Grief, stress, and post-traumatic stress disorder

Grief—this is the constellation of psychological responses to the loss of a loved one. Normal grief arguably develops in stages and dissipates in strength and impact over time. Some people (14–34%) suffer from pathological grief, where intense emotional distress and impairment of functioning persist for 6 months or more. This is often comorbid with other psychiatric disorders. Grief—and pathological grief in particular—carry an increased risk of mortality in the bereaved person, hence treatment of pathological grief using psychological therapy is advised.

Stress—the term can refer either to an external object, event, or situation that is the source of ongoing emotional distress, or to the constellation of psychological responses, dominated by elevated physiological arousal, that comprise an individual’s subjective experience in response to such stimuli. A subdiagnostic level of stress is common and is a risk factor for numerous physical health problems. Stress of this nature can frequently be ameliorated by lifestyle changes.

Pathological stress responses—these include acute stress disorder and post-traumatic stress disorder (PTSD), which occur in response to extremely stressful events. PTSD is characterized by (1) re-experiencing of the stressful event—e.g. nightmares, images, and flashbacks; (2) sustained avoidance of reminders of the event or of stimuli that might trigger re-experiencing; and (3) hyperarousal—e.g. sleep disturbance, irritability.

Management—debriefing in the early stages is not recommended as a routine intervention for all who have been exposed to traumatic events. However, PTSD is a disabling condition that is often comorbid with other psychiatric problems. Trauma-focused psychological interventions are the treatment of choice, with pharmacological interventions being a second-line treatment for those who do not wish to engage in a psychological intervention.