Bereavement by traumatic means: The complex synergy of trauma and grief

When people lose intimates unexpectedly, in particular from malicious acts of violence, they are at risk for chronic grief reactions. The phenomenology, clinical symptoms, clinical needs, and risk factors associated with loss by traumatic means and the combined influences of loss and trauma exposure are yet to be systematically studied. We review the complex interplay between trauma and loss by traumatic means. The distinctions between normal and traumatic loss, and complicated and traumatic grief, are contrasted with the traditional conceptualization of posttraumatic stress disorder. The role of various mediators such as concurrent or life-span trauma exposure and interpersonal factors, particularly the degree of attachment to the individual or group traumatically lost, is discussed. We offer a more integrated and focused view of traumatic grief, its predictors, and future directions for the integrative study of trauma and loss outcomes.