Traumatic Grief

Are you at risk for post traumatic stress?

Imagine driving down the street and crossing an intersection. You glance quickly left and right, but out of nowhere you are hit by an oncoming vehicle.  The impact is painful, crushing, debilitating. It takes your breath away and spirals you out of control for what seems like an eternity. Spinning, spinning, spinning, you finally come to a stop and have the sudden realization that you have survived.

Time stands still; everything around you is in slow motion. You have difficulty breathing. You are confused, disoriented, dazed. You feel numb. Even though others have circled around you, you feel alone and afraid. You look down and see that you are wounded, but can’t tell how vast or deep those wounds may be. Anxiety overwhelms you.

You look around and the world you knew just minutes ago is infinitely different; changed, unknown, untrustworthy. You search for something you had with you before the accident and it's no longer there. You become frantic, not wanting to accept that what is lost may be gone forever. You try to pick yourself up but the heaviness in your heart weighs you down. You make it part way, but you realize that you need to reach out your hand and get support.

In the aftermath of the sudden or violent death of a loved one, feeling traumatized and grief-stricken are common reactions for survivors. Just like the sudden, violent car crash described above, the impact of a traumatic death has been described by survivors as feeling like being broadsided.

In the past decade we have begun to recognize and better understand individuals, families, and communities that have been affected by elements of both grief and trauma. As the bereaved try to heal and repair their lives after a sudden violent death, they (and those around them) may expect that grief will be the usual natural reaction to the death of a loved one. Most are not aware that death by traumatic means qualifies as a traumatic stressor and leaves the survivor more vulnerable to post traumatic stress in addition to grief.

While all deaths may have an element of personal trauma, the nature and circumstances of the death are significant factors in traumatic grief. Sudden or violent deaths, such as those caused by accident, suicide, homicide, acute sudden illness, disaster, or war, readily qualify as traumatic stressors. So also does the death of a child of any age. When the death is sudden or untimely, it offers no opportunity for emotional or psychological preparation for the loss. Circumstances involving violent or stigmatized deaths can leave survivors at risk for developing post-traumatic stress disorder (PTSD) and complications in their grief.

If you are the survivor of a loved one who died a traumatic death, you may be experiencing trauma symptoms. It is important to understand that there is a relationship between trauma and grief and that you may be experiencing both at the same time. Trauma can overlap grief, meaning that you may be experiencing trauma symptoms in addition to the normal reactions of grief. If left unaddressed trauma impairs grief work and can interfere with the survivor's ability to understand and accept the reality of their loved one's death—an essential first task in the ability to begin to heal.

Traumatic death survivors can often feel “stuck” or “frozen in time.” Sudden, untimely, or violent deaths produce circumstances in which post traumatic stress responses take emotional priority in managing the overwhelming loss, horror, and profound sense of helplessness. Trying to cope with these post trauma symptoms becomes the first priority rather than working on normal expressions of grief, and the survivor’s ability to grieve can be delayed.

Dealing with the dual affects of both grief and trauma can be an overwhelming experience for survivors who deal with, and alternate between, conflicting sets of thoughts, feelings, and reactions. It may take months or years for traumatic death survivors to truly begin to work on their grief.

Recognizing the Symptoms

Symptoms of post traumatic stress can be horrifying and often times debilitating, interfering with your ability to manage daily activities and get through the day. The symptoms can begin soon after a traumatic event or even years later. If these symptoms persist for several months or cause you great distress, you may be experiencing PTSD:

• Re-living or re-experiencing the traumatic event. This may be indicated by painful, intrusive thoughts or nightmares about the death. You may feel like you are going through the death or notification over and over again in your mind. These are called flashbacks. There may be a trigger such as a sight, sound, or smell that causes you to relive the event, such as going back to where the death occurred, hearing gunfire, smelling the cologne or perfume your loved one used to wear, or seeing a person in a military uniform.

• Avoidance of reminders of the person or event. This can include staying away from activities, places, or things related to your loved one or his death. You may find yourself avoiding people once associated with him or her. You may not want to talk about your loved one. You may avoid visiting military installations or watching movies that have military scenes in them. You may keep yourself very busy, distracting yourself with many projects. You may also avoid seeking help.
• Feeling numb and detached. This may be another way to avoid feelings or memories. You may not be able to remember elements about the traumatic event or talk about them. You may lack any interest in activities you once enjoyed or avoid relationships which require you to try and feel positive emotions.
• Hyperarousal. This can include feeling keyed-up or having persistent anxiety which may cause “the jitters,” difficulty sleeping, trouble concentrating, feeling always on guard, and startling easily.

PTSD and complications in bereavement can impair your health, well-being, and functioning, as well as delaying your ability to begin on a journey of healing.

When is it a Good Idea to Seek Treatment and Support?

Some of the following experiences may suggest that professional support is needed: 

• The intensity of your trauma and grief symptoms persists intensely and acutely for more than six months or interferes with your ability to care for yourself and others, hold a job, or gain employment.

• You continue to experience intense yearning that does not diminish over time and have difficulty accepting the death.
• You become severely depressed, hopeless about the future, and have difficulty experiencing any positive feeling. 
• You experience persistent feeling of guilt, shame, hopelessness, and despair.
• You begin to experience significant relationship difficulties.
• You engage in risk-seeking behavior. 
• You abuse alcohol, drugs, or other substances (including prescription medications or nicotine).
• You harbor persistent suicidal thoughts.  

Effective treatment and comforting support is available to those suffering from the impact of a sudden, traumatic loss. There are a variety of interventions available, including individual psychotherapy, group counseling, peer support groups, cognitive-behavioral therapies, complicated grief therapy, and medication therapies. Information about the latest treatments for PTSD can be found on the Department of Veterans Affairs website at www.ptsd.va.gov.

It is important that survivors who have experience traumatic grief find a counselor or therapist who is experienced in working with both trauma and bereavement as a dual process. For help connecting with a counselor in your local area, call TAPS at 800-959-TAPS (8277) or email info@taps.org. TAPS connects you with individual counseling through programs that offer free, unlimited counseling such as the VA’s Vet Centers and Give an Hour.

By Jill Harrington-LaMorie, DSW, LCSW: Dr. Jill Harrington LaMorie is the surviving spouse of Navy Lieutenant Commander Andrew LaMorie and proud mother of their children, Madeline and Alexander. She served as the TAPS Director of Professional Education for three years, as well as being a peer mentor, group facilitator, and workshop presenter. Jill completed her doctorate in social work at The University of Pennsylvania and currently works as the Senior Field Researcher on the National Military Family Bereavement Study.