ISTSS :: Terrorism and Trauma : Sudden Traumatic Loss

Sudden Traumatic Loss

What is a sudden traumatic loss?
Few things in life are as painful as the sudden, traumatic death of a loved one, or a friend, coworker, or neighbor. Causes of such losses include war, combat, disasters, and terrorism, as well as medical catastrophes, airline crashes, suicide, and homicide. In some of these situations, multiple traumatic losses occur. Each of these affects individuals as well as their communities.

Sudden traumatic deaths can include (1) deaths that occur without warning, providing no opportunity to anticipate, prepare, or say goodbye; (2) deaths that are otherwise untimely, including the death of one's child at any age; (3) deaths that occur as the result of violence and deaths that result in violent harm to the body; (4) deaths of more than one person; and (5) deaths that occur as a result of the willful misconduct of others, carelessness, or negligence. Many individuals experience the sudden traumatic loss of a loved one at some point in their lives. And some communities share these traumatic losses. In each case, many additional losses accompany this experience.

What symptoms are typical following a sudden, traumatic loss?
The range of people's reactions can vary a great deal from person to person and from culture to culture. Survivors often experience reactions that may include two kinds of symptoms -- trauma symptoms and grief symptoms -- which sometimes can overwhelm their capacity to cope.

Trauma symptoms may include feelings of horror and anxiety on the one hand and emotional numbness and a sense of disconnection on the other. Some people cannot remember significant parts of what happened, while others are plagued by memories or feel as if they are re-experiencing or reliving the event through painful flashbacks. Traumatic deaths often cause extreme distress over an extended period of time that can significantly interfere with daily functioning.

Many people develop symptoms of a psychological condition called post-traumatic stress disorder (PTSD). There are three groups of symptoms that indicate PTSD: (1) re-experiencing of the traumatic event as indicated by painful, intrusive thoughts or nightmares about the death; (2) avoidance, as indicated by marked efforts to stay away from activities, places, or things related to the loved one's death, and emotional numbing, as indicated by feeling detached from others; and (3) increased arousal, as indicated by difficulty sleeping, irritability, difficulty concentrating, and a tendency to become startled easily.

Aside from the typical symptoms of PTSD, surviving loved ones sometimes experience self-blame and guilt. People may imagine ways they could or should have prevented these experiences from occurring or how they could have rescued the person, and they may experience guilt surrounding events prior to the death. Whether someone is present at or far from the site at which others were killed, survivor guilt can be common.

Symptoms of grief involve an overwhelming sense of loss with strong feelings of yearning or longing for the loved one. Survivors may feel a profound sense of emptiness and a sense that a part of them has died. They often speak of generalized pain or heaviness in their chest. They may feel depressed and hopeless about the future. Things that were once important may not seem to matter so much any more. In addition, they may cry easily, lose interest in eating, or experience stomach upset, headaches, and feelings of restlessness.

Traumatic losses often threaten the survivor's sense of personal safety, security, and ability to trust others. It can take a significant amount of time to accept the reality of sudden traumatic loss. Survivors may know intellectually that their loved one is dead, but find themselves expecting the loved one to walk through the door or call on the telephone. It can be particularly hard to part with the loved one's possessions. It may be especialy difficult when a loved one's body is not recovered. Sudden traumatic losses often raise existential and spiritual issues as well, such as difficulty making sense of these losses or feeling betrayed by God.

How long will the feelings last?
Because survivors of sudden traumatic death must come to terms with the loss of their loved one, as well as the manner in which it occurred and the additional or secondary losses, it can take time for the painful feelings and thoughts to diminish. Traumatic deaths are particularly likely to result in intense and prolonged distress if the death was violent or if the death was brought about deliberately. Following such deaths, it is also common for survivors to agonize about what their loved ones experienced during their final moments of life. Particularly if harm was intended, the survivor must grapple with the realization that others can and will commit malevolent acts. This awareness can result in many reactions. It may provoke intense feelings, including denial, fierce protection of survivors, or powerful rage toward those perceived to be responsible. In addition, survivors may be more vulnerable if they witnessed the death or were also threatened with death. Finally, the death of a child poses unique problems for recovery. People expect to die before their children and so it seems profoundly wrong when a child dies first.

It may also take longer to deal with the loss if the survivor (1) has previously experienced psychological problems, such as major depression; (2) has experienced previous trauma or traumatic loss, especially if it is similar in some way to this loss; (3) has few friends or relatives who are supportive, or (4) is simultaneously coping with other serious concerns, such as dislocation, major health problems, psychosocial stresses, or other losses.

As the initial shock of the death diminishes, there may be intervals when the survivor is able to focus on other issues and not feel the pain of the loss so intensely. Gradually, these intervals will become longer, and there will be good days and bad days. Over time, the proportion of good days to bad days typically increases. However, people can experience setbacks during the process. On a relatively good day, the bereaved person may encounter a reminder of the loved one, and this may cause the reemergence of painful feelings of loss. People often have difficulty dealing with occasions such as holidays, birthdays, the anniversary date of the death, or other times of meaning.

What can survivors do to help themselves?
Because physical health may be affected by grief, it is important for survivors to try to maintain adequate nutrition, sleep, and exercise. It's especially important for individuals with any chronic health problems, such as heart disease, if at all possible to stay in contact with a physician to ensure proper monitoring of their condition. Survivors are often preoccupied by their grief and may be prone to other sorts of mishaps, such as accidents, so extra caution is important. Similarly, it may be more difficult if survivors must make major decisions during the first several months after a loss, since life changes may bring on additional stress.

Most experts recommend that survivors confide in someone about the loss and find a support system. This can be a friend, a clergy person, or another person who has experienced similar loss. It may take some time to identify friends who can be good listeners. Not everyone knows what to say or do to be helpful. Some survivors withdraw from social contact because of the possibility of hurtful comments. This is unfortunate, because it can cut people off from interactions that could be healing.

Grieving is a long and difficult process because it involves slowly remembering what happened. Sometimes the memories may seem like more than the survivor can bear. It can be helpful for survivors to learn ways to calm themselves. These might include such things as taking a walk, being with people, or participating in a distracting activity. Some survivors find it useful to write or to read.

When is it a good idea to seek professional help?
It is important for an individual to know they can ask for help. If they continue to experience frequent or severe trauma symptoms, as described above, for more than several months after the death, and if these reactions interfere with other parts of normal life, such as being able to care for one's children or hold a job, asking for support from a professional can be helpful. In addition, any of the following experiences suggest that professional help may be needed:

continuing to experience intense yearning for the deceased that does not diminish over time
struggling with substantial feelings of guilt or uncontrolled rage
becoming severely depressed and feeling hopeless about the future
harboring persistent suicidal thoughts
abusing alcohol or other drugs or increasingly greater tobacco use.

Treatment can help
No matter how long someone has been suffering from the impact of a sudden traumatic loss, comforting and effective treatments are available. It is important for survivors of sudden traumatic loss to select a therapist who is experienced in treating both trauma and bereavement. And it is important to feel comfortable with language, cultural considerations, and style of expression when choosing a psychotherapist.

A variety of individual psychotherapies and support groups are available. Medication and psychotherapy may be effective with symptoms of both depression and PTSD. In addition, temporary medication may be useful for those who initially experience intense anxiety or the inability to sleep at all.

A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist with experience in treating sudden traumatic loss.

For more information about psychological trauma or the International Society for Traumatic Stress Studies call 1-877-469-PTSD (7873).

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