Traumatic grief after a sudden or violent death
Grief after a death that was sudden, violent or both: an accident, a killing, a disaster, a suicide. The mind holds two things at once, the loss of the person and the shock of how they died, and the second can crowd out the first.
What drives it
The story of the dying replays in place of the life that was lived, which Rynearson saw again and again in families after violent death. Useful for identification because it explains why someone cannot yet miss the person in the ordinary way: the images of the death keep getting in first.
How it shows
Work
Freezing at the sound of a siren outside the office. Being unable to drive past the junction, so the commute now takes an extra half hour.
Relationships
Families split over the inquest, the trial or what should have been done. A person who can’t look at photos of the one who died because their mind goes straight to the last day.
Self
Notice whether memories of the person arrive on their own, or whether the way they died always comes first. Notice startle, sleep and the places you now go round.
What tells it apart
Post-traumatic stress disorder (PTSD): PTSD centers on fear and threat: reliving, avoiding, staying on guard. Traumatic grief may carry all of that and more likely adds yearning for the person. The two often occur together and can be told apart by asking which one fills the day.
Prolonged grief disorder (ICD-11, DSM-5-TR): Prolonged grief disorder is defined by yearning or preoccupation lasting a year or more in adults (DSM-5-TR), whatever the cause of death. Traumatic grief describes the circumstances of the loss, and it may or may not become prolonged grief.
Grief (complicated, disenfranchised, anticipatory): Grief after an expected death may hurt as much. Traumatic grief is more likely when the shock, the images and the unanswered questions about how it happened are as present as the missing.
A test
Ask the person to tell one ordinary memory of the one who died. If the account keeps slipping back to the day of the death, the grief may be traumatic in this sense.
Questions to carry
- When I think of them, which picture comes first?
- Which places or sounds have I been going round since it happened?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
- Watch: 3 secrets of resilient people, Lucy Hone, TEDxChristchurch, 2019. A resilience researcher on the months after her 12-year-old daughter Abi was killed in a car crash, and the three habits she leaned on. She describes the five-stage leaflets she was handed. One family's account, free to watch.
How strong the research is
moderate. A meta-analysis of 25 studies of people bereaved by unnatural deaths (Djelantik, Smid, Mroz, Kleber and Boelen, 2020) put prolonged grief disorder at about 49%, higher after the death of an only child and after killings, lower after natural disasters and with more time since the loss. That compares with roughly one in ten across bereaved adults in general (Lundorff and colleagues, 2017). The studies varied widely in method, and the authors ask for caution with the figure. The name is also used in two ways: Prigerson and colleagues (1999) used ‘traumatic grief’ for the criteria that later became prolonged grief disorder, whatever the cause of death.
Where it comes from
Holly Prigerson and colleagues, Consensus criteria for traumatic grief, British Journal of Psychiatry, 1999. Edward Rynearson, Retelling Violent Death, 2001