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Transcript
Unique Aspects of Trauma-Related Bereavement Janice Harris Lord www.jhlord.org [email protected] 817-492-9208 At the end of this Session participants will be able to: Name at least three unique aspects of trauma-related bereavement Differentiate common and different components of trauma-bereavement, depression, and post-traumatic stress disorder Describe a somewhat structured chronology of treatment goals Killing and dying are VERY different. Unique Features of Homicide Sudden Unique Features of Homicide Sudden Violent Unique Features of Homicide Sudden Violent Someone’s Fault Unique Features of Homicide Sudden Violent Someone’s Fault Justice system Involvement (homicide only) Unique Features of Homicide/Suicide Sudden Violent Someone’s Fault Justice system Involvement (homicide only) Financial Issues Unique Features of Homicide/Suicide Sudden Violent Someone’s Fault Justice system Involvement (homicide only) Financial Issues Spiritual Issues Death Notification Homicide/Suicide-Related Trauma Death (Rynearson, 1998) Natural Grief Thoughts: Reunion Feelings: Longing/Yearning Behavior: Searching Homicide/Suicide-Related Trauma Death (Rynearson, 1998) Natural Grief Thoughts: Reunion Feelings: Longing/Yearning Behavior: Searching Traumatic Grief Thoughts: Reenactment Feelings: Intrusion/Avoidance Behavior: Approach/Avoidance Differentiating Between Trauma Grief, Depression, and PTSD Symptom Trauma Dppsn PTSD Grief Grief Spasms X Specific Guilt X Spiritual/Mystical Visitations X Wishes to Die X Rage/Revenge Fantasies X Pre-occupation with manner of death X Differentiating Between Trauma Grief, Depression, and PTSD Symptom Trauma Dppsn PTSD Grief Recurrent Intrusive Memories X Avoidance X Death-Related Dreams X Eating Problems (significant weight gain or loss) X Grief vs. Depression (Simons, 1985) Trauma Grief Depression Responds to comfort & support Does not seek or accept support Often openly angry Irritable and complaining but not openly expressive of anger Relates feelings to loss Depressed feelings generalized Can still experience moments of enjoyment and satisfaction Exhibits an all-pervading sense of doom Feels sad and lonely Feels hopeless and empty Transient physical complaints Chronic physical complaints Guilty over specific aspect of loss Generally guilty Temporary loss of esteem General loss of esteem Differentiating Between Trauma Grief Depression, PTSD Symptom Eating problems (significant weight gain or loss) Trauma Grief X Dpsn X Psychomotor agitation/retardation X Fatigue most of every day X Worthlessness/generalized guilt X Suicidal Ideation, plan, or attempt X Fear/anxiety/panic attacks X Sometimes PTSD Post-Traumatic Stress Disorder Traumatic event (includes death) Intrusive symptoms Avoidance symptoms Arousal symptoms PTSD often related to: Death Notification Visual Re-Enactment (real or imaginary) Powerlessness to Protect Much higher rates of PTSD following homicides, suicides, and vehicular crashes than anticipated deaths. Differentiating Between Trauma Grief, Depression, and PTSD Symptoms Trauma Grief Dprssn Sometimes PTSD Fear/anxiety/panic attacks X Recurrent intrusive recollections X X Recurrent distressing dreams X X X Intense fear, helplessness, horror X Dissociative flashbacks X Intense psychological reaction at exposure X Differentiating Between Trauma Grief, Depression, and PTSD Symptoms Trauma Grief Dprssn PTSD Intense physiological reaction at exposure X Inability to recall important aspects X Significantly restricted range of affect X Sense of foreshortened future X Hypervigilance X Exaggerated startle response X Time distortion* X General Chronology of Treatment Physical and Emotional Safety Education about Trauma Reaction Assessment Stabilization of Symptoms Identification of Strengths and Resilience Traits General Chronology of Treatment Addition of Case Management as Needed Narration of Trauma Experiences Reach Rational thinking Before Behavior Relationship Skills Meaning Making and How to Go On