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Carol's Columns

The Treatment of PTSD in the Bereaved Parent

In the last newsletter we looked at the diagnosis of PTSD (Post Traumatic Stress Disorder) and the bereaved parent. Briefly, there are four categories of criteria needed to make this diagnosis. (1) The occurrence of a traumatic event. (2) Experiencing a reoccurrence of nightmares, flashbacks or psychological distress. (3) Avoidance of trauma-related stimuli. (4) Manifestations of hypervigilance, irritability, emotional numbness and/or difficulty sleeping. These symptoms persist for at least one month and cause significant disturbance in the patient's social and/or occupational functioning.

As we know, we all grieve differently. While some parents have a need to talk about the death, others don't and where some have a need to relive all the details, others won't. For this reason, treatment can be difficult. If any of the above symptoms do persist, I would highly recommend seeing a therapist. When choosing a therapist, make sure they are not only compassionate, but experienced with grief related issues.

After the death of a child, a family system can become pretty dysfunctional pretty fast. A mother may not be able to stop crying while a father can't talk about it. The surviving children become fearful and begin acting out. The surviving children's needs go on while we as bereaved parents want to disappear under the covers until the nightmare goes away. Some parents turn to alcohol and drugs, prescription or otherwise, to numb the pain and others disappear into their work. With both parents hurting, the normal spousal support systems are nonexistent, creating an exceptionally high divorce rate amongst bereaved parents. These families need help.

There are three arms of treatment available. First is educational. Helping a bereaved parent understand what they are going through and what is to be expected is very important. This normalizes the process of grief and feelings of going crazy. The Compassionate Friends is invaluable to this part of healing. Because these parents are in all stages of healing, sharing our stories with them not only helps with the normalization process but with learning methods of coping that may work for us as well.

The second arm of treatment is psychotherapy. When I would see bereaved couples, I would from time to time see them individually as well. The reason for this is that couples often have a need to protect each other and may feel they are inflicting more pain if they share certain feelings, i.e. guilt, anger, suicidal ideations. Ideally, the therapist will focus on the effects of the child's death on the family as well as the individual. Therapy should be symptom focused with an eye toward individualized coping mechanisms along with breathing and muscle relaxation techniques for insomnia and generalized anxiety. Substance abuse programs may be warranted as an adjunct to therapy.

Thirdly, there is sometimes a need for pharmacologic treatment if the symptoms persist. These may include anti-depressants or medications for persistent insomnia accompanied by significant hyperarousal and reexperiencing symptoms. If symptoms persist despite these initial interventions, a consultation with a psychiatrist should be obtained before sedative or hypnotic agents are used.