Grief

TRAUMATIC

Traumatic grief is defined as profound emotional trauma and separation distress suffered after the death of a loved one. It includes yearning, searching for the deceased, and excessive loneliness resulting from the loss. Traumatic loss sometimes happens when a death is sudden, unexpected, preventable, or of a child. Traumatic loss shatters the bereaved person's worldview, leaving him or her feeling overwhelmed and helpless.

Diagnostic Considerations

There are four diagnostic criteria for traumatic grief: (1) Traumatic grief occurs after the death of a significant other and includes distress that intrudes into the victim's consciousness; (2) traumatic grief lasts at least two months; (3) traumatic grief symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning; and (4) traumatic grief includes eleven marked, persistent symptoms that include behaviors, thoughts, and emotions. These symptoms reflect the bereaved person's feelings of devastation as a result of the death. Behaviors include frequent efforts to avoid reminders of the deceased (e.g., thoughts, feelings, activities, people, and places); and displaying excessive irritability, bitterness, or anger related to the death. Thoughts include purposelessness or feelings of futility about the future; difficulty imagining a fulfilling life without the deceased person; difficulty acknowledging the death; and a shattered worldview. Emotions include a subjective sense of numbness, detachment, or absence of emotional responsiveness; being stunned, dazed, or shocked; a sense that life is empty or meaningless; and feeling that part of oneself has died. Traumatic grief does not refer to the cause of the disorder or aspects of the death, but rather to the bereaved person's actual experience.

Two related forms of grief are delayed grief and complicated grief. Delayed grief is not apparent initially, but appears within the first six months of bereavement. Delayed grief might be particularly difficult to diagnose. Complicated grief occurs at least fourteen months after the death. The scholars who constructed this definition avoided twelve months because anniversaries often cause intense turbulence in the bereaved individual. Complicated grief includes intruding thoughts or avoidance behavior that is severe enough to interfere with daily functioning. The intruding thoughts may include unbidden memories or fantasies about the lost relationship, strong spells of severe emotion related to the lost relationship, and distressingly strong yearnings for the deceased. The avoidance symptoms include feeling far too alone or personally empty; excessive avoidance of people, places, or activities that remind the bereaved of the deceased person; unusual levels of sleep disturbance; and loss of interest in work, social activities, care taking, or recreational activities. These symptoms last for at least one month.

There are several differences between traumatic grief and complicated grief. One difference is in the duration of symptoms. For traumatic grief, the duration is at least two months, with no specification about the time since the death. For complicated grief, the duration is only one month, and the grief occurs within fourteen months of the bereavement. Another difference is in sleep disturbance. Only complicated grief includes sleep difficulty, which may be a result of the person being overly aroused. A third difference is that traumatic grief includes symptoms that reflect the devastation in the bereaved person's life caused by the death. There are no closely related symptoms in complicated grief.