to reminders of their loss. in the case of the amygdala, this links to their sadness intensity. in those individuals who avoid such thoughts, there is a related opposite type of pattern in which there is a decrease in the activation of the dorsal amygdala and the dorsolateral prefrontal cortex. in those not so emotionally affected by reminders of their loss, studies of fmri scans have been used to conclude that there is a high functional connectivity between the dorsolateral prefrontal cortex and amygdala activity, suggesting that the former regulates activity in the latter. in those people who had greater intensity of sadness, there was a low functional connection between the rostral anterior cingulate cortex and amygdala activity, suggesting a lack of regulation of the former part of the brain upon the latter. evolutionary theories from an evolutionary perspective, grief is perplexing because it appears costly, and it is not clear what benefits it provides the sufferer. several researchers have proposed functional explanations for grief, attempting to solve this puzzle. sigmund freud argued that grief is a process of libidinal reinvestment. the griever must, freud argued, disinvest from the deceased, which is a painful process. but this disinvestment allows the griever to use libidinal energies on other, possibly new attachments, so it provides a valuable function. john archer, approaching grief from an attachment theory perspective, argued that grief is a byproduct of the human attachment system. generally, a grief-type response is adaptive because it compels a social organism to search for a lost individual (e.g., a mother or a child). however, in the case of death, the response is maladaptive because the individual is not simply lost and the griever cannot reunite with the deceased. grief, from this perspective, is a painful cost of the human capacity to form commitments. other researchers such as randolph nesse have proposed that grief is a kind of psychological pain that orients the sufferer to a new existence without the deceased and creates a painful but instructive memory. if, for example, leaving an offspring alone at a watering hole led to the offspring's death, grief creates an intensively painful memory of the event, dissuading a parent from ever again leaving an offspring alone at a watering hole. more recently, bo winegard and colleagues argued that grief might be a socially selected signal of an individual's propensity for forming strong, committed relationships. from this social signaling perspective, grief targets old and new social partners, informing them that the griever is capable of forming strong social commitments. that is, because grief signals a person's capacity to form strong and faithful social bonds, those who displayed prolonged grief responses were preferentially chosen by alliance partners. the authors argue that throughout human evolution, grief was therefore shaped and elaborated by the social decisions of selective alliance partners. risks bereavement, while a normal part of life, carries a degree of risk when severe. severe reactions affect approximately 10% to 15% of people. severe reactions mainly occur in people with depression present before the loss event. severe grief reactions may carry over into family relations. some researchers have found an increased risk of marital breakup following the death of a child, for example. others have found no increase. john james, author of the grief recovery handbook and founder of the grief recovery institute, reported that his marriage broke up after the death of his infant son. health risks many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. colin murray parkes in the 1960s and 1970s in england noted increased doctor visits, with symptoms such as abdominal pain, breathing difficulties, and so forth in the first six months following a death. others have noted increased mortality rates (ward, a.w. 1976) and bunch et al. found a five times greater risk of suicide in teens following the death of a parent. bereavement also increases the risk of heart attack. complicated grief prolonged grief disorder (pgd), formerly known as complicated grief disorder (cgd), is a pathological reaction to loss representing a cluster of empirically derived symptoms that have been associated with long-term physical and psycho-social dysfunction. individuals with pgd experience severe grief symptoms for at least six months and are stuck in a maladaptive state. an attempt is being made to create a diagnosis category for complicated grief in the dsm-5. it is currently an "area for further study" in the dsm, under the name persistent complex bereavement disorder. critics of including the diagnosis of complicated grief in the dsm-5 say that doing so will constitute characterizing a natural response as a pathology, and will result in wholesale medicating of people who are essentially normal. shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions. complicated grief is not synonymous with grief. complicated grief is characterised by an extended grieving period and other criteria, including mental and physical impairments. an important part of understanding complicated grief is understanding how the symptoms differ from normal grief. the mayo clinic states that with normal grief the feelings of loss are evident. when the reaction turns into complicated grief, however, the feelings of loss become incapacitating and continue even though time passes. the signs and symptoms characteristic of complicated grief are listed as "extreme focus on the loss and reminders of the loved one, intense longing or pining for the deceased, problems accepting the death, numbness or detachment ... bitterness about your loss, inability to enjoy life, depression or deep sadness, trouble carrying out normal routines, withdrawing from social activities, feeling that life holds no meaning or purpose, irritability or agitation, lack of trust in others". the symptoms seen in complicated grief are specific because the symptoms seem to be a combination of the symptoms found in separation as well as traumatic distress. they are also considered to be complicated because, unlike normal grief, these symptoms will continue regardless of the amount of time that has passed and despite treatment given from tricyclic antidepressants. individuals with complicated grief symptoms are likely to have other mental disorders such as ptsd (post traumatic syndrome disorder), depression, anxiety, etc. an article by the nejm (the new england journal of medicine) states complicated grief cases are multifactorial, and that complicated grief is distinguished from major depression and post-traumatic stress disorder. evidence shows that complicated grief is a more severe and prolonged version of acute grief than a completely different type of grief. while only affecting 2 to 3% of people in the world, complicated grief is usually contracted when a loved one dies suddenly and in a violent way. in the study "bereavement and late-life depression: grief and its complications in the elderly" six subjects with symptoms of complicated grief were given a dose of paroxetine, a selective serotonin re-uptake inhibitor, and showed a 50% decrease in their symptoms within a three-month period. the mental health clinical research team theorizes that the symptoms of complicated grief in bereaved elderly are an alternative of post-traumatic stress. these symptoms were correlated with cancer, hypertension, anxiety, depression, suicidal ideation, increased smoking, and sleep impairments at around six months after spousal death. a treatment that has been found beneficial in dealing with the symptoms associated with complicated grief is the use of serotonin specific reuptake inhibitors such as paroxetine. these inhibitors have been found to reduce intrusive thoughts, avoidant behaviors, and hyperarousal that are associated with complicated grief. in addition psychotherapy techniques are in the process of being developed. disenfranchised grief disenfranchised grief is a term describing grief that is not acknowledged by society. examples of events leading to disenfranchised grief are the death of a friend, the loss of a pet, a trauma in the family a generation prior, the loss of a home or place of residence particularly in the case of children, who generally have little or no control in such situations, and whose grief may not be noticed or understood by caregivers. american military children and teens in particular move a great deal while growing up, an aborted or miscarried pregnancy, a parent's loss or surrender of a child to adoption, a child's loss of their birth parent to adoption, the death of a loved one due to a socially unacceptable cause such as suicide, or the death of a celebrity. there are fewer support systems available for people who experience disenfranchised grief compared to those who are going through a widely recognized form of grief. therefore, people who suffer disenfranchised grief undergo a more complicated grieving process. they may feel angry and depressed due to the lack of public validation which leads to the inability to fully express their sorrow. moreover, they may not receive sufficient social support and feel isolated. examples of bereavement death of a child it is a fearful thing to love what death can touch.josephine jacobson, the instant of knowing (library of congress, 1974), 7. this 1860 woodcut by julius schnorr von karolsfeld depicts the death of bathsheba's first child with david, who lamented, "i shall go to him, but he will not return to me" (2 samuel 12:23) death of a child can take the form of a loss in infancy such as miscarriage, stillbirth, neonatal death, sids, or the death of an older child. among adults over the age of 50, approximately 11% have been predeceased by at least one of their offspring. in most cases, parents find the grief almost unbearably devastating, and it tends to hold greater risk factors than any other loss. this loss also bears a lifelong process: one does not get 'over' the death but instead must assimilate and live with it. intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide. feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies. suicide parents may feel they cannot openly discuss their grief and feel their emotions because of how their child died and how the people around them may perceive the situation. parents, family members and service providers have all confirmed the unique nature of suicide-related bereavement following the loss of a child. the difference in suicide-related bereavement is that there are different reactions and ways when we respond to the loss of someone we love dearly. some examples are post-traumatic stress, family, and relationship tensions. post-traumatic stress (pts) can affect the person severely when witnessing the death of someone. it can give them horrible trauma and nightmares may occur making them have a lack sleep. another reaction is family and relationship tensions. having loved ones by their side could really support them, but some families might lack connections or communications with one another. they feel as if they are going to bring more burden to others. some have different perspectives on themselves when communicating with others and might keep their feelings to themselves. it's a way to protect their inner feelings as if they're scared to share with others. death of a spouse many widows and widowers describe losing 'half' of themselves. a factor is the manner in which the spouse died. the survivor of a spouse who died of an illness has a different experience of such loss than a survivor of a spouse who died by an act of violence. often, the spouse who is "left behind" may suffer from depression and loneliness, and may feel it necessary to seek professional help in dealing with their new life. furthermore, most couples have a division of 'tasks' or 'labor', e.g., the husband mows the yard, the wife pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. planning and financing a funeral can be very difficult if pre-planning was not completed. changes in insurance, bank accounts, claiming of life insurance, securing childcare can also be intimidating to someone who is grieving. social isolation may also become imminent, as many groups composed of