Loss & Psychotrauma.
Lectures & Literature, 2023.
Lecture notes, workgroup notes, and literature summaries can be found on pages 2 – 73.
The Burback article summary (lecture 1 & lecture 7 literature) can be found on pages 57 – 69.
Practice open questions, not exam reflective, can be found on pages 76 – 86.
A summary of treatment methods can be found on pages 87-88.
A list of theories for each disorder can be found on page 88.
1
,Loss & Psychotrauma.
Lectures & Literature, 2023.
Loss and Psychotrauma, Lecture 1.
Introduction on Loss & Psychotrauma and its most Common Psychological
Consequences.
Part 1 – Grief.
Loss is associated with a separation from someone or something that you are attached to (can
be personal but can also be material).
Separation distress: pain, sadness, yearning, preoccupation, difficulties with
acceptance.
AKA grief.
Psychotrauma: experiencing or witnessing an event that is threatening to the safety, control,
integrity, or health of self or others.
Traumatic distress: re-experiencing, anxiety, hypervigilance, sense of current
threat.
Both loss and psychotrauma are negative and stressful, however, they can be distinguished
from one another by their description of the situation.
Loss and trauma are usually different concepts; however, they can co-occur, hence,
traumatic loss.
Bereavement: the situation of having lost a loved one.
Grief: the emotional/psychological response to a loss.
Unhealthy, disordered, complicated grief: general terms for stagnated grief which could
possibly develop into a full grief disorder.
Prolonged grief disorder (PGD): term for formal classification of grieving disorder.
Misconceptions of Grief:
Normal grieving is a process that occurs in stages.
o Denial, Anger, Bargaining, Depression, Acceptance.
The same reactions are always part of the grieving process.
o Anger, depression, sadness.
Intense emotions in the initial period of mourning predict healthy adjustment,
absence of reactions indicates unhealthy, abnormal grief.
Losing a child is always worse than losing a partner.
o Both are worse than losing a parent.
A grieving process ends after one year if you lose a partner and two years if you lose
a child.
Note. Understanding these misconceptions are crucial for guiding bereaved individuals.
What is Grief?
Grief is the primary emotional reaction to the death of a significant other.
Grief is a complex emotional syndrome accompanied by physical symptoms.
Grief involves a wide range of possible cognitive and behavioural reactions.
Grief primarily includes separation distress.
o Separation distress is an automatic response after being separated from an
attachment figure.
o Feelings of yearning and longing occur following separation distress.
o The individual experiencing separation distress exhibits proximity-seeking
behaviour.
2
,Loss & Psychotrauma.
Lectures & Literature, 2023.
o The thoughts of an individual experiencing separation anxiety include a
preoccupation with thoughts about the deceased and death event.
o Perceptions that may occur following separation distress are sensations of
seeing or hearing the person, and hence, feeling that the separation is not
real.
Adjusting to a loss is about tasks, not stages.
The tasks completed following a loss are as follows – facing the reality of the loss, allowing
emotions aroused by the loss to be felt, and continuing usual, valued activities.
^ Normal grief involves the oscillation between loss-orientated tasks and restoration-
orientated tasks; unhealthy grief occurs when this oscillation fails to occur.
Disturbed, Unhealthy Grief:
Chronic grief (too much).
Suppressed grief, delayed grief (too little).
Ambivalent grief (grief after a disturbed relationship).
Note. These are simplistic and not empirical descriptions; this area is hard to research due to
the lack of standardisation.
3
, Loss & Psychotrauma.
Lectures & Literature, 2023.
ICD-11 PGD DSM-5 PGD
A. Event History of bereavement of a person A. Event and Time Death of a close person at least 12
Criterion. close to them. Criteria. months ago.
B. Separation Persistent & pervasive grief response B. Separation Development of persistent grief
Distress. characterised by either longing or Distress. response characterised by either
persistent preoccupation with the yearning/longing or preoccupation
deceased. with the deceased, which have been
present most days for at least the
last month to a clinically significant
degree.
C. Intense Intense emotional pain. C. Cognitive, At least three of the following
Emotional Difficulty accepting the death. Emotional, and symptoms have been present most
Pain. Feeling a loss of oneself. Behavioural days:
Inability to experience a positive Symptoms. - Identity disruption.
mood. - Marked sense of disbelief.
Emotional numbness. - Avoidance of reminders.
Difficulty engaging with social - Intense emotional pain.
activities. - Difficulty reintegrating.
- Emotional numbness.
- Feel that life is meaningless.
- Intense loneliness.
D. Functional Significant impairment in important D. Functional Significant distress or impairment
Impairment. areas of functioning. Impairment. in important areas of functioning.
If functioning is maintained, it is only
through significant additional effort.
E. Cultural and Pervasive grief response has persisted E. Cultural Duration & severity of the
Time Criteria. for an abnormally long period. Orientation. bereavement reactor clearly exceed
Grief responses lasting for less than 6 expected social, cultural, or
months and for longer periods in some religious norms for the individual’s
cultural contexts should not be cultural context.
regarded as meeting this requirement.
F. Relation to Symptoms are not better explained
Other Mental by another disorder or attributable
Disorders. to physiological effects of a
substance or other condition.
Differences Between ICD-11 & DSM-5 PGD:
Typological VS. detailed description of criteria.
o More detail in the DSM-5.
A number of symptoms and severity specifications for diagnosis.
o More symptoms and severity in the DSM-5.
Timing after loss when a diagnosis can be made.
o More than 6 months for the ICD-11, and more than 12 months for the DSM-5.
Both include separation distress, but the DSM-5 emphasizes it more strongly.
There is no given number of symptoms required to be present for criteria C of the
ICD-11, however, there is for the DSM-5.
4
Lectures & Literature, 2023.
Lecture notes, workgroup notes, and literature summaries can be found on pages 2 – 73.
The Burback article summary (lecture 1 & lecture 7 literature) can be found on pages 57 – 69.
Practice open questions, not exam reflective, can be found on pages 76 – 86.
A summary of treatment methods can be found on pages 87-88.
A list of theories for each disorder can be found on page 88.
1
,Loss & Psychotrauma.
Lectures & Literature, 2023.
Loss and Psychotrauma, Lecture 1.
Introduction on Loss & Psychotrauma and its most Common Psychological
Consequences.
Part 1 – Grief.
Loss is associated with a separation from someone or something that you are attached to (can
be personal but can also be material).
Separation distress: pain, sadness, yearning, preoccupation, difficulties with
acceptance.
AKA grief.
Psychotrauma: experiencing or witnessing an event that is threatening to the safety, control,
integrity, or health of self or others.
Traumatic distress: re-experiencing, anxiety, hypervigilance, sense of current
threat.
Both loss and psychotrauma are negative and stressful, however, they can be distinguished
from one another by their description of the situation.
Loss and trauma are usually different concepts; however, they can co-occur, hence,
traumatic loss.
Bereavement: the situation of having lost a loved one.
Grief: the emotional/psychological response to a loss.
Unhealthy, disordered, complicated grief: general terms for stagnated grief which could
possibly develop into a full grief disorder.
Prolonged grief disorder (PGD): term for formal classification of grieving disorder.
Misconceptions of Grief:
Normal grieving is a process that occurs in stages.
o Denial, Anger, Bargaining, Depression, Acceptance.
The same reactions are always part of the grieving process.
o Anger, depression, sadness.
Intense emotions in the initial period of mourning predict healthy adjustment,
absence of reactions indicates unhealthy, abnormal grief.
Losing a child is always worse than losing a partner.
o Both are worse than losing a parent.
A grieving process ends after one year if you lose a partner and two years if you lose
a child.
Note. Understanding these misconceptions are crucial for guiding bereaved individuals.
What is Grief?
Grief is the primary emotional reaction to the death of a significant other.
Grief is a complex emotional syndrome accompanied by physical symptoms.
Grief involves a wide range of possible cognitive and behavioural reactions.
Grief primarily includes separation distress.
o Separation distress is an automatic response after being separated from an
attachment figure.
o Feelings of yearning and longing occur following separation distress.
o The individual experiencing separation distress exhibits proximity-seeking
behaviour.
2
,Loss & Psychotrauma.
Lectures & Literature, 2023.
o The thoughts of an individual experiencing separation anxiety include a
preoccupation with thoughts about the deceased and death event.
o Perceptions that may occur following separation distress are sensations of
seeing or hearing the person, and hence, feeling that the separation is not
real.
Adjusting to a loss is about tasks, not stages.
The tasks completed following a loss are as follows – facing the reality of the loss, allowing
emotions aroused by the loss to be felt, and continuing usual, valued activities.
^ Normal grief involves the oscillation between loss-orientated tasks and restoration-
orientated tasks; unhealthy grief occurs when this oscillation fails to occur.
Disturbed, Unhealthy Grief:
Chronic grief (too much).
Suppressed grief, delayed grief (too little).
Ambivalent grief (grief after a disturbed relationship).
Note. These are simplistic and not empirical descriptions; this area is hard to research due to
the lack of standardisation.
3
, Loss & Psychotrauma.
Lectures & Literature, 2023.
ICD-11 PGD DSM-5 PGD
A. Event History of bereavement of a person A. Event and Time Death of a close person at least 12
Criterion. close to them. Criteria. months ago.
B. Separation Persistent & pervasive grief response B. Separation Development of persistent grief
Distress. characterised by either longing or Distress. response characterised by either
persistent preoccupation with the yearning/longing or preoccupation
deceased. with the deceased, which have been
present most days for at least the
last month to a clinically significant
degree.
C. Intense Intense emotional pain. C. Cognitive, At least three of the following
Emotional Difficulty accepting the death. Emotional, and symptoms have been present most
Pain. Feeling a loss of oneself. Behavioural days:
Inability to experience a positive Symptoms. - Identity disruption.
mood. - Marked sense of disbelief.
Emotional numbness. - Avoidance of reminders.
Difficulty engaging with social - Intense emotional pain.
activities. - Difficulty reintegrating.
- Emotional numbness.
- Feel that life is meaningless.
- Intense loneliness.
D. Functional Significant impairment in important D. Functional Significant distress or impairment
Impairment. areas of functioning. Impairment. in important areas of functioning.
If functioning is maintained, it is only
through significant additional effort.
E. Cultural and Pervasive grief response has persisted E. Cultural Duration & severity of the
Time Criteria. for an abnormally long period. Orientation. bereavement reactor clearly exceed
Grief responses lasting for less than 6 expected social, cultural, or
months and for longer periods in some religious norms for the individual’s
cultural contexts should not be cultural context.
regarded as meeting this requirement.
F. Relation to Symptoms are not better explained
Other Mental by another disorder or attributable
Disorders. to physiological effects of a
substance or other condition.
Differences Between ICD-11 & DSM-5 PGD:
Typological VS. detailed description of criteria.
o More detail in the DSM-5.
A number of symptoms and severity specifications for diagnosis.
o More symptoms and severity in the DSM-5.
Timing after loss when a diagnosis can be made.
o More than 6 months for the ICD-11, and more than 12 months for the DSM-5.
Both include separation distress, but the DSM-5 emphasizes it more strongly.
There is no given number of symptoms required to be present for criteria C of the
ICD-11, however, there is for the DSM-5.
4
