296 Grief and Loss Across the Lifespan
this loss experience changed your life?” can help clients to make meaning from
their experiences. Practitioners can help clients who have suffered disenfran-
chised losses by validating their grief. Bereaved clients may find that loss is the
impetus to reassess their spiritual and/or emotional lives while also reeval-
uating their priorities in a way that makes meaning and leads to a new
self-image. Although we would hesitate to ask most grievers if their loss has a
silver lining, helping them identify what remains good (or improved) in life is
often an important aspect of meaning making.
Among the best predictors of eventual adaptation to a loss is the struggle
to make sense of it and the discovery of some “life lesson in the loss” (Neimeyer
et al., 2002, p. 240). Walter’s research (2003) with bereaved widows, widow-
ers, and partners found that the participants who made meaning from their
experiences were able to move forward in their lives. The degree of frustration
increases for both individuals and families who are unable to redefine the loss
and tend to focus on the “negatives of the situation and wish that things were
different than they are” (Neimeyer et al., 2002, p. 248).Trauma and Grief
When the bereaved have experienced trauma, loss may not seem to elicit grief.
People exposed to trauma, especially in childhood, tend to stifle affect as a
result. Trauma from adverse childhood events (ACE), particularly if paired
with trauma related to a recent loss, may interact in ways that have similari-
ties and differences from typical grief trajectories. The responses to the earlier
trauma may mask some of the response to grief.
Trauma is the result of events by which “the victim is rendered helpless
by overwhelming force” (Herman, 1997, p. 33). Earlier versions of the DSM
focused on trauma as resulting from life-threatening events that provoked
symptoms of re-experiencing, avoidance and hyperarousal in their wake
(though not for everyone who had experienced such an event). The DSM-5
broadens the type of event that provokes trauma (sexual violence has been
added) and the criteria now include avoidance, re-experiencing, persistent
negative change in mood and cognition, and arousal and reactivity.
Recent research indicates that post-traumatic stress disorder (PTSD) and
prolonged grief disorder (PGD) have different symptom profiles that some-
times overlap after renewed exposure to trauma and loss. In research with
Mandaean refugees and asylum seekers in Australia, Nickerson et al. (2014)
showed that traumatized individuals who had also experienced recent loss
had recognizable clusters of symptoms. Their sample included 16% who
combined PTSD/PGD symptoms (primarily psychogenic amnesia, restricted
affect, and loss of meaning), 25% who exhibited primarily symptoms of PTSD
(intrusive memories, avoidance of thoughts/activities, and hyperarousal and
less restricted affect), 17% with symptoms primarily of PGD (longing and
yearning, bitterness, and difficulty accepting the death, with some intrusive
memories and other discrete PTSD symptoms)—and 43% were asymptomatic
and classified as resilient (an additional 9% could not be classified at all). To
validly and reliably distinguish PGD from PTSD this way among previously
traumatized individuals exposed to further traumatic loss would be extremely
useful for assuring efficacious treatment.