Survivors of Trauma Struggle to Move On From the Loss of Loved Ones

Summary: PTSD in trauma survivors is associated with an increased risk of complicated grief following the death of loved ones. Complicated grief is marked with symptoms of grief lingering and worsening over time, rather than fading.

Source: APA

Among individuals who survive a trauma that resulted in the loss of a close friend or loved one, symptoms of post-traumatic stress disorder can predict complicated grief—a sense of persistent sadness and an inability to cope—years after the trauma, according to research published by the American Psychological Association.

“Grief is a normal response to the loss of someone close, but traumatic losses may severely harm survivors for years,” said Kristin Alve Glad, PhD, a researcher at the Norwegian Centre for Violence and Traumatic Stress Studies and lead author of the study. “Our findings suggest that when treating trauma survivors, targeting symptoms of PTSD early might help them avoid complicated grief later on.”

For most people who experience grief, feelings of distress and bereavement tend to diminish over time, according to Glad. In the case of complicated grief, instead of fading, symptoms can often linger or worsen and can impair or prevent people from living their normal lives.

“Complicated grief has been defined as a persistent, intense yearning, longing and sadness, usually accompanied by insistent thoughts or images of the deceased and a sense of disbelief or an inability to accept the painful reality of the person’s death,” said Glad.

In the study, published in the journal Psychological Trauma: Theory, Research, Practice and Policy, researchers interviewed survivors of a 2011 domestic terrorist attack on Utøya, an island in Norway, who lost someone close to them in the attack. Of the 275 participants, 256 lost a close friend, six lost a family member and 13 lost a close friend and a family member/partner.

Participants took part in individual, face-to-face interviews with experienced health care personnel three times following the attack on Utøya: 4-5 months, 14-15 months and 30-32 months after the attack. The interviews included questions about the post-traumatic stress symptoms and complicated grief reactions (e.g., trouble accepting the death of their loved one, interference of grief in their daily life, troubling thoughts relating to death, avoidance of reminders of the loss and feelings of isolation or distance from others).

Researchers found that participants who reported symptoms of PTSD were significantly more likely to report symptoms of complicated grief as well. They also found that participants who experienced early symptoms of PTSD a year after the attack experienced even greater symptoms of complicated grief years later.

This shows a sad looking man
For most people who experience grief, feelings of distress and bereavement tend to diminish over time, according to Glad. Image is in the public domain

“The fact that we found that PTSD symptoms predicted complicated grief reactions at a subsequent time point, but complicated grief did not predict the development of PTSD, is interesting, because it suggests that targeting PTSD symptoms may hinder later development of complicated grief,” said Glad. “This may have important implications for clinicians working with bereaved trauma survivors.”

The researchers believe that the effects of the terrorist attack on the survivors were particularly severe because they did not just lose a loved one – they were directly exposed to the attack as well. This dual burden of the unexpected loss and the survivors’ high exposure to trauma may result in a different trajectory of PTSD symptoms and complicated grief than for bereaved who are not directly exposed to the trauma.

These findings could apply to anyone who has lost a loved one in a potentially traumatizing way, according to Glad. Knowledge about the relationship between symptoms of PTSD and complicated grief over time may help clinicians develop more effective treatment strategies and formulate better treatment plans for the survivors who struggle the most to cope, the researchers said.

About this PTSD research news

Author: Kristin Alve Glad
Source: APA
Contact: Kristin Alve Glad – APA
Image: The image is in the public domain

Original Research: The full study, “The Longitudinal Association Between Symptoms of Posttraumatic Stress and Complicated Grief. A Random Intercepts Cross-Lag Analysis” by Kristin Alve Glad et al in Psychological Trauma: Theory, Research, Practice and Policy is available in PDF format

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  1. Where could someone in the US find the appropriate therapy and help getting through complicated grief if they have no family, few friends, and no one around to help them financially or otherwise?

    1. Scott, the quickest option is to look for a survivor/support group.
      Building an isolated person’s network, resources, and connection to others is probably the strongest starting point to solve multiple issues.

      A healthy group will validate each other’s experiences, and a person will be more likely to feel seen/understood in a deeper way. There is likely to be something on Facebook, meet-up, or elsewhere on social media. NAMI also has sanctioned groups for disorder-specific support like depression and bipolar disorder. Grief and/or trauma will likely be included in a metro area near you.

      This does not replace therapy, but can be a good adjunct and a great starting point.

      For psychotherapy, it depends on a lot of factors. The person will need to find a therapist that accepts their insurance, does sliding scale, or works in community mental health. Some do cash only. There is significant burnout/high workload in MH due to COVID. More people are seeking mental health that wouldn’t before, and the various stressors the pandemic caused likely influenced an increase of new cases/symptoms.

      They will probably need to call around a lot, and their first therapist may not be the right fit. It is important they not be discouraged, hence the support group as a safety net. Having the ability to have multiple people look for something obv increases the likelihood of finding what they need.

      You could try calling a mental health outpatient center run by your state as well.

      Depending on the complications or trauma around grief, there are a number of evidence based trauma therapies (CPT, CBT-T) that could help explore complex grief and the emotions/cognitive distortions that come with it. Other therapies like EMDR can help process sensations that are stuck within the mind/memory. Somatic therapies can help for stress stuck within the body.

      Yoga, exercise, body work can help relive some things that get stuck in our bodies as well. I probably need to research this more. You could read The Body Keeps the Scorr by Bessel Van Der Kolk. It’s well written, but a bit intense.

      If their complications were especially deep (betrayal, captivity), what some would call complex trauma, they must be prepared for the longer journey to constructing new meaning in life. Even after the phyaical trauma symptoms diminish to a manageable level, their can be emotional and spiritual wounds that require self-compassion and self-love.

      There are a number of books that can help with this too, specifically Man’s Search for Meaning, a psychiatrist and existentialist’s story of surviving Asuchwitz Berkanow.

      I know this is long, but I hope if a person in your life is dealing with the hypothetical you presented, this can help them begin to heal.


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