Loss and Psychotrauma
LECTURE 1
Loss: Separation from someone or something that you are attached to
↓
Separation distress (grief): Pain, sadness; yearning for/preoccupation with what is lost;
difficulties accepting and believing the object of attachment is gone
-------------------------------------------------------------------
Definitions:
Bereavement = Situation of having lost a loved one/relative
Grief = The emotional/psychological responses to this loss
Mourning = Behavioural and social expressions of grief, which are shaped by the practices
of a given society or cultural group (e.g. mourning rituals).
Unhealthy, disordered, complicated grief = General terms for stagnated grief – possibly
developing into a full-blown grief disorder.
Persistent Complex Bereavement Disorder = Term for formal classification of grieving
disorder in DSM-5 (section 3)
Prolonged Grief Disorder = Term for formal classification of grieving disorder in
DSM-5-TR(section 2) and ICD-11
Adjusting to loss is all about TASKS not about STAGES/PHASES:
- Facing the reality of the loss
- Allowing the emotions aroused by the loss to be felt
- Continuing usual, valued activities
What is actually grief?
- Primarily (the persistence of) separation distress
- All automatic responses occurring after being separated from an attachment
figure
- Attachment figure = person providing a safe haven for you (parent, partner)
- Attachment figure = person you are responsible for as a caretaker
- Feelings = yearning, longing
- Behaviour = proximity seeking (searching)
- Thoughts = preoccupation with thoughts about the deceased
- Perceptions = sensation of seeing/hearing the person; feeling that separation is
‘unreal’
“Normal” grief: both loss-oriented and restoration oriented
,Disturbed, unhealthy grief (old definitions; 90’s)
- Too much grief > chronic grief
- Too little grief > suppressed grief, delayed grief
- Grief after disturbed relationships > ambivalent grief
Prolonged Grief Disorder (DSM-V)
The phenomenological distinction between healthy grief and PGD:
1. Degree of progress in the grieving process
○ PGD? No progress, worsening of condition over time
2. Duration of grief reactions
○ PGD? Grief reactions persist > 1 year post-loss
3. Degree of suffering
○ PGD? Grief causes distress + impairs functioning
Diagnostic assessment:
1) Self-report questionnaire to get indication of disturbed grief (TGI-SR+)
2) Clinical interview to make formal diagnosis PGD
Traumatic Grief Inventory Self Report Plus (TGI-SR+)
• Allows to set diagnosis of probably PGD as defined in DSM-5-TR and ICD-11
• Total score of ≥71 indicates clinically relevant PGD
Risk factors:
- Gender (women experience more problems)
- Stigmatisation
- Anxious attachment
- Death of a child or a partner
- Unnatural violent death
Protective factors:
- Age (the younger, the better)
- High education
- Perceived support
- Secure attachment
A sudden lost can, next to PGD, increase chances of developing many other mental health
conditions (PTSD, depression, alcohol abuse)
, 4 core problematic psychological processes:
- Lack of integration of the loss with pre-existing knowledge
- Anxious avoidance of loss-oriented coping, driven by catastrophic misinterpretations
- Depressive avoidance of restoration-orientation, driven by negative predictions,
survivor guilt, and limited repertoire of activities
- Maladaptive appraisals and associated emotions
-------------------------------------------------------------------
Psychotrauma: Experiencing or witnessing an event that is threatening to safety, control,
integrity, health of self or others
↓
Traumatic distress: Reexperiencing, anxiety, hypervigilance; sense of current threat
(difficulties accepting and believing threat is in the past)
-------------------------------------------------------------------
Potentially traumatic events;
1. The event is discrepant with pre-existing mental representations:
- Violent assault, sexual assault > representation of the world as a safe
predictable place
2. The event is extremely meaningful (has use implications) and causes strong
emotions
- Violent assault, sexual assault > “there is danger everywhere, I dont have
control, others cannot be trusted, i am not a worthy person” > fear, depression
3. Via classical conditioning + generalisation, responses are automatically elicited by
many different cues
4. Internal and external cues associated with event are avoided (maintained by operant
conditioning principles)
All reactions to all aversive life events can be conceptualised in these 4 principles:
LECTURE 1
Loss: Separation from someone or something that you are attached to
↓
Separation distress (grief): Pain, sadness; yearning for/preoccupation with what is lost;
difficulties accepting and believing the object of attachment is gone
-------------------------------------------------------------------
Definitions:
Bereavement = Situation of having lost a loved one/relative
Grief = The emotional/psychological responses to this loss
Mourning = Behavioural and social expressions of grief, which are shaped by the practices
of a given society or cultural group (e.g. mourning rituals).
Unhealthy, disordered, complicated grief = General terms for stagnated grief – possibly
developing into a full-blown grief disorder.
Persistent Complex Bereavement Disorder = Term for formal classification of grieving
disorder in DSM-5 (section 3)
Prolonged Grief Disorder = Term for formal classification of grieving disorder in
DSM-5-TR(section 2) and ICD-11
Adjusting to loss is all about TASKS not about STAGES/PHASES:
- Facing the reality of the loss
- Allowing the emotions aroused by the loss to be felt
- Continuing usual, valued activities
What is actually grief?
- Primarily (the persistence of) separation distress
- All automatic responses occurring after being separated from an attachment
figure
- Attachment figure = person providing a safe haven for you (parent, partner)
- Attachment figure = person you are responsible for as a caretaker
- Feelings = yearning, longing
- Behaviour = proximity seeking (searching)
- Thoughts = preoccupation with thoughts about the deceased
- Perceptions = sensation of seeing/hearing the person; feeling that separation is
‘unreal’
“Normal” grief: both loss-oriented and restoration oriented
,Disturbed, unhealthy grief (old definitions; 90’s)
- Too much grief > chronic grief
- Too little grief > suppressed grief, delayed grief
- Grief after disturbed relationships > ambivalent grief
Prolonged Grief Disorder (DSM-V)
The phenomenological distinction between healthy grief and PGD:
1. Degree of progress in the grieving process
○ PGD? No progress, worsening of condition over time
2. Duration of grief reactions
○ PGD? Grief reactions persist > 1 year post-loss
3. Degree of suffering
○ PGD? Grief causes distress + impairs functioning
Diagnostic assessment:
1) Self-report questionnaire to get indication of disturbed grief (TGI-SR+)
2) Clinical interview to make formal diagnosis PGD
Traumatic Grief Inventory Self Report Plus (TGI-SR+)
• Allows to set diagnosis of probably PGD as defined in DSM-5-TR and ICD-11
• Total score of ≥71 indicates clinically relevant PGD
Risk factors:
- Gender (women experience more problems)
- Stigmatisation
- Anxious attachment
- Death of a child or a partner
- Unnatural violent death
Protective factors:
- Age (the younger, the better)
- High education
- Perceived support
- Secure attachment
A sudden lost can, next to PGD, increase chances of developing many other mental health
conditions (PTSD, depression, alcohol abuse)
, 4 core problematic psychological processes:
- Lack of integration of the loss with pre-existing knowledge
- Anxious avoidance of loss-oriented coping, driven by catastrophic misinterpretations
- Depressive avoidance of restoration-orientation, driven by negative predictions,
survivor guilt, and limited repertoire of activities
- Maladaptive appraisals and associated emotions
-------------------------------------------------------------------
Psychotrauma: Experiencing or witnessing an event that is threatening to safety, control,
integrity, health of self or others
↓
Traumatic distress: Reexperiencing, anxiety, hypervigilance; sense of current threat
(difficulties accepting and believing threat is in the past)
-------------------------------------------------------------------
Potentially traumatic events;
1. The event is discrepant with pre-existing mental representations:
- Violent assault, sexual assault > representation of the world as a safe
predictable place
2. The event is extremely meaningful (has use implications) and causes strong
emotions
- Violent assault, sexual assault > “there is danger everywhere, I dont have
control, others cannot be trusted, i am not a worthy person” > fear, depression
3. Via classical conditioning + generalisation, responses are automatically elicited by
many different cues
4. Internal and external cues associated with event are avoided (maintained by operant
conditioning principles)
All reactions to all aversive life events can be conceptualised in these 4 principles:
