Make It Make Sense: Differing Between Grief and Traumatic Grief

By Robyn C. Hill, Ed.D., LPCC

I have always seen my fair share of grief clients over the years, but I do believe there has been an influx in recent years.  I would also say loss due to trauma is in higher numbers, just based on my first hand lived experience.  Yet, in practice I see the expectation to treatment to be a cookie cutter approach. How can this be when grief and loss is so nuanced? Let’s start with the difference between grief and traumatic grief.

Grief is a process that most people experience when they lose someone or something that is close to them.  It is a distressing period in one’s life that evokes negative thoughts and emotions, as one tries to move forward with the void the loss has left. Grief and bereavement are encapsulated in recalling memories of the past, feeling the loss in the present, and anxiety about the absence of the loss in the future (Maciejewski & Prigerson, 2023). 

Maciejewski & Prigerson (2023) speak of grief as “intense sadness or pain” along with “an experience of absence and emptiness, with the [bereaved] longing or yearning for the richness and sense of coherence, meaning, purpose, place, and wholeness provided by a relationship that is no longer part of one’s lived experience.”  When a person experiences a loss, they are often left with a need to know why, because loss often doesn’t make sense.  So, the person is left longing to make it make sense, and depending on how severe the longing is, may determine how severe the grief may become (Milman et al, 2017).

The concept of grief and its severities have been studied in the field of psychology by theorists going back to Freud. Generally, when a person presented with a severe form of grief, psychiatrists and the medical community presumed the patient had a comorbid grief and other mental health disorder, e.g. depression, post-traumatic stress disorder, generalized anxiety disorder (Maciejewski & Prigerson, 2023).

It wasn’t until the 1990s that Holly Prigerson and her team of researchers challenged the idea of solely diagnosing comorbid grief and mood/anxiety disorders and proposed that there could be a severe grief disorder that could stand on it’s on.  The researchers presented the terms complicated grief and later traumatic grief to the psychiatric community to help lay the groundwork in developing the diagnostic criteria for a grief disorder, now known as prolonged grief disorder (Maciejewski & Prigerson, 2023).

Prolonged Grief Disorder (PGD) generally persists for 6 months or longer.  There are some significant symptoms that make prolonged grief stand out from typical grief.  There tends to be a preoccupation and incessant longing for the loss.  This also comes with a strong emotional responses whether it is being emotionally numb or extreme sadness, feelings of guilt, possibly even anger.  There may be denial and struggles to accept the loss, as well as thoughts and feelings of blame. The person may feel like they have lost  a part of themselves and may find themselves socially withdrawn (Maciejewski & Prigerson, 2023).

PGD not only has long term psychological effects, but research has found that it can have long term physiological effects as well.  Milman et al. (2017) discuss some of the health problems that PGD is a predictor to, which include hypertension/high blood pressure, heart disease, and cancer.  They also explain that PGD can still be comorbid with other mental health disorders and substance use disorders, and has presented with suicidality. The researchers discuss that while PGD can have many negative outcomes, there is the potential for post-traumatic growth with the use of meaning making (Milman et al., 2017).

As stated before, the inability to make sense, or give meaning to the loss, as well as the severity of the loss can determine the severity of the grief.  Being able to redefine one’s own identity in a positive way and/or give a new meaning to their ongoing life has shown an upward trend in the research (Milman et al., 2017.) So when we see people start foundations, walks, advocacies, etc. in the memories of their losses they are contributing to their own post-traumatic growth.

So Grief and Traumatic Grief/PGD on the surface may look the same but are two very different ailments.  They both feel like emotional turmoil, but grief is the normal process one will feel when separated from someone or something that they love. Traumatic grief or prolonged grief disorder, the longing for the loved one doesn’t seem to let up and the emotional pain feels like depression, PTSD, or anxiety. It’s lasting a long time, and it is interfering with daily tasks. It’s different; and by differentiating it the treatment approaches are now different.                    

References

Maciejewski, P. & Prigerson, H. (2023). Defining and Diagnosing Prolonged Grief Disorder. In C. F. Reynolds (Ed.), Grief and Prolonged Grief (1st ed., pp. 99-118). American Psychiatric Publishing.  

Milman, E., Neimeyer, R., Fitzpatrick, M., MacKinnon, C., Muis, K., & Cohen, S. (2017). Prolonged grief symptomatology following violent loss: The mediating role of meaning. European Journal of Psychotraumatology, 8(sup6), 1503522. https://doi.org/10.1080/20008198.2018.1503522