Palliative and Supportive Care

Original Articles

The special case of complicated grief in women at high risk for breast cancer

David K. Wellischa1 c1 and Marie M. Cohena1

a1 Department of Psychiatry, UCLA School of Medicine, Los Angeles, California


Objective: Exploration of complicated grief focusing on the relationship of post-traumatic stress disorder (PTSD) and complicated grief in a population of women at high risk for developing breast cancer. Special reference is made to women who have experienced a material death.

Method: We reflected on the clinical attributes of the Revlon UCLA High Risk Clinic population in terms of their own perceived risk of developing breast cancer. For part of our population, their perceived risk was coupled with their reactions to the loss of their mothers to breast cancer. We compared and contrasted this pattern of reactions to those described by Licihtenthal et al. (2004) in their developmental review of complicated grief as a distinct disorder.

Results: We concluded that our population of women differed from Lichtenthal et al.'s (2004) model for complicated grief. Lichtenthal's group postulated that the key element of complicated grief involves the protracted nature of separation anxiety and distress and excludes PTSD. In our populations, the daughter with complicated grief experiences a combination of separation anxiety and a type of PTSD involving anxiety over the perceived certainty of her own future diagnosis of breast cancer. It was noteworthy that Lichtenthal's model population was composed of individuals caring for terminally ill spouses. Significantly, the spousal caretakers did not have an ongoing genetic link to their partners whereas our population is genetically linked. We postulate that this accounts for the unique presentation of complicated grief and PTSD in our population.

Significance of results: We submit that this combination of complicated grief and PTSD requires a cognitive reframing of thier perceived inevitability of developing breast cancer and desensitization techniques to help high risk women pursue preventative health care rather than avoiding it.

(Received April 15 2009)

(Accepted October 17 2009)


c1 Address correspondence and reprint requests to: David K. Wellisch, Department of Psychiatry, UCLA School of Medicine, Neuropsychiatric Institute and Hospital, Center for the Health Sciences, 760 Westwood Plaza, Los Angeles, CA 90024-1759. E-mail: