Complicated grief after violent death: identification and intervention

In periods of peace especially, violent deaths account for only a small percentage of total deaths, with, for example, 7% of annual deaths in the United States falling within the category of murder, suicide, and accidents (National Centers for Disease Control, 2009). However, there is considerable clinical evidence to support the premise that violent dying has specific and enduring effects on bereavement and grief (Rando, 1993; Rynearson, 2001). The violent death of a loved one is a traumatizing experience. In research on family members of murder victims, researchers have drawn attention to the likelihood of strongly intrusive and avoidant thoughts combined with hyperarousal, suggesting the presence of posttraumatic stress reactions (Parkes, 1993; Rynearson, 1994). Because of the often unexpected suddenness of violent death, combined with violation, and often intentionality or culpability associated with the death, those attached to the victim are not only vulnerable to levels of distress that are characteristic of reactions to non-violent deaths, but particularly prone to thoughts of remorse, retaliation, and fears of recurrence related to the act of violent dying. Furthermore, following the work of Janoff-Bulman, it has become widely accepted that fundamental assumptions people hold about themselves, the world, and the relation between these two may be shattered following traumatic loss (Janoff-Bulman, 1992; Matthews & Marwit, 2003), although recent evidence suggests that these effects may not be as strong as has been claimed (Mancini, Prati, & Bonanno, 2011).