.....bereavement research has focused primarily on heterosexual, married couples, frequently within the later years of life. The latest research has taken a step towards understanding bereavement among members of the LGBTQ community, particularly, lesbians (Fenge, 2013). By understanding main themes in relation to same-sex bereavement, one can better draw a clear plan of assessment to help someone like Emily deal with the grief of losing a loved one. Some main themes seen in recent research in this area is disconnection from family, internalizing homophobia as well as seeking a place for sincerity and acceptance, benefits of friendships displaying cross-sexual orientation, and intimacy of relationships among women (Ingham, Eccles, Armitage, & Murray, 2016). With this information in mind, the questions asked center on depression, PTSD, available support, and desire to perform daily activities.The first question would be: "How many times do you shower, eat, and sleep each week?" This is because Emily has stated she has problems sleeping and eating. This could be related to depression and therefore would be a clear indicator of a potential depression diagnosis. The second question would be: "Does your job interest you anymore?" Emily stated she was given a warning due to her poor performance and absences. If she no longer wishes to work due to her illness, this could support the diagnosis of depression. The other questions would focus on complex bereavement.

Complex bereavement or persistent complex bereavement disorder is a DSM-5 disorder similar to depression yet is characterized by an unrelenting grief that will not improve over time. The symptoms are caused by the loss of a loved one unlike depression, that can be caused by multiple factors. " . . . symptoms do not reflect an inferred, unobservable category or dimension, but rather are themselves constitutive of the disorder. PCBD constitutes a causal system of mutually reinforcing symptoms that arise following the death of a loved one settling into pathological equilibrium" (Robinaugh, LeBlanc, Vuletich, & McNally, 2014, p. 510).

Questions 3-5 would be: "Have you felt this way only since Christine died?" "What have you done to cope with the loss and has it worked?" "What about Christine's death has you most affected?" These questions are meant to help understand the degree of grief Emily is feeling while also collecting information on Emily's current condition.

2.

It seems that the problems arose after Emily lost Christine. She exhibits signs of complicated grief or persistent complex bereavement disorder. She has a preoccupation with thoughts of Christine, especially the circumstances that surrounded her death....

This can also be seen as a lack of desire to pursue personal plans/interests. She also displays intense sadness and feels like she has no one to talk to about her situation with Christine.
Emily stated her parent's religious beliefs prevent them from accepting homosexuals. Therefore, Emily feels she must keep the loss of her loved one a secret from her family for fear they will chastise her for her feelings. She also has not come out of the closet with her friends. While she discussed having some lesbian friends that she may be able to turn to for support, her introverted nature may prevent her from reaching out. Add to that, the decision Christine's family made on behalf of Christine to end her life, and this presents another issue.

Essentially, Emily may feel like she has nowhere to turn to because of her sexuality, her introverted nature, and the pain she feels from the decision Christine's family made to end her life. Therefore, Emily's grief is not the normal grief typically experienced. Her grief becomes complicated grief due to the lack of options she has for support and her personality.

3.

The first referral would be to a primary care physician. The information provided on Emily said she has a gaunt appearance from not eating. While she needs a therapist to talk to and perhaps CBT therapy, the most important referral that should take priority is for a primary care physician so she can get some blood work done. Long periods of not eating can wreak havoc on a person's physical health and can lead to other health complications (Bartrop, Buckley, & Tofler, 2016).

Bereavement may present an increased risk of cardiovascular disease. "The death of a loved one has been known to convey an adverse health risk, including increased cardiac events. While mortality risk appears to be greatest in the initial weeks following bereavement, it remains elevated during the first 6 months" (Bartrop, Buckley, & Tofler, 2016, p. 229). Bartrop, Buckley, & Tofler explain early bereavement can be tied to immune imbalance, prothrombotic and hemodynamic changes, altered sleep, and neuroendocrine activation. Such changes can lead to an increased cardiovascular risk. Couple that with a lack of eating and it can lead to death. Emily needs to find out if she is deficient in any key nutrients and then may be referred to a nutritionist who can help her get back to a healthy weight with supplements and an eating plan.

Earlier mentioned was the possibility of seeing a therapist. Cognitive behavioral therapy has been used successfully for a myriad of mental disorders like PTSD and depression (Bryant et al., 2014).…