It’s not uncommon for grief and PTSD to occur together after a traumatic experience.
Grief is a natural response to loss. It’s a complex emotional experience that can involve feelings of sadness, anger, confusion, shock, and disbelief, among many others.
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur after a traumatic experience. It features symptoms of re-experiencing, like flashbacks, and avoidance behaviors toward people, places, and thoughts associated with the trauma.
For many people, grief occurs because of a traumatic event, making it possible to live with PTSD during the grieving process.
The process of grieving doesn’t directly turn into PTSD, but grief can exacerbate PTSD symptoms. PTSD can also prolong the grieving process.
“I don’t think it’s so much that grief turns into PTSD,” Margaret Pendergrass, a licensed clinical social worker and certified grief counselor with Roswell Grief Counseling in Roswell, Georgia, told Healthline. “It’s more that grief and PTSD can both be caused by a traumatic and stressful loss. They can occur simultaneously.”
You may not notice symptoms of PTSD immediately after a loss. However, as your mind filters through feelings of helplessness, fear, or danger related to the event, PTSD symptoms can emerge. This can make it seem as though grief has transitioned into PTSD.
Can you develop PTSD from losing a loved one?
When the loss of a loved one involves traumatic circumstances like violence, accidents, natural disasters, or suicide, it can result in what’s known as traumatic bereavement.
Traumatic bereavement can mean intense grief with PTSD-like symptoms, or it can be grief that simultaneously occurs with PTSD.
Becca Reed, a licensed clinical social worker and trauma therapist from Yarmouth, Maine, said this type of loss is often unexpected or sudden. It brings the challenge of coping with loss and trauma at the same time.
“This type of shocking loss can throw a major roadblock on the journey through grief,” she explained. “All the turbulent emotions get bottled up, with no outlet. Before you know it, those unresolved feelings snowball into post-traumatic stress type symptoms — flashbacks, anxiety, avoidance, detachment.”
Grieving is a natural human experience after loss. It’s a temporary state involving many emotions, like sadness and anger. It improves with time, though how much time is very individual.
PTSD is a mental health disorder rather than a typical reaction to loss. It also features strong negative emotions, especially those related to fear, but it doesn’t always involve a component of grief.
Unlike regular grief, PTSD often requires treatment to improve.
What’s the difference between grief-related PTSD and complicated grief?
Grief-related PTSD is not the same as complicated grief, but these two conditions can occur together.
Grief-related PTSD is PTSD that’s associated with traumatic loss. Complicated grief is a prolonged grieving process where grief isn’t naturally resolving. Complicated grief does not always involve a traumatic element.
“Trauma can put someone at increased risk for complicated grief, but it does not cause complicated grief, and there are other risk factors for complicated grief outside of trauma,” Pendergrass said.
Complicated grief is also known as prolonged grief disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). It’s defined as grief that:
- persists past what’s expected
- doesn’t improve or worsens
- causes significant impairment in everyday life
Researchers found prolonged grief disorder and grief-related PTSD cause different cognitive changes in memory processing and coping strategies specific to the experiences of loss.
It’s not always easy to tell whether what you’re experiencing is grief, PTSD, or both.
According to Pendergrass, grief and PTSD can both lead to feelings of anger, guilt, and fear. Grief and fear can lead to avoiding reminders of the trauma or loss. Even flashbacks and nightmares can be common in grieving and PTSD, she said.
According to Reed, PTSD with grief symptoms include:
- reliving the traumatic loss in your mind
- feeling on edge
- avoiding people, places, or things that remind you of your loss
- feeling detached
- overwhelming sense of guilt or shame
- pulling away from everyday activities
“If the grieving person is still struggling with very severe symptoms months after the loss, or the symptoms get worse instead of better over time, it’s possible there is underlying, unresolved trauma that needs PTSD-specific treatment,” Reed said.
Treating traumatic bereavement PTSD often requires a therapy approach that addresses the grieving process and the core symptoms of PTSD.
A mental health professional can help. They can pull from different therapeutic frameworks, like cognitive behavioral therapy (CBT), to create a treatment plan that works for you.
CBT approaches commonly treat PTSD, such as:
- prolonged exposure therapy
- cognitive processing therapy
- trauma-focused cognitive behavioral therapy
- group therapy
Grief doesn’t usually require treatment, but speaking with a therapist can be helpful to sort your feelings and move forward through the grieving process.
If traumatic bereavement PTSD has led to prolonged grief disorder, your treatment plan may involve:
- grief-focused cognitive behavioral therapy
- complicated grief treatment
- exposure therapy
- cognitive restructuring
- group therapy
Grief and PTSD have a complex relationship. While grief doesn’t directly develop into PTSD, the circumstances around grief can lead to co-occurring PTSD. PTSD can increase the chances of experiencing complicated grief.
It can be challenging to know whether you’re living with regular grief, PTSD, complicated grief, or a mixture of these conditions.
Speaking with a mental health professional can help you treat PTSD and manage grief, and work through the feelings that come with grieving.