bereavement  refers to the psychological reactions of those who survive significant loss and grief is the subjective feeling precipitated by the death of a loved one . bereavement responses can be atypical and have been called  abnormal  and  complicated . proposed the term  complicated grief  and demonstrated its distinction from other psychiatric disorders . , have proposed the diagnosis of prolonged grief disorder and established its psychometric validity for inclusion in dsm v and icd-11 . we present the case of an elderly woman who did not manifest any signs of grief for over three decades and the diagnostic dilemma posed . sm , an 80-year - old woman admitted to the surgical unit for a gluteal abscess , was referred for psychiatric evaluation . the referring physician said that the patient believed that her deceased son was still alive . the deceased son was her favorite , but her relationship with other family members was depleted . when he was in his twenties , he was accused of fraud at his workplace , following which he developed depressive symptoms . at 10 days later he committed suicide by consuming poison , leaving separate notes for his mother and sister . when taken to the morgue , she often rushed up to the terrace at the sound of airplanes and would say that her son was returning home . her daughter reported that during the current admission the patient had been looking for her son among the medical interns . patient was an emotionally restrained person who was not demonstrative about her affection for her children . there was a family history of suicide in her paternal uncle , sister and her son as described above and depression in her grandson . on mental status examination , she said she could not talk about him , but requested us to arrange for his return . based on the history and examination , we considered differential diagnoses of delusional disorder and atypical bereavement . based on the history and examination , we considered differential diagnoses of delusional disorder and atypical bereavement . patient posed a diagnostic difficulty because she did not clearly fit in any of the existing diagnostic categories . her symptoms could be viewed as an atypical bereavement response , as delusional disorder or an overlap between the two . we first examine her diagnosis in the light of terminology used to describe atypical bereavement . atypical bereavement responses are described as  abnormal   complicated  and  maladaptive . jacobs used the term  pathological  grief and described five variants that included absent , delayed , prolonged , inhibited and distorted grief . lichtenthal , lichtenthal et al . built a case for inclusion of  complicated grief  as a distinct diagnostic category . it was shown that complicated grief had risk factors including caregiver burden ( not a predictive factor for major depressive disorder ) , a close and insecure attachment style ( not a predictive factor for mdd ) and a lack of preparedness for death ( not a predictive factor for major depressive disorder or ptsd ) . pasternak et al . and prigerson et al . also showed that complicated grief did not respond to treatment with nortriptyline or interpersonal therapy as opposed to mdd . our patient does not fall in these categories , but has two risk factors for abnormal grief , namely , lack of preparedness for the death and death by suicide . recent studies concluded that pgd met the dsm criteria for a distinct mental disorder as it was a clinically significant form of psychological distress associated with disability . the study proposed nine symptoms that included confusion about one 's role in life , difficulty accepting the loss , avoidance of reminders of the loss , inability to trust others , bitterness or anger related to the loss , difficulty moving on with life , numbness , feeling that life is meaningless and feeling stunned or shocked by the loss . our patient had difficulty accepting the death , avoidance of reminders of loss and emotional numbing . delusional disorder can be diagnosed if a patient has persistent non - bizarre delusions for a period of 1 month . this is a diagnostic possibility in our patient as she firmly believed that her son was alive . our patient illustrates that bereavement itself can be atypical or it can act as a stressor to precipitate another psychiatric disorder and that it is was not easy to differentiate the two .
bereavement reactions are associated with numerous physical and mental complications . 
 atypical bereavement reactions have been described but their place in the classificatory system has not been established . 
 we present the case of an eighty - year - old woman who came with the belief that her deceased son was alive . 
 we discuss the diagnostic dilemma she posed and conclude that it may be difficult to differentiate atypical bereavement from other psychiatric illnesses .