Objective: Bereavement is the experience of losing a loved one to death and grief is accepted as a natural reaction to bereavement. When symptoms of grief are particularly severe, last longer than expected according to social norms and accompanied by impairment in functionality; it can be defined as complicated grief. Psychotherapy has been mentioned as the first-line treatment in complicated grief and interpersonal psychotherapy as one of the options. Grief occurring in perinatal period is important because it possesses some special aspects and it is not very well known by clinicians.
Herein we aimed to present a case which was diagnosed with complicated grief occurred in perinatal period, after intrauterine loss of twins and to discuss her treatment process with interpersonal psychotherapy along with pharmacotherapy.
Case: Twenty-six year old female, married for five years without children, has received in vitro fertilization treatment and after third attempt twin pregnancy has been occurred. At the six and a half months of pregnancy, an early labor has started resulting in death of and both babies. One and a half year after this event, she has been referred to psychiatry and diagnosed with complicated grief. She was started on Sertraline 50 mg/day and titrated to 100 mg/day in one and a half month. In addition, she was followed with biweekly sessions of interpersonal psychotherapy. A total number of 14 sessions were made and a significant improvement occurred in symptoms with an increase in functionality. During psychotherapy sessions the featured themes were bereavement, evaluation of current relationships and closeness circle, conflicts with her husband and her mother, strengthening of social support systems, the moment when she learned of the death of her babies (concrete event), times before and after the death of her babies, and role transitions.
Conclusion: Complicated grief is accepted as a distinct disorder and its symptoms could persist for years when left untreated causing severe impairment in functionality and quality of life. Symptoms of complicated grief may improve with effective treatment and psychotherapy has been mentioned as the first-line treatment.
We want to emphasize that complicated grief should be included in differential diagnosis in perinatal period, in cases who experienced an intrauterine loss. Among pharmacotherapy and psychotherapy options, interpersonal psychotherapy should be considered as a beneficial and feasible alternative.
complicated grief, interpersonal psychotherapy, perinatal
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