distinct psychological syndrome known as "complicated grief."

Now, in the first attempt to study it with brain scanning technology, researchers have found a biological clue that appears to help confirm the existence of the syndrome and explain why it happens.

"This is very important," said Camille B. Wortman, a professor of psychology at Stony Brook University in New York. "I think it has very important implications for how grief is conceptualized and how it is treated."

While cautioning that the findings need to be confirmed and explored by additional research, others agreed.

"This shows that there's actually a difference in the brains of people who have the syndrome compared to the ones who don't," said Katherine Shear, a professor of psychiatry at Columbia University. "Some people are still confused by the fact that it does resemble regular grief."

For the study, Mary-Frances O'Connor of the University of California at Los Angeles and her colleagues conducted functional magnetic resonance imaging (fMRI) on 11 women experiencing complicated grief, including Van Wagner, and 12 others who grieved more normally following the death of a mother or sister from breast cancer. During the scans, which show what parts of the brain are active at a given moment, each woman was asked to look at a picture of her lost loved one, with words superimposed to remind her of the death, or at similar pictures of strangers.

"I wanted to know if there is something different in the brain when people are processing their grief in those who are adapting well and those who are not adapting well," O'Connor said. "The question was: Are their brains processing their grief differently?"

In all the women, the parts of the brain involved in physical and emotional pain activated only when they saw the pictures of their loved ones. But in the women experiencing complicated grief, another area also lighted up. Called the nucleus accumbens, it is part of the brain's reward system, the researchers report in a paper being published this month in the journal NeuroImage.