The neurobiological reward system in Prolonged Grief Disorder (PGD): A systematic review

Abstract

Prolonged Grief Disorder (PGD) is a debilitating condition affecting between 7% and 10% of bereaved individuals. Past imaging and psychological studies have proposed links between PGD's characteristic symptoms -in particular, profound yearning -and the neural reward system. We conducted a systematic review to investigate this connection. On December 19, 2019, we searched six bibliographic databases for data on the neurobiology of grief and disordered grief. We excluded studies of the hypothalamic-pituitary-adrenal (HPA) axis, animal studies, and reviews. After abstract and full-text screening, twenty-four studies were included in the final review. We found diverse evidence for the activation of several reward-related regions of the brain in PGD. The data reviewed suggest that compared to normative grief, PGD involves a differential pattern of activity in the amygdala and orbitofrontal cortex (OFC); likely differential activity in the posterior cingulate cortex (PCC), rostral or subgenual anterior cingulate cortex (ACC), and basal ganglia overall, including the nucleus accumbens (NAc); and possible differential activity in the insula. It

Validation of the new DSM‐5‐TR criteria for prolonged grief disorder and the PG‐13‐Revised (PG‐13‐R) scale

“…Research over the past quarter century has shown not only that a small but substantial proportion of grief reactions can be severe, disabling, and endure beyond normal expectations, but that they may respond only to specialist treatment. Specifically, studies have documented that certain grief symptoms are distinct from those of bereavement-related depression [6][7][8][9] , have idiosyncratic neurobiological 10 and clinical [11][12][13] correlates, can persist unabated for months or even years 8,14 , prove distressing and dysfunctional [14][15][16] , and may only respond to targeted intervention 17,18 . Thus, there exists a substantial and mounting body of evidence in support of a psychiatric syndrome of maladaptive grief.…”

Naltrexone treatment for prolonged grief disorder: study protocol for a randomized, triple-blinded, placebo-controlled trial

“…The first reason is that PGD has been shown to demonstrate a distinct neural profile when compared to MDD or PTSD [15]. In contrast to conceptualizing PGD as a mood disorder such as MDD or a stress response syndrome such as PTSD, there is emerging evidence to suggest that PGD may be conceptualized as a reward dysfunction disorder, with the deceased person as the rewarding stimulus for whom the bereaved person yearns [16]. PGD, as noted above, is at its core a disorder of attachment and a craving and yearning for the deceased from whom they are separated (resulting in significant separation distress).…”

“…Neurobiologically, numerous studies suggest that there are associations between symptoms of PGD and the reward pathway, which is the same pathway primarily responsible for addiction [ 16 ]. The reward pathway refers to a group of interconnected structures in the brain that uses dopamine as a signal to modulate the experience of reward.…”

Liebeskummer

“…Einem Review zufolge [33] Gestützt wird die Annahme, dass ein primär durch negative Emotionen geprägter langanhaltender Zustand nach einem Verlusterlebnis mit einer Belohnungsdysregulation einhergehen kann, allerdings durch ähnliche Befunde bei PGD, der anhaltenden Trauerstörung [41]. So zeigen sich bei PGD in bildgebenden Studien ebenfalls Aktivierungen des Belohnungssystems, der Basalganglien, des orbitofrontalen Kortex und der Amygdala, ähnlich wie bei den Liebeskummerstudien und ähnlich wie in Studien zu Suchterkrankungen.…”