Persistent Complex Bereavement Disorder Vs PTSD After A Traumatic Loss: Differences And Similarities

The death of a loved-one (and even someone you spent a lot of time though you didn't particularly like them) is almost always, in some way, hard. Contrary to popular belief and "stages of grief" models, everyone grieves in their very own way. Common reactions include sadness, shock, denial of reality, emotional numbness, anger, confusion, and feeling lost.

Grief is normal — a very human way of coming to terms with the fact that someone who was there with you just a while ago now isn't. Under typical circumstances, mourning a loss certainly isn't pathological or a mental illness, and though grieving people usually need social support, a psychologist's help isn't necessary to process a loss and come to terms with it. 

Things can be a bit different if you've lost someone under traumatic circumstances. 

Perhaps you have lost someone important to you to suicide, murder, a tragic accident, a natural disaster, or even a sudden and entirely unexpected medical emergency. In some cases, you'll have been there during the final moments of the person's life and saw them suffer, or you may have found their body. When a death was unpredictable, tragic, malicious, and all around unfair, your feelings around the bereavement are also likely to differ significantly from those you'd experience after a normal bereavement. 

What do you need to know about persistent complex bereavement disorder?

The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) — the giant book mental health professionals in the US use to diagnose mental disorders — includes persistent complex bereavement disorder in its chapter on conditions that require further study. It can currently be diagnosed under the heading "other specified trauma- and stressor-related disorder" (which falls into the same general category as PTSD) if you experience its symptoms after a traumatic loss.

You may be diagnosed with persistent complex bereavement disorder "with traumatic bereavement" if:

• Someone close to you died under traumatic circumstances, with suicide and homicide specified. 
• You experience, for at least a year following the loss, symptoms that can include profound yearning for the person you lost, intense emotional pain and sadness, constant thinking about the person you lost, and constant distressing thoughts about the circumstances under which the person died — in this case, often thinking about how hard their last moments must have been and about their suffering. 
• You have had trouble accepting that the person is gone, find it hard to believe the person is really dead, feel emotionally numb, haven't yet been able to remember the person in a positive way, feel bitter, angry, or blame yourself for the death, or do your best to avoid reminders of the person or their death. All these symptoms fall under the category of "reactive distress". Again, they will last for at least a year.
• You have wished you would die too so you could be with the person you lost, see life as meaningless without the person, have had trouble trusting people since the loss, feel isolated or detached from others, no longer understand your place in the world, or find it hard to carry on with daily life. These symptoms signify existential disruption, and will, again, go on for a year or more in people dealing with a complex traumatic bereavement. 
• The symptoms you have are considered to exceed those that are expected for normal grief in your own cultural context, and cause significant problems in daily functioning. (This part is a little subjective — we'll admit that. That means a diagnosing psychologist's own views play a key role in whether or not you end up with this diagnosis.)

What do you need to know about post-traumatic stress disorder?

Post-traumatic stress disorder can be diagnosed in people who meet the diagnostic criteria after they've been exposed to some sort of trauma, which the DSM-5 defines as "actual or threatened death, serious injury, or sexual violence". This exposure can happen in one of four ways:

• Experiencing the trauma first-hand. 
• Witnessing, in person, someone else suffer a trauma. 
• Learning that someone you were very close to suffered a trauma, in which case the circumstances must have been either violent or accidental. 
• Repeatedly being exposed to the grueling details of traumas others have suffered, such as in the case of first responders, law enforcement officers, or psychologists. 

People with post-traumatic stress disorder will experience:

• At least one "intrusion" symptom in which they feel like they're at the place of trauma again — flashbacks, intrusive memories, nightmares, and physical and mental reactions after being reminded of an aspect of the trauma are all examples. 
• A persistent need to avoid reminders of the trauma — that can mean dodging people, places, events, and circumstances that remind you of the trauma, as well as fighting thoughts, feelings, and memories of the event.
• Negative changes in mood and thought — such as difficulty remembering important aspects of the trauma, feeling worthless and experiencing unwarranted guilt, feeling the world is dangerous and nobody can be trusted, chronic fear or anger, or an inability to experience positive emotions.
• Hyperarousal symptoms including hypervigilance (always being on guard), an intense startle response, dysfunctional sleep, trouble concentrating, and aggressive or angry outbursts.

PTSD vs complex bereavement: What are the similarities and differences?

Indeed, looking at the symptoms of both, it is incredibly easy to see how someone who experienced a trauma during which they also lost someone could have both at the same time. The two conditions are different, though. PTSD centers around reactions to the trauma, while complex bereavement centers around feelings about the loss itself. 

Exploring possible diagnoses, ideally with a therapist, can help you understand what you are going through better, which may in turn allow you to find a way to cope and heal.  

Anyone who experiences complex feelings, of the kind that makes it nearly impossible to function well or feel OK, after losing someone under traumatic circumstances can, however, benefit from professional assistance. You don't need a formal diagnosis for that. Whether you are diagnosed with PTSD, persistent complex bereavement disorder, something else, like depression or adjustment disorder, or don't meet the diagnostic criteria for any of these disorders but still find it hard to cope, talk therapy can help you process your memories, thoughts, and feelings.