The medico-legal perspective in the assessment of the complicated grief disorder: considerations about 58 forensic cases

Abstract

The authors deal with the theme of the medico-legal assessment of the biological damage due to complicated grief through a retrospective analisys of 58 forensic cases observed during the 2000-2004 quinquennial at the Section of Criminolgy and Forensic Psychiatry of the University of Genoa, concerning to 13 fathers (22,4%), 20 mathers (34,5%), 9 widows/widowers (15,5%), 10 sons (17,3%), 6 siblings (10,3%) suffering from complicated grief. The main critical areas of this medico-legal investigation are highlighted, especially the problems concerning both the clinical/diagnostical and the forensic stage of the causality demonstration. The lack of specific diagnostic criteria for complicated grief in DSM-IV-TR is considered the main cause of the frequent use of less specific diagnostic categories such as: major depressive disorder (46,6%), adjustment disorders (17,3%), dysthymic disorder (10,3%), post-traumatic stress disorder (8,6%), generalized anxiety disorder (8,6%), separation anxiety disorder (8,6%). This implicate possible mistakes both in the comprehension of the real disorder’s nature and in the quantitative estimation of the damage because of the frequent instrumental use of the nosologic diagnosis for the biological damage quantification. The results confirm the relevance of the main risk factors described in most grief  literature, suggest the absence of proportionality between gravity of disorder and demand of medical care and indicate the family of the victim as the main resource to obtain indications useful for comprehension and causal explanation. Indeed, the family characteristics and the special dinamics that follow the loss of a member often play a key role in following grief devolopment. Despite the small sample size, this study may however encourage a more concrete discussion around medico-legal criteria useful to evaluate biological damage of relatives with problems of coping with grief, regardless of DSM diagnosis