The death of a loved one triggers a series of difficult and painful emotional reactions that the person going through the grieving process must respond to (Payás, 2008). Most individuals manage to decrease the intensity of these responses over time, but a minority experiences complications that deteriorate their physical and mental health. According to Payás (2002), coping styles refer to the different ways or strategies that individuals consciously or unconsciously employ to reduce, manage, and overcome the natural physical, mental, and emotional symptoms that arise during grief.
These coping mechanisms are dynamic processes that adapt to internal or external demands that exceed individuals' own resources (Payás, 2008). They are not fixed traits but active processes seeking to face a threatening, stressful, or loss situation in the best possible way. According to Payás (2008), how individuals react to these situations depends on internal variables such as developmental factors, personality traits, and previous loss experiences, among others; and external variables such as the type of trauma and perception of available support.
Among coping styles, the ruminative style is characterized by repetitive and passive attention to difficult or negative aspects of grief (Payás, 2008). This cognitive style has been associated with a higher incidence and severity of major depressive disorder, chronicity of the grieving process, and an increase in symptoms, especially those related to post-traumatic stress disorder. Therefore, the ruminative style is maladaptive and predicts an imbalance and lower quality of life for the affected person. However, according to Payás (2008), other studies suggest the opposite: that this persistent cognitive focus on thoughts or feelings related to the deceased and the impact of their loss on the mourner's life is a common response in grief, with very individual and potentially adaptive purposes and outcomes.
Although rumination has a negative correlation with overall well-being in some stages of grief, it does not necessarily mean that ruminating is always unproductive (Payás, 2008). Repetitive reviewing of the traumatic event can help individuals cope with the emotional impact and find a new meaning for the loss. According to Payás (2008), this construction of new meanings helps develop a new framework or worldview that incorporates the traumatic event and allows for a good resolution of grief.
Characteristics
When people lose a loved one, they experience obsessive rumination in grief, which are repetitive thoughts that persist in their minds without reaching any valid conclusion (Psonrie, n.d.). These thoughts generate a state of discomfort and anxiety, and they cannot be "blocked" despite the discomfort (Babis, 2020). In line with Ruiz (n.d.), this type of rumination is common in grief processes (Ruiz, n.d.), and it is associated with a lack of action, expression of emotions, and a general outlook on things in individuals experiencing them.
How do They Appear?
As a way of coping with pain, obsessive thinking is expressed through an internal verbal monologue in which the mourner addresses themselves, another person, or something, formulating questions, assigning blame, making accusations, taking responsibility, or expressing desires for revenge. Alternatively, they may review details about a situation in search of elements, answers, or meanings (Payás, 2008). These thoughts, related to three fundamental aspects: the circumstances of the death, the lost connection, and the repercussions of that loss, are characterized by their recurrence and reference to issues, situations, or elements that the mind has not yet assimilated; for example: "What if...?", "If I could go back...," "It's all my fault," "I can't live without him/her," among others (Psonrie, n.d.; Ruiz, n.d.). Thus, according to Ruiz (n.d.), obsessive ruminations commonly manifest through uncontrollable and intrusive thoughts that enter consciousness without the person intending or anticipating it.
How do They act?
The search for answers is a characteristic of obsessive rumination, where the person examines certain situations or elements that may explain the cause of the loss (Ruiz, n.d.). Likewise, obsessive ruminations manifest through a strong fixation on details surrounding death, especially those of lesser importance (Ruiz, n.d.). These ruminations lead individuals to become obsessed with finding answers that do not exist, believing that this will provide relief (Psonrie, n.d.). Additionally, through these intrusive thoughts, individuals focus on the negative symptoms caused by the death of a loved one, as well as the possible causes and consequences (Ruiz, n.d.). In line with Ruiz (n.d.), the result of all these processes is that individuals ruminate on things or ideas without obtaining a clear or healing response, thereby depleting their mood and energy.
The Obsession Characteristic of Ruminations
Obsessions involve a mental experience of reality in which the person does not live but rather thinks about living. Therefore, everything is centered in the mind, in repeating things, seeking answers, and meandering without taking action (Ruiz, n.d.). In this mental experience, the person focuses on a specific aspect of reality; in this case, aspects related to death or the grieving process (Psonrie, n.d.). As a result, the overall view of the situation is lost; the person ceases to perceive much of reality due to the obsession with meticulously examining only one part of it (Ruiz, n.d.). This leads to a loss of perspective and objectivity, obtaining only a partial and simplistic view of what is happening, preventing a healthy conclusion of the grieving process (Psonrie, n.d.). Thus, Ruiz (n.d.) describes the obsession inherent in obsessive rumination as a rigid and inflexible cognitive fixation that hinders the individual's progress in their grief and obstructs a healthy and adaptive process.
Consequences
The fixation, where the person only perceives a part of reality, leads directly to inactivity or passivity, where the person does not take action but remains immersed in certain thoughts (Psonrie, n.d.). This is accompanied by a sense of loneliness inherent in this stage (Ruiz, n.d.). In this way, individuals experiencing frequent obsessive rumination often tend to isolate themselves, making it difficult for them to connect with their surroundings and themselves. Similarly, obsessive ruminations alter the behavior of the person going through the process, which may involve looking down, talking to themselves, among other things (Ruiz, n.d.). In summary, the obsessive mechanism is a form of death, a death to oneself, a death to relationships with others, and a death to life (Payás, 2008). Consequently, according to Ruiz (n.d.), it is common for the individual to struggle to connect with their subjective experience and with what they are communicating to others.
Psychological Functions
The psychological functions of obsessive rumination, although a pathological mechanism, are explained by the mind's need to avoid suffering (Ruiz, n.d.). These functions are classified into three categories: those related to the trauma of death, those related to bonding, and those related to the denial of pain (Ruiz, n.d.). The first, arising as a survival response after the traumatic death of a loved one, serve to enhance predictability in the face of the reality of death (Payás, 2008). Obsession involves the fantasy of changing the past and doing things differently, representing an attempt at control. The brain, in an effort to prevent a repetition of the trauma, constantly reviews the details of death, seeking understanding of what happened. Thus, according to Payás (2008), obsessive thinking becomes a cognitive defense that helps the grieving individual create order and improve predictability in the face of future losses.
In relation to bonding, obsession in the form of guilt serves a reparative psychological function (Payás, 2008). Guilt thoughts act as an internalized self-critique to avoid external criticism; it is a way to avoid the fear of imperfection, of having done something wrong, and of being accused of negligence – essentially, it is a form of self-punishment with an expiatory function for the harm. Additionally, ruminating satisfies another relational need, ensuring the continuity of the relationship with the deceased by maintaining a certain level of contact with the absent loved one and fantasizing about the missing person. This is a way to connect with the past and avoid the emotional experience of death. In this sense, according to Payás (2008), it performs a stabilizing psychological function that protects against the flow of unpleasant emotions accompanying regression.
Lastly, the denial of pain can be a defense mechanism providing a sense of control and stability to the fragile ego of the bereaved (Ruiz, n.d.). Rumination may be a way to avoid contact with the real pain of grief and maintain a sense of control over the emotional experience (Payás, 2008). Obsessions act as a defense against the emergence of threatening painful feelings, such as anger and guilt, manifesting as stubbornness, persistence, rigidity, and resentment. In vulnerable personalities, death can cause internal fragmentation, and obsessions may appear as an attempt to fill this lack of internal structure. Rumination acts as anchors to maintain inner fragility and compensate for personal experiences that would otherwise be chaotic. In this sense, according to Payás (2008), rigid and routine thoughts would have a stabilizing and protective function against a fragile, immature, and dependent self.
Risk Factors
Attachment theory argues that security collapses when one suddenly loses the person they are attached to, and adapting to the new reality becomes more difficult and stressful than if the death had been anticipated (Payás, 2008). Obsessive thinking prevails in situations of non-anticipation, especially if the loss was traumatic or if the grieving individual believes it could have been avoided, as in cases of alleged medical negligence or domestic accidents. The lack of information about what happened around the death forces the grieving individual to imagine all or part of the events. In these situations, in line with Payás (2008), obsession seems to be triggered by the fantasy that explores the various possibilities of what is happening, resulting in a state of hyper-alertness that drives obsessive thinking.
Personal risk factors also influence the onset of obsessive thoughts after a loss (Payás, 2008). Perfectionistic, demanding individuals with obsessive traits are more prone to ruminate about death. The same applies to fragile, insecure individuals with control issues or immaturity who had never reflected on death before. These personalities face greater adaptation difficulties and experience high levels of anxiety related to obsessions. Finally, according to Payás (2008), individuals with ambivalent attachments are more prone to chronic grief and ruminative styles.
References
Bobis, M. (2020). Duelo por muerte de un familiar: 5 formas en las que nos puede afectar - Psicólogo Manuel Bobis Reinoso. Psicólogo Manuel Bobis Reinoso - Sevilla. Recuperado 21 September 2021, a partir de https://www.psicologomanuelbobis.com/duelo-por-muerte-de-un-familiar-5-formas-en-las-que-nos-puede-afectar/
Michael, S., & Snyder, C. (2005). Getting Unstuck: The Roles of Hope, Finding Meaning, and Rumination in the Adjustment to Bereavement among College Students. Taylor & Francis. Recuperado 21 September 2021, a partir de https://www.tandfonline.com/doi/full/10.1080/07481180590932544?casa_token=FkpJlaGtDwMAAAAA%3AMLeqiQ0NiTQMUVVApSJ0HMCYgydR7kJDeKbOCQIIuoZMTQfHarbpH3dtGyUhcSgUCyRd6PTvVKdpp9l_
Payás, A. (2008). Funciones psicológicas y tratamiento de las rumiaciones obsesivas en el duelo. Scielo.isciii.es. Recuperado 21 September 2021, a partir de https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0211-57352008000200005
Ruiz, L. Rumiaciones obsesivas en el duelo: qué son y cómo aparecen. Psicologiaymente.com. Recuperado 21 September 2021, a partir de https://psicologiaymente.com/clinica/rumiaciones-obsesivas-duelo
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