PTSD and the Bereaved Parent
I was once asked by a bereaved parent if the death of a child can cause PTSD (Post-traumatic Stress Disorder). My answer was, "ABSOLUTELY!" The essential feature of this disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor. What could be more extreme for parents than the death of their child? This is the greatest nightmare of any parent.
In this article I will identify the criteria needed to make this diagnosis and in the next newsletter, I will address ways parents can be helped. For grieving parents, PTSD can be especially severe when the death of their child was of human design, as in murder or suicide. This disorder can occur at any age including childhood and can develop in individuals without any predisposing conditions.
The bible for mental health clinicians is the DSM-IV. The criteria that validates this diagnosis in a bereaved parent is:
- A. (1) The death of one's child as experienced by the parent is considered a traumatic event and (2) due to the death, the parent has experienced intense fear, helplessness, or horror. In children this may be expressed instead by disorganized or agitated behavior.
- B. The trauma of the death is persistently reexperienced in one (or more) of the following ways: (1) Recurrent and intrusive distressing recollections of the event. In young children, repetitive play may occur where themes or aspects of the death are acted out. (2) Distressing dreams and with children this may occur without recognizable content. (3) Flashbacks of the event including a sense of reliving the experience. (4) Intense psychological distress at exposure to internal or external cues that resemble the death. (5) Physiological reactivity when exposed to these cues.
- C. Avoidance of stimuli associated with the trauma and a general numbing of responsiveness that wasn't experienced before the child's death that includes three or more of the following: (1) Avoidance of thoughts, feelings or conversations associated with death. (2) Avoidance of activities, places or people associated. (3) Inability to recall an important aspect of the death. (4) Markedly diminished interest or participation in significant activities. (5) Feelings of detachment or estrangement (6) A restricted range of affect (e.g. unable to have loving feelings). (7) A sense of a foreshortened future.
- D. Persistent symptoms of increased arousal that includes two or more of the following: (1) Sleep difficulties. (2) Irritability or anger outbursts. (3) Difficulty concentrating. (4) Hypervigilance. (5) Exaggerated startle response.
- E. Duration of the disturbances in B, C, and D last more than one month.
- F. The disturbances cause significant distress in areas of functioning from social to career.