What's the Relationship Between Grief and Trauma?

Grief and trauma both describe powerful feelings felt after the loss of a loved one (in grief) or a painful event (in trauma). Both can greatly impact a person’s mental health. In this article we define similar, yet different, entities. At the end, we discuss how the two are related and review how you can get the help you need to face them. 

What is grief? 

Grief is a collection of strong, often painful, feelings that follow a loss. Usually – but not always –  grief follows the loss of a loved one. Grief can happen in anticipation of a loss or after the loss has occurred. It is a natural human reaction that feels and looks different for each person. 

The trajectory of grief for each person varies greatly. There is no “normal.” Some individuals show resilience easily, others feel a sense of relief that their loved one is no longer in pain, and yet others still who experienced a depressed mood prior to the loss may feel even worse after. This universal yet personal experience varies greatly. 

Just as there is no “getting over” other important life events and milestones such as graduations, weddings, or births, there is no “getting over” grief. Waves of grief come and go, becoming manageable with time, a strong support network, healthy coping skills, and clinical support when needed. 

A multitude of symptoms and thought processes that an individual feels inside can play a part in grief. These may include the following :

• Denial and shock 
• Separation anxiety
• Confusion
• Guilt 
• Yearning 
• Questioning of faith or strengthening of faith 
• Anger
• Sadness 
• Apprehension about the future

Signs of grief that others may notice from the outside include: 

• Lack of energy 
• Sleeping too much 
• Working too much 
• Memory lapses 
• Irritability 
• Mood swings including depression or feelings of euphoria 

{{mid-page-newsletter}}

What is complicated grief?

As stated above, a wide range of reactions to grief exists. However about 7% of individuals who experience loss develop what is referred to by clinicians as complicated grief, also called persistent complex bereavement disorder. This type of grief is often seen in individuals who have lost a spouse or child. 

Persistent complex bereavement disorder is defined as persistent feelings of sadness that result in continued functional impairment lasting from 12 months after a loss to many years after a loss. Instead of grief becoming manageable with time, grief in these individuals remains at the forefront of their life and impairs their day-to-day life. Some signs and symptoms of complicated grief may include the following: 

• Having trouble with your normal day-to-day routine 
• Continuing to isolate yourself from friends, family, and other loved ones 
• Feeling that life is not worth living and wishing you had died with your loved one 
• Being unable to distract yourself from thinking about the loss 
• Feeling like you are unable to enjoy life or have positive experiences 
• Having difficulty accepting the death 
• Feeling numb and detached from the world 

Do children and teens experience grief differently than adults? 

Younger individuals do experience grief in a different manner as compared with adults. 

Children younger than the age of 5, for example, cannot fully grasp the concept of death and believe that it is something temporary or reversible. From ages 5-9, children begin to understand death more, but still have a hard time understanding it could happen to them or anyone they know. Beyond 9, a child's and later adolescent’s understanding of death is more solidified. 

The American Academy of Child & Adolescent Psychiatry offers this advice for handling children in grief: 

• When a child loses a sibling, parent, or loved one, their primary caretaker or parent may be so shaken with grief themselves that they are unable to partake in normal childcare responsibilities. It is important to ensure that the child is cared for through the help and support of extended family and close friends when available. 
• A child who is scared about attending a funeral should not be forced. There are many ways to celebrate and honor an individual’s life. This may include a religious service at home, reviewing memories of the deceased, or creating artwork related to the loss. 
• Children should be able to express and show their grief in their own way. 
• It may take time for a child to understand the loss. When they do, they will likely experience grief and sadness on and off for a long time. 
• Anger toward family members, sadness regarding the loss, experiencing nightmares, irritability, and acting out are all normal reactions.
• Acting younger than a child’s stated age is also commonly observed. Examples of this behavior may include wetting the bed, requiring more attention, baby talk, becoming needier, or more. 
• Sometimes, younger children believe that they are the sole cause of events around them. Children may believe that they are the cause of a parent’s or sibling’s death, for example, if they once wished them dead in an argument, and may need reassurance that this is not the case. 

In addition, parents or guardians should understand the “normal” signs of grief in contrast to signs that a child is having serious problems. Worrisome signs in children may include: 

• Extended periods of depression in which the individual loses interest in daily activities 
• Withdrawal from friends 
• Refusal to attend school 
• Acting much younger for an extended period of time 
• Believing they can see or talk to the deceased for a long time 

If these signs last, or if you are worried about how you or your child is handling grief, seeking professional help can be beneficial. 

Adolescents, in addition to children, may cope with grief in ways different from adult family members. Adolescents may feel less connected to and reliant on family members, withdrawing and isolating during their period of grief. They may turn to social media, act out, or experiment with boundaries. 

Worrisome signs in teens, in addition to those described above, may include the following: 

• Abuse of drugs and alcohol 
• Worsening anxiety or depression 
• Panic attacks
• Disordered eating 

‍
Clinicians offer the following advice regarding helping your teen manage their grief: 

• Reaching out and creating open lines of communication are key. Make sure your teen knows that they can talk to you when needed. 
• Allow your teen to talk and grieve at their own pace. Do not force them to talk with you until they are ready. Sitting in silence or participating in other activities honoring the deceased can be healthy. 
• Make sure you as a parent or guardian get the mental health support you need to care for your teen. Model good coping skills and have your child participate in these coping skills with you. This may include writing letters, going for walks, leaning on friends and family, practicing mindfulness, and more. 
• Be open about your own feelings to let your teen know it is ok for them to do the same. 
• Make sure your children and teenagers know they are allowed to be happy and feel happiness. Remind them that their loved one would want them to be happy and that happiness does not negate the loss. 

What kind of treatment exists for grief and complicated grief? 

First and foremost, if you are having thoughts about ending your life, please call the 988 Suicide & Crisis Lifeline, available 24 hours a day 7 days a week. The Lifeline Chat and Text service is also always available. 

Grief counseling is therapy focused on grief. You do not need to necessarily show any of the signs or symptoms above to participate in grief counseling. It can be completed one-on-one with a clinician or with a group, and many forms of grief counseling exist and have been studied. While some individuals may benefit from grief counseling, others are able to experience the phases of grief with the help of family and friends. 

Treatment for complicated grief (CG) includes CG prevention in at-risk individuals and CG treatment. Modalities used include cognitive behavioral therapy (CBT), interpersonal individual therapy, writing therapy where participants are asked to write about the events and their emotions surrounding the event, and medication when needed. Studies have shown that these therapy modalities help improve the mental health of individuals experiencing chronic grief. 

What is trauma? 

In contrast to grief, trauma is a collection of emotions that occurs not just as a result of a significant loss, but also as a result of experiencing terrible, shocking, or painful events. 

Traumatic events in childhood are often referred to as adverse childhood experiences, or ACEs. From research in this field, we know that ACEs lead to several problems after childhood and into adulthood - including physical and mental illness, substance abuse, not finishing school, challenges with employment, and more. 

Examples of events that could cause trauma include:

• Seeing violence or war in your community
• Experiencing rape and sexual assault 
• Living through national disasters or severe car accidents 
• The sudden or unexplained loss of a loved one 
• Poverty 
• Experiencing racism or discrimination 
• Living within a family where there is substance abuse, mental illness, or domestic violence 
• Experiencing physical or emotional abuse 
• Being neglected as a child 
• Being a witness or victim of a crime 

Signs and symptoms of trauma that an individual child or adolescent may feel or others may notice include: 

• Intense, long-term emotional feelings of sadness, anger, anxiety, or guilt  
• Depression 
• Anxiety and heart pounding 
• Behavioral changes 
• Academic changes 
• Difficulty sleeping
• Difficulty eating
• New aches and pains 
• Difficulty paying attention 
• Withdrawing and spending time alone 
• Fixating on thinking about the traumatic event 

Traumatic stress and post traumatic stress disorder

Traumatic stress is a name given to a situation in which a child or adolescent has been exposed to one or more traumas either acutely or for so long that their reactions and symptoms listed above persist and affect their daily lives. It is defined differently by different clinicians and may mean something different depending on whom you are speaking with. Generally speaking, individuals experiencing traumatic stress experience some of the symptoms listed above. Some individuals have a hard time moving forward and may even be diagnosed with post-traumatic stress disorder later in life. 

Post traumatic stress disorder (PTSD) is a specific diagnosis that includes the following components: 

• The individual continues to re-imagine and re-experience the traumatic event through flashbacks, nightmares for over a month after the traumatic event occurred 
• The child blocks out the event by refusing to think about it, through memory lapses
• The child has symptoms such as irritability, constantly being on age, difficulty sleeping, etc. 

Not every child who experiences a traumatic event will develop traumatic stress and not every child who experiences traumatic stress will develop PTSD. 

{{mid-page-cta="/dev-resources/staging"}}

How can I help my child or teen cope with trauma? 

While the data regarding trauma and ACEs are daunting, there is hope. Many modifiable protective factors that can be enacted on an individual and family level are available to help children and adolescents who have experienced traumatic events. 

Examples of these changeable factors include making sure children have adult role model figures, underscoring the importance of school as a family, role modeling conflict resolution amongst family members, and more. 

Additionally, trauma-focused therapy with the help of a trained professional can help. 

Trauma-focused therapy is a type of therapy that recognizes how a child’s or adolescent’s history with a traumatic experience connects with and influences the individual’s emotional and behavioral responses. Through trauma-focused therapy, a mental health professional offers skills and strategies to help your child understand, cope with, and process the trauma they have experienced. 

The following steps are often involved in trauma-focused therapy: 

Re-establish safety

A traumatic event is often one in which a child’s safety has been taken away. Trauma-informed therapy will help your child re-develop a sense of safety in the everyday world.  

Identify triggers

Identifying triggers will allow your child to feel like they have control over symptoms and they do not come out of anywhere. 

Find coping skills

Coping skills like relaxation skills or anxiety management can help lessen the response to trauma.  

Improve traumatic stress symptoms

Symptoms as a result of trauma may be feelings of anxiety, guilt, shame, experiencing of intrusive thoughts, and more. Therapy can help target your child’s specific trauma stress symptoms.  

Process trauma

Processing trauma in order for an individual to feel that they can regain control and power over their past experiences is an important part of trauma-informed therapy. Processing trauma can help your child see themselves and the world in a more positive and healthy way. 

How are grief and trauma related? 

As described at the beginning of this article, grief and trauma both describe a host of emotions one feels after experiencing a difficult event - either the loss of a loved one or a source of pain or traumatic suffering. 

In addition to being separate entities, the two can be intertwined. An individual may feel grief after a traumatic event. On the flip side, someone might experience trauma after a sudden or unexpected death in the family. 

Because both describe our reactions to difficult events, it makes sense that certain therapy modalities focus on both at the same time. 

Trauma and grief support at Charlie Health

At Charlie Health, trauma-informed CBT is a core part of our virtual Intensive Outpatient Program's curriculum. We're available 24/7 to get you started on your healing journey. 

‍