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Is There a Connection Between PTSD and Grief?

woman experiencing grief

By J Cangialosi, LCPC, Therapist, Learning and Development Coordinator, Relief Mental Health in Oak Brook, Illinois

To answer the question in the title of this article, I’ll start by defining post-traumatic stress disorder (PTSD) and grief in clinical terms. Most of us have an idea of what both these things are, but reading the official definitions will get us on the same page so you can understand the similarities and distinctions that characterize the relationship between PTSD and grief.

First, here’s an accessible definition of PTSD published by the Mayo Clinic:

“Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event.”

That’s a good starting point for understanding PTSD. We experience an awful event – something traumatic, like witnessing or being a direct victim of violence or abuse – and the event changes us. The fallout – a.k.a. symptoms – can prevent us from participating in even the most basic activities of daily life. That’s what makes PTSD a serious diagnosis: it’s more than bad memories of a bad day. It’s something that can seriously disrupt social, psychological, and emotional wellbeing.

Now let’s look at a definition of grief, as published by the American Psychological Association (APA):

“Grief is the anguish experienced after significant loss, usually the death of a beloved person. Grief often includes physiological distress, separation anxiety, confusion, yearning, obsessive dwelling on the past, and apprehension about the future. Intense grief can become life-threatening through disruption of the immune system, self-neglect, and suicidal thoughts.”

Based on those two definitions, it’s a relatively easy jump to assume there’s a connection between PTSD and grief. Three things make the connection seem clear:

  1. An individual experiences a terrible event – a traumatic experience (PTSD) or a significant loss (grief).
  2. The experience has profound emotional and psychological consequences, in the form of symptoms.
  3. In severe instances of both PTSD and grief, the symptoms disrupt daily functioning and overall life satisfaction.

Those facts lead me to ask a question:

Can grief cause PTSD – and vice-versa?

PTSD and Grief: Common Components

In order to determine if grief can turn into PTSD, let’s first examine the main markers for PTSD, as defined by the Diagnostic and Statistical Manual of Behavioral Disorders, Volume 5 (DSM-V):

  • Exposure to a traumatic event that involved actual or perceived threat of danger.
  • Feelings of fear or helplessness in response to the event.
  • Persistent, unwanted thoughts and images related to the event.
  • Reliving the event in the days that follow.
  • Nightmares and sleep disturbances.
  • Avoidant behaviors such as talking about the event, thinking about it, or avoiding activities, places, or people for fear of remembering the event.
  • Hypervigilance

If we understand PTSD as a response to a traumatic event, then – based on the symptoms above – grief certainly can turn into PTSD if the loss involves a traumatic event or if the loss is considered traumatic by the surviving loved one(s). However, it’s important to understand that grief will always feel distressing and includes difficult emotions that require time to process. If any of the above listed factors occur, grief can evolve into PTSD.

Traumatic Bereavement and PTSD

Traumatic bereavement is a type of grief that mental health professionals also call traumatic grief, and define as follows:

“A severe form of separation distress that usually occurs following the sudden and unexpected death of a loved one. Numbness and shock are frequently accompanied by a sense of futility and the meaninglessness of life, although the total syndrome includes many other painful and dysfunctional responses.”

Shock, distress, depressed mood are all typical responses to setbacks and negative events, especially the loss of a loved one. However, what makes these events traumatic is the individual response:

  • Duration: if an extreme emotional response to a significant loss lasts more than a month, it’s considered traumatic grief/bereavement.
  • Severity: if the symptoms are strong enough to impair daily functioning for that duration of time, it’s considered traumatic grief/bereavement.

Realistically speaking, we rarely stop grieving entirely for the loved ones we lose during our lives. People who experience the loss of a loved one agree: what happens is that the sadness eventually fades and becomes easier to process in the moment. Over time, the good memories, in most cases, begin to replace the negative feelings of grief, and while the memories are bittersweet, the grief experience becomes manageable.

The difference between typical grief and traumatic bereavement – in addition to duration and severity – is that most people need some sort of professional support to process traumatic bereavement, whereas typical grief often resolves within a month or several months, with or without professional support.

Grief-Related PTSD and Complicated Grief

These are two more conditions that can occur that look similar, have overlapping causes and symptoms, but lead to different adaptations in the brain.

Grief-Related PTSD

Grief-related PTSD typically involves ongoing distress as a result of reliving certain aspects of a loved one’s death, such as remembering how your loved one looked in the days leading up to their passing. As a result, most people will do their best to avoid such thoughts. Flashbacks and avoidance of thoughts are both markers for PTSD.

Evidence shows that 64 percent of people who experience extreme, complicated grief (see below) also develop PTSD. Further, evidence shows that people with combined grief and PTSD experienced greater dysfunction in memory characteristics, coping strategies, and social disconnection, compared to people with extreme, complicated grief alone.

Complicated Grief

Complicated grief, labeled in the DSM-5 as persistent complex bereavement disorder (PCBD), can be a bit confusing as it looks the same as grief but feels far more intense. Typical grief responses tend to fade over time. Complicated grief will continue to feel intense for a longer duration of time, with little to no improvement. These complications intensify when negative beliefs form with regard to the loss, such as believing that the loss was your fault or that you cannot move forward with your life without that person.

Evidence from the study cited above on grief-related PTSD shows that while people with complex grief, persistent complex bereavement disorder, or prolonged grief disorder all show similar cognitive dysfunction compared to people with grief-related PTSD or grief and PTSD, people with the additional PTSD diagnosis report greater levels of impairment and cognitive dysfunction than people with complex grief alone. However, people with grief-related PTSD/grief + PTSD reported almost identical rates of social disconnection when compared to people with complex grief alone.

Treatment and Support: Warning Signs for Grief Turning to PTSD

If you’re concerned a friend or a loved one who experienced a recent loss may be at risk of developing PTSD, watch for the signs and symptoms of PTSD listed above. If nightmares and flashbacks begin to occur, PTSD may be present. Expression of fear and anxiety is a major indication for the presence of PTSD. It’s important to consult with a mental health professional who can provide the proper treatment for PTSD as well as grief.

The latest data from the Department of Veterans Affairs (VA) and the National Institute of Mental Health (NIMH) shows that around 5 million people in the U.S. received a diagnosis of PTSD in the past year (2020), and around 6.5 million people have received a PTSD diagnosis at some point in their lifetime.

That means millions of people need evidence-based help and support for PTSD. Evidence shows the most effective treatments for PTSD – including grief that turns into PTSD, or grief-related PTSD – are the following:

The APA also finds moderate evidence for the use of the following treatments for PTSD:

Finally, evidence also indicates two new, innovative approaches for the treatment of PTSD. One is a brain stimulation technique, and one is a medication:

How to Find Help for Prolonged Grief or PTSD

You’re doing the first thing you need to do already. You’re learning more about the relationship between PTSD and grief by reading articles like this one. If you think you, a friend, or a loved one needs professional support processing grief after a painful loss, or think that you, a friend, or loved one is on the verge of developing grief-based PTSD, I recommend finding a licensed and qualified therapist or psychiatrist to perform a full evaluation and assessment.

The best way to find a good therapist is word-of-mouth, through the recommendation of trusted friends or family members. If you’re uncomfortable asking friends and family, you can use these online resources:

You can also contact us here at Relief Mental Health. Give us a call, or fill out our online contact form, and we’ll get back to you quickly!

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