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Trauma and Loss
Coping with trauma and loss
Someone close to you may have died in sudden and/or traumatic circumstances. You may have witnessed the death, or the deaths and injury of others. This leaflet explains some common reactions and sources of help.
what is traumatic loss?
There’s variation in how traumatic loss is defined in the research, but for our purposes, I think this definition from Wortman & Latack (2015) does the trick:
“A death is considered traumatic if it occurs without warning; if it is untimely; if it involves violence; if there is damage to the loved one’s body; if it was caused by a perpetrator with the intent to harm; if the survivor regards the death as preventable; if the survivor believes that the loved one suffered; or if the survivor regards the death, or manner of death, as unfair and unjust.”
That’s a pretty broad definition, and we should also add circumstances in which the survivor witnessed the death, when their own life was threatened, and when the mourner experiences multiple deaths.
In addition to the nature of the death, other trauma risk factors include:
- Having to make medical decisions about life support, organ donation, etc
- Uncertainty about whether the person has a died (ex. they are missing; information about their condition has not been disclosed)
- Media attention
- Limited opportunities for social support
- Being blamed for the death
- Prolonged court proceedings
- Having a prior history trauma
What is the impact of experiencing a traumatic loss?
Generally speaking, it has been shown that traumatic death, especially violent deaths, lead to increased distress. For example, a 2003 study looking at the bereavement trajectories of 173 parents who experienced the death of a child by accident, suicide, homicide, or undetermined causes found that five years after the violent death 27.5% of mothers and 12.5% of fathers met the diagnosis for PTSD. These rates were significantly higher than those in the general population.
When someone experiences a traumatic death, their challenges become two-fold. One, they must cope with the trauma and two, they have to cope with their grief. The experiences of trauma and grief are two different things unto themselves, yet after a traumatic death, they get thrown into one big emotional blender. Things get tangled, thoughts and emotions get fused, and people sometimes find themselves utterly stuck. Understandably, it is not uncommon for people who’ve experienced a traumatic death to experience significantly more intense, pervasive, and prolonged symptoms.
What can I expect after experiencing a disaster?
Most child, adolescent, adult, and older adult survivors experience some of the
following normal stress responses to varying degrees. They may last for many months after the disaster has ended, and even longer. Normal stress reactions include:
- Emotional (feeling) reactions: feelings of shock, disbelief, anxiety, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, betrayal, depression, emotional numbness (difficulty having feelings, including those of love and intimacy, or taking interest and pleasure in day-to-day activities)
- Cognitive (thinking) reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, repeated imagery, self-blame
- Physical (bodily) reactions: tension, fatigue, edginess, difficulty sleeping, nightmares, being startled easily, racing heartbeat, nausea, aches and pains, worsening health conditions, change in appetite, change in sex drive
- Interpersonal reactions: neediness, dependency, distrust, irritability, conflict, withdrawal, isolation, feeling rejected or abandoned, being distant, judgmental, or over-controlling in friendships, marriages, family, or other relationships.
- Spiritual ( meaning) reactions: wondering why, why me where was God; feeling as if life is not worth living.
What factors increase the risk of lasting vulnerability?
During or after massive disasters, many survivors may be directly exposed to or witness things that may make them particularly vulnerable to serious stress reactions. Disaster stress may revive memories or experiences of earlier trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems. While trauma reactions can become lasting problems, the shared experience of disasters and people’s resiliency can provide support. Being aware of risk factors is important. They include:
- Loss of family, neighborhood, or community
- Life-threatening danger or physical harm (especially to children)
- Exposure to horrible death, bodily injury, or bodies
- Extreme environmental or human violence or destruction
- Loss of home or valued possessions
- Loss of communication with or support from important people in one’s life
- Intense emotional demands
- Extreme fatigue, weather exposure, hunger, or sleep deprivation
- Extended exposure to danger, loss, emotional/physical strain
- Exposure to toxic contamination (such as gas, fumes, chemicals, radioactivity, or biological agents)
Studies show that some individuals are more vulnerable to serious stress reactions and lasting difficulty, including those with a history of:
- Other traumatic experiences (such as severe accidents, abuse, assault, combat, immigrant and refugee experiences, rescue work)
- Chronic medical illness or psychological problems
- Chronic poverty, homelessness, unemployment, or discrimination
- Recent or earlier major life stressors or emotional strain (such as divorce or job loss.
Treatments and Therapies
The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.
The most studied type of medication for treating PTSD are antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Other medications may be helpful for treating specific PTSD symptoms, such as sleep problems and nightmares.
Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Check the U.S. Food and Drug Administration website for the latest information on patient medication guides, warnings, or newly approved medications.
Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT. CBT can include:
- Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
- Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.
How Talk Therapies Help People Overcome PTSD
Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:
- Teach about trauma and its effects
- Use relaxation and anger-control skills
- Provide tips for better sleep, diet, and exercise habits
- Help people identify and deal with guilt, shame, and other feelings about the event
- Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.
Beyond Treatment: How can I help myself?
It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH’s Help for Mental Illnesses page or search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
To help yourself while in treatment:
- Talk with your doctor about treatment options
- Engage in mild physical activity or exercise to help reduce stress
- Set realistic goals for yourself
- Break up large tasks into small ones, set some priorities, and do what you can as you can
- Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately
- Identify and seek out comforting situations, places, and people
Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts).