A new perspective on agitated grief reactions

This paper suggests a psychodynamic formulation to promote further understanding of patients manifesting symptoms commonly referred to as agitated grief, or agitated depression. This condition is associated primarily with the death of a parent. Insufficiently separated identity, regressive processes of identification, and AA-pseudo-autonomy are identified as significant contributors to this condition. Most significantly, an unconscious fantasy of imminent death to befall the symbiotic survivor is identified as precipitating the panic, terror, and moderate-severe disorganization of ego functions which differentiates agitated grief from bereavement or other forms of depressive reactions. During the crisis stage the therapist's informed presence can provide the patient with a stable secondary reference point. This element of the therapeutic relationship can lead to a pronounced diminution of anxiety, halt further ego disorganization and promote improved coherence of ego functions. Given this stabilization, the unconscious fantasy of imminent death can be introduced to the patient's consciousness thus obviating its pathological effects.