Traumatic Grief: How to Cope & When to Get Help

What Is Traumatic Grief?

Grieving, while painful, is a normal occurrence after the death of a loved one. In traumatic grief, a traumatic event is connected to the loss, making it more difficult to cope. Some characteristics about a death can heighten the risk for a traumatic reaction, but all deaths have the capacity to terrify and overwhelm. Just because a death is understood as being traumatic doesn’t necessarily mean that it will traumatize a person, and vice versa.

A death may be considered traumatic if:³

• It occurs without warning
• It is untimely
• It involves violence
• There is damage to the loved one’s body
• It was caused by a perpetrator with intent to harm
• The survivor/griever regards the death as preventable
• The survivor/griever believes that the loved one suffered
• The survivor/griever regards the death, or manner of death, as unfair and unjust
• The survivor/griever witnessed the death
• The survivor/griever is confronted with multiple deaths
• The survivor/griever’s own life is threatened

Typical Grief Vs. Traumatic Grief

Grief always includes a complex web of painful emotions like sadness and anxiety. It is a normal reaction to the loss of a loved one or something that had great personal meaning like a job or a beloved pet. The intensity, frequency, and duration of the symptoms will vary between people. There is no right or wrong way to grieve. With normal grief eventually people begin to heal and move forward with their lives after a significant loss. They begin to establish a new normal with recreated personal goals.

Grief that occurs after an unexpected trauma is more challenging to cope with. There is an unstoppable yearning for whoever or whatever is gone. When a loss is sudden, unexpected, or related to a traumatic experience, it can feel more overwhelming and the ability to overcome it may at least initially feel inconceivable. Traumatic grief may linger longer and cause more distress, hindering people’s ability to function.

Common Symptoms of Trauma Grief

Symptoms of traumatic grief often include a combination of what’s typically seen with grief and trauma respectively. Everyone is unique and no two experiences will be the same, but there are common or typical ways someone may experience both grief and trauma, including shock, anger, guilt, and preoccupation with the deceased loved one.

Traumatic grief symptoms can include:^5,6

• Yearning or longing for the loved one
• Sadness or loneliness
• Disbelief, shock, and confusion
• Anxiety
• Anger
• Depression, despair, hopelessness or numbness
• Guilt or relief
• Thoughts or images of the loved one (grief hallucinations)
• Being easily startled
• Difficulty concentrating and forgetfulness
• Loss of identity, sense of self, meaning or purpose
• Feeling disconnected or purposefully isolating from others
• Changes in sleep or appetite
• Fatigue, muscle tension, headaches or aches
• Abdominal/digestive distress
• Palpitations
• Continually thinking about what happened
• Flashbacks – reliving the experience through frightening throughs
• Preoccupation with thinking about the deceased or intrusive images of the death
• Avoidance of places, people, or things that trigger traumatic memories and responses

Signs & Symptoms of Childhood Traumatic Grief

Just like adults, children grieve the death of a loved one in their own way and can experience traumatic grief after any type of loss. Childhood grief will differ depending on the age and cognitive development of the child, previous life experience, emotional health prior to the loss, and their support system.⁴

Traumatic grief symptoms in children can include:⁴

• Changes in sleeping and eating patterns
• Feelings of sadness, anger, anxiety, guilt, and self-blame
• Thoughts about the death
• Nightmares
• Bedwetting
• Regressive behaviors (acting in a younger or needier way)
• Avoidance of reminders of the loved one who died or the death experience
• Irritability
• Decreased concentration
• Difficulty in school
• Stomachaches
• Headaches
• Fears about their own safety and the safety of other loved ones

PTSD & Grief

PTSD involves a reaction to witnessing or experiencing a traumatic event. Thoughts and behaviors are often focused on the trauma or distressing circumstances; you may avoid thoughts or situations that trigger or remind you of the traumatic situation.

Post-traumatic stress disorder (PTSD) can include the following symptoms:⁹

• Recurrent, involuntary, and intrusive distressing memories
• Recurrent distressing dreams
• Flashbacks
• Avoidance of triggers or reminders
• Feelings of fear, horror, anger, guilt, or shame
• Hypervigilance, irritability, and problems with concentration
• Sleep disturbances

Traumatic Grief & Depression

Traumatic grief can turn into depression, or more specifically, major depressive disorder (MDD). This can include symptoms like low mood most of the time, loss of interest or pleasure in activities, sleep and appetite changes, and feelings of worthlessness.⁹ With depression, the strongest feelings are an overwhelming sadness and an inability to feel happiness or pleasure. Depressive feelings often focus on yourself and others (not just the deceased loved one).

How to Cope with Traumatic Grief

The first step in coping with traumatic grief is to start with compassion and empathy for yourself. After compassion, it can help to understand specific self-care and coping strategies. Take a moment and think about the ways you take care of your body, mind, and soul.

Here are some tips for coping with traumatic grief:

Maintain a Routine

Traumatic grief disrupts life and makes it feel like you have lost control. Bringing structure to your life by creating a routine can give you a sense of regaining control over what happens and when it happens. Bringing control into your days where you can may help bring a measure of comfort. It also helps to wake up and know what to expect during the day ahead.

Don’t Avoid Feeling Your Difficult Feelings

The first step in healing is facing and understanding your feelings. Tough feelings like anger and sadness are challenging to deal with, but when difficult feelings are suppressed or not dealt with they come out in ways you may not even be aware of. Unaddressed feelings can create heightened levels of depression, anxiety, or risk of  increased drug or alcohol use in order to cope. It can also create physical symptoms like body aches, muscle tension, gastrointestinal disorders, or headaches.

Know That What You’re Feeling Is Normal

Give yourself permission to feel whatever you are feeling. Show yourself empathy in the midst of grief. People experience a range of feelings that relate to their grief, and feelings can vary depending on the closeness of the relationship with the loved one lost and the nature of the loss. Grief is a unique experience for each individual with no designated parameters of right or wrong.

Find Healthy Ways to Express What You’re Feeling

The key to healing from traumatic grief is to find healthy outlets for expressing your feelings. It can help you feel less alone and can also help to clarify what you are feeling and why. Examples of healthy outlets for expressing feelings include journaling (try using grief journaling prompts), talking to someone you trust, or working with a therapist who specializes in trauma and grief therapy

Lean on Others for Support

Sometimes people are reluctant to share their feelings of pain and loss with others. They may perceive it as weakness when in reality the opposite is true. It is important to seek help from others as you begin to face the grief stemming from loss. You may gain strength from talking to others who have also experienced traumatic grief to help you know you are not alone and to normalize your feelings. Getting support from close friends, family, a spiritual advisor, or a healthcare professional can be the key to overcoming traumatic grief. Often, people need some type of outside support to begin to initiate the necessary steps to move forward towards healing.

When to Get Professional Help for Traumatic Grief

Due to the fact that the term traumatic grief is not a recognized mental-health disorder, clinicians look more closely at the diagnosable conditions that people may be at higher risk for, including major depressive disorder (MDD), post-traumatic stress disorder (PTSD), prolonged grief disorder, and suicidal ideation.^1,7

Wondering whether it’s time to seek professional help for complex bereavement, complicated grief or traumatic grief? Ask yourself two questions:

• Does the intensity of my emotional pain overwhelm my ability to cope?
• Have there been any shifts in my experience since the death, or do I feel stuck even after months or years?

If the answer to either is ‘yes’ then a therapist trained in grief and trauma can probably help.

Start your search to find a grief counselor using an online therapist directory. If you are having thoughts of harming yourself or others, it is imperative to get help immediately. Call 1-800-273-8255 (National Suicide Prevention Lifeline) 24/7 for free, confidential support.

Treatment for Trauma & Grief

Treatment for trauma grief should integrate elements of treatment for trauma and grief, starting by creating a sense of physical and mental safety.

Grief and trauma counseling options include:⁸

• Cognitive behavioral therapy (CBT)
• Cognitive processing therapy (CPT)
• Prolonged exposure therapy
• Brief eclectic psychotherapy
• Eye movement desensitization and reprocessing therapy (EMDR)
• Narrative exposure therapy

There’s less research on effective treatments for grief, partly due to the fact that grief isn’t a mental-health disorder. For those who meet the criteria for prolonged grief disorder, adaptations of cognitive-behavioral therapy that incorporate strategies from exposure therapy, cognitive restructuring, interpretive therapy, and interpersonal therapy have been found to be helpful.¹

Supports for Those Without a Diagnosis

For people who have not been diagnosed with prolonged grief disorder (PGD) or another mental health disorder, here are ways to support the grieving process:

• Psychoeducation (education on the typical experience of grief)
• Commemorative services and grief rituals for processing the loss in healthy ways
• Peer or professional led support groups
• Strong social support network (friends, family, clergy, counselors)
• Implementing self-care practices

Final Thoughts

What you are struggling with is unique to you, but you are not alone. Talking with a therapist, trusted friend or family member, or spiritual advisor can make a positive difference in how you feel. Don’t be afraid to reach out for more support.