In recent years public dialogue and awareness about Posttraumatic Stress Disorder (PTSD) and trauma have expanded. This is due largely to the staggering numbers of veterans returning from combat with PTSD, and the willingness of persons suffering from the disorder or other effects of trauma to share about their experience. As a result, research has expanded, treatment has improved, and there is less stigma, and more compassion, toward trauma survivors – and yet, there sadly remains little conversation, research, or literature about the intersection of grief, trauma, and PTSD, often leaving people bereaved by traumatic loss without the support and understanding they so desperately need.
The first requirement for a diagnosis of PTSD is experiencing a traumatic event, of which the death of a loved one can certain qualify. However, before talking about traumatic loss, we first want to say a few things about trauma. In this context, trauma is an emotional response to a deeply distressing or disturbing event that leads to lasting emotional and/or psychological impairment. Immediately following a traumatic event, shock, numbness, and denial are common, but longer-term manifestations (often showing up about one month following the death) include unpredictable emotions, flashbacks or intrusive thoughts, anxiety, insomnia, survivor’s guilt, and an overwhelming number of other psychological and even physical symptoms.
A sudden death, especially by violent means, is most often considered a traumatic loss, however, it is really the survivor’s perception of their loss that determines whether or not it’s traumatic to them. A whole array of factors, such as previous losses or traumas, personality, mental health history, coping style, secondary stressors, and access to support, can all influence the way a person experiences their loss. So, while certain types of death, such a suicide or homicide, may be more likely to be experienced as traumatic, it is really the survivor’s perception of their loss that matters. That being said, all deaths have the capacity to traumatize. Just as a person whose loved one died from violent and unexpected means may experience PTSD symptoms, so too could a person whose loved one’s death was anticipated due to cancer or other terminal illness.
In addition to unbearable psychological and emotional symptoms, persons grieving a traumatic loss are also more vulnerable to what we might call “maladaptive coping mechanisms,” such as drug or alcohol abuse, as well as to physical illness, phobias, depression, and suicidal thinking or behavior. For some, without treatment PTSD symptoms may last years, and may lead to another diagnosis – Complex Persistent Bereavement Disorder (CPBD), commonly known as “complicated grief.”
Often compounding the pain of a person suffering from traumatic loss is the sense of isolation frequently experienced, as friends and family may not understand what their loved one is going through – sometimes even if they are grieving the same death (again, trauma is often a subjective experience). Also, as we mentioned before, there remains a lack of understanding about traumatic loss, even within the mental health community.
For a person suffering from PTSD or CPBD things might seem hopeless. However, there are promising treatments. Trauma-focused psychotherapy, cognitive behavioral therapy, and eye movement desensitization and reprocessing (EMDR), and, specifically for CPBD, complicated grief therapy, all have demonstrated efficacy. There are also a growing range of support group offerings for people suffering from PTSD and traumatic loss, and, for many, the benefit of a community of other survivors is powerful.
Additionally, there are simple and accessible coping strategies that can help to regulate mood and emotions, such as regular exercise, adequate rest, healthy diet, journaling, practicing mindfulness, connecting with others, establishing a consistent schedule, and spending time outdoors. Although these might sound like simple things, their effect is cumulative and can be very critical to managing trauma-related anxiety.
If you think you may be suffering from PTSD or CPBD, or feel that you need help processing a traumatic experience, speak with a medical or mental health professional who can guide you to appropriate resources. Be advised that not all grief counselors have training in working with trauma, so it is important to ask what their experience is before beginning counseling. Even if you do not meet the criteria for a diagnosis of PTSD, it does not mean that you are not having a trauma response that is worthy of professional assistance. Whatever you are experiencing deserves compassionate care. There is no need for you to continue to suffer – PTSD diagnosis or not.
It’s also important to note that, just as the reaction to a loss or potentially traumatizing events varies from one person to another, so too does what effective treatment looks like. Don’t be discouraged if a treatment like EMDR just isn’t working for you, and don’t be afraid to speak up if a therapist or a group doesn’t feel like the right fit. With the good treatment, support, and time, symptoms can become manageable, and you can enjoy life again.