Is This Person Suffering Grief or Trauma or Traumatic Grief?Annie Cantwell-Bartl

Traumatic Grief is a new conceptemerging in the field of bereavementand trauma. Over the years there hasbeen extensive literature on loss andbereavement. The literature of traumaand its impact is still new. As with bereavement,where there has been anemphasis on a person suffering fromtrauma, it has usually been viewed asa single entity. It is only recently thatthere is more formally acknowledgementthat a person may be strugglingwith the joint manifestations of bothgrief and trauma.

WHAT IS THE DIFFERENCE BETWEENTRAUMA AND GRIEF?It is important to understand the symptomsof grief and trauma as separateentities and then to consider that aperson may manifest both sets ofsymptoms.

GRIEF?Grief, in this context, is defined as aprimarily emotional reaction to the lossof a loved one through death. It incorporatesdiverse psychological(cognitive, social-behavioural) andphysical (physiological-somatic) manifestations(Stroebe, Hansson, Stroebe& Schut, 2001). The bereaved personwill experience separation distress,which is a normal grief response. Theyare preoccupied with the person whohas died, seek reminders of them andare aroused and continually focusedon the dead person.

TRAUMA?Trauma is defined as any event that isoutside of the usual realm of humanexperience that is markedly distressing

e.g. evokes reactions of intense fear,helplessness and horror. Such traumaticstressors usually involve the perceivedthreat to one’s physical integrity or tothe physical integrity of someone inclose proximity (Mitchell & Everly,2001). In contrast to a grief responsethe traumatized person ispreoccupied with the scene of thetrauma and the violent encounter ofdeath, or an experience that couldhave resulted in death. They wish toavoid reminders of the event; theyare hyper-vigilantly aroused andorientated to threat, danger, or thereturn of a similar threat. There is agreat deal of anxiety and the worldseems an unsafe place.

WHAT IS TRAUMATIC GRIEF?Traumatic Grief is defined as a conceptwhere a person suffers fromgrief as a result of a death and alsofrom traumatic distress (Jacobs,1999). If people are grieving andexperiencing separation anxiety thesymptoms will consist of yearning,searching and loneliness. Whenthere is concurrent traumatic distressthe person will also be experiencingnumbness, disbelief, distrust, angerand a sense of futility about the future.Traumatic Grief captures bothdimensions of a person’s response.

CRITERIA FOR TRAUMATIC GRIEF ASPROPOSED BY TRAUMA SPECIALISTS(JACOBS, 1999)A. First, a person has to be exposedto an event or events thatthey regard as horrifying. Theresponse involves intrusive, distressingpreoccupation with theperson who has died (yearning,longing or searching).B. In response to the death the followingsymptoms are present:- Frequent attempts to avoid remindersof what has happened.- Feeling of purposelessness and asense of futility about the future.

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Subjective sense of numbness, detachmentor an absence of an emotionalresponse. Feeling stunned, dazed or shocked.- Difficulty acknowledging the death.- Feeling that life is empty or meaningless.- Difficulty imagining a fulfilling life.- Feeling that part of oneself has died.- Shattered world view (e.g. a lostsense of security, trust or control).- Assumes symptoms of harmful behaviours of, related to, the deceasedperson- Excessive irritability, bitterness, oranger.C. The duration of the disturbance orthe symptoms is at least twomonths.D. The disturbance causes clinicallysignificant impairment in social,occupational, or other importantareas of functioning.

SOME FURTHER POINTS OF CLARIFICATION(JACOBS, 1999)- Other losses may seem traumaticbut do not qualify under this classificatione.g. a loss of a job doesnot fit into the category of traumaticgrief.- The symptoms of traumatic griefmay result from a sudden, violentor unexpected death but the deathmay not have been objectivelytraumatic in order to make the diagnosis(Horowitz, Siegel, Holen,Bonnano, Milbrath & Stinson,1997).- Symptoms of traumatic grief mayfollow any death that is personallydevastating, e.g. where a bereavedperson had a close andconfiding relationship (this comesfrom the particular relationshipwith the deceased person andother personal vulnerability factors).- As distinct from normal grief theseparation anxiety persists at amarked level of intensity, remainsintrusive and distressing, and alongwith other symptoms, interferes withsocial, occupational and other importantareas of functioning.

WHY IS IT IMPORTANT TO CONSIDERTHAT PEOPLE MAY BE SUFFERING TRAUMATIC GRIEF?There is a need to consider the impactof both grief and trauma onpeople. This is important because ifpeople are suffering from both, theirgrief is more complicated and a failureto recognize traumatic grief mayresult in inadequate support andcare.

WHAT ARE THE POTENTIAL PREDICTORSFOR TRAUMATIC GRIEF?There are a number of predictors fortraumatic grief. Some possible onesare:- Sudden unexpected death oreven unexpected death in terminalillness.- Violent death: suicide, sudden accidentsand vehicle accidents.- The death of a child, a familymember or someone very close tothe mourner (Rando, 1999).- A mourner’s psychological predispositionto trauma: e.g. when amourner is very dependant on theperson who has died.- People are pre-disposed to traumaticgrief when they are carryingother unresolved trauma from thepast.

SOME GENERAL POINTS TO KEEP IN MINDIN ASSISTING A TRAUMATIZED PERSON- Be aware of the significance ofemergency mental health intervention,as practiced by the model, CriticalIncident Stress Debriefing (CISD)and its parallel traumatic “stress defusing”(Mitchell, 2001), where appropriate.- People first need basic practicalhelp. The effected person will beemotionally raw and overwhelmedwith what to do next. It is likely thatthere will be many things to do andpeople traumatized may not havethe initial resources to consider theirown emotional requirements.- When a distressed person has time,

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remember the importance of attentivelistening and spending time withthem. Never under-estimate thevalue of empathy and compassion.- The person and the family may requiresome education about the impactof traumatic death. Don’t rush tointervene and be careful aboutstrategies too early.- Keep in mind the vulnerability of theeffected person.- Most people will recover and will notneed professional help but helpersneed to recognize their limitations ifsomeone needs further assistance.- Remember self-care yourself! Don’tunder-estimate your own vulnerabilityto vicarious trauma or the impacton your family if you are traumatizedwhich can result in secondarytrauma (Catharall, 1992).

REFERENCES1. Catharall, D.R. (1992). Back fromthe brink: a family guide to overcomingtraumatic stress. New York.Bantam Books.2. Horowitz, M.J., Siegel, B., Holen,A., Bonnano, G. A., Milbrath, C., &Stinson, C.H. (1997). Diagnosticdisorder for complicated grief disorder.American Journal of Psychiatry,154, 904-9103. Jacobs, S.(1999). Traumatic Grief:Diagnosis, Treatment and Prevention.Bruner/Mazel:NY4. Mitchell, J.T. (2001) Stress Defusing.International Critical IncidentStress Foundation, Inc Ellicott City,MD5. Mitchell, J.T., & Everly, G.S.(2001). The Basic Critical IncidentStress Management Course: BasicGroup Crisis Intervention. 3rd Edition.International Critical IncidentStress Foundation, Inc. Ellicott City,MD.6. Rando, T.A. (1993). Treatment ofComplicated Mourning. ResearchPress.Illinois7. Stroebe, M.S, Hansson, R.O.,Stroebe, W., and Schut, H. (Ed.)

(2001). Handbook of Bereavement.Research. American PsychologicalAssociation. WashingtonDC. (Abridged version. Full versionavailable from Cantwell-

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