Beyond Grief: Understanding Post Traumatic Stress Disorder (PTSD)

When one first hears “post traumatic stress disorder” your mind might go right away to veterans  — those who were/are members of the military and have had to endure some experiences that one would classify as traumatic. It is usually not a diagnosis that one throws around likely and it can be a challenging one to manage and get through.

Women who experience miscarriage, stillbirth or neonatal death are also at risk of developing acute stress disorder (these symptoms with onset before 1 month) or post traumatic stress disorder (PTSD).  The cycle of trauma is at risk of overshadowing the grief process and due to the nature of miscarriage, stillbirth and neonatal death — losing a loved one in an unexpected way & traumatically so — one needs to watch out for the signs of PTSD. It has been estimated that 10% of women who experience loss will develop acute stress disorder on top of their grief and 1% will develop post traumatic stress disorder.

Diagnostic Criteria for Post Traumatic Stress Disorder (DSM-IV – 309.81):

A.  The person has been exposed to a traumatic event in which both of the following have been present:

1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
2. The person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2. Recurrent distressing dreams of the event.
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have loving feelings)
7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), indicated by at least two of the following:

1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hyper-vigilance
5. Exaggerated startle response

E.  Duration of the disturbance (symptoms in B, C, and D) is more than one month.

F.  The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

If you are worried that what you or a loved one could be dealing with post traumatic stress disorder on top of grief please go speak with your doctor.

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