The term ”secondary losses” has a habit of sounding dismissive – particularly for grievers who believe these losses to be anything but easy!
”Secondary loss” refers to the losses resulting from a death (direct loss). These are usually non-death losses like losses related to financial security, sense of self, a sense of purpose, and support systems.
Essentially, secondary losses are in no way less strenuous or less traumatizing than primary losses. Unfortunately, however, as many grievers will attest, secondary losses are often overlooked at best and utterly unacknowledged at worst.
What are secondary losses?
The death of a loved one is a life-altering experience.
Multiple losses
Ultimately, forever losing someone we thought would always be around, whether that person is a sibling, parent, child, or partner, often throws our lives off course, disrupting any plans and goals.
Losing a loved one frequently catapults people into existential crisis since the feelings and emotions associated with grief, among many things, often change an individual’s identity, perception, and sense of self.
The result of the death
For many grievers, this ‘loss of self’ allows them to view the world and those around them through an entirely different lens, usually a traumatic one.
Regardless of the circumstances and who might have passed away, grief is a leveler. It changes the emotional baseline of a person, sometimes forever.
Within the mental health field, the losses that get called secondary are a normal part of grief – they may unfold over time or manifest immediately in the aftermath of a death.
Identifying and acknowledging secondary losses can often be the first step to grieving them, but what are they?
Many losses
Essentially, after the death of a loved one – bereaved individuals may find that the remaining people in their lives have become difficult to identify with and connect to, and this can be disconcerting.
They may even feel that the people around them have changed or treat them differently from how they did before.
Often, all this can result in the death of the remaining relationships left in a grievers’ life.
There are also the financial implications of dealing with death to consider. For example, the loss of a parent might result in the family house getting sold or paying off any debt that a deceased loved one may have accrued.
Support systems
By and large, many grievers will experience multiple losses post-bereavement while dealing with the ramifications of a loved ones’ death.
These secondary losses include:
Friendships (this may involve losing numerous friends or a best friend who no longer identifies with or understands you post-bereavement)
Home (many people move house after experiencing a loss, which can create different feelings of grief, such as loss of familiarity, memories, etc.)
Identity
Traditions
Privacy (grievers may have to move in with other family members due to debt or other financial circumstances)
Relationships (many grievers report losing significant relationships post-bereavement, such as cutting ties with their brother, mom, wife, children, husband or another critical relationship)
Loss of a support system
Grief process
Secondary losses add another dimension to grief, whether it’s our best friends that we lose in the wake of a death or another person who has (fortunately) not died.
Essentially, the pain of a secondary loss is not to get sniffed at, and many people require support in understanding the complex process of secondary loss.
How to move forward
Many grief specialists speak about secondary losses as a way for grievers to grow; since we often use the people in our lives as crutches, we get to choose whether we sink or swim when this support system gets taken away.
Understanding our loss of support
Being consciously aware of secondary losses allows grievers the opportunity to identify them – it may not make the grieving process of secondary loss any less painful, but it does make it less confusing.
Broadly, putting a name to something allows us to look at it from a different vantage point.
By doing this, we may end up feeling less alone. We may even find it easier to open up and talk to the remaining people in our lives about our losses.
Many grief recovery programs teach people to come to terms with their grief by adopting strategies that allow them to view their losses in a different light.
It will never be OK to lose a friend, father, mother, brother, or another family member, but having the right support group can be the difference between moving forward or staying stuck in our grief.
Grieving the loss
The most basic recovery strategy is allowing ourselves the space to grieve our losses.
All this sounds simple enough, yet so many grievers feel an incredible amount of pressure to be ” over it” months later or to put on a brave face after someone they love has passed away.
One loss after another
In many cases, grievers often end up feeling like burdens in the wake of grief since, primarily, society is ill-prepared to support grievers.
As a result, many people smile, drink or ”good vibes” their way through the bereavement process, believing that their ”silence” will make the remaining people in their lives stick around.
However, all this is not sustainable in the long-term, and eventually, the cracks begin to show, inevitably resulting in difficult conversations, and as is often the case, additional losses.
Sorry for your loss
Essentially, people will assume that a griever only has to deal with one loss, which is the primary loss.
Yet, surprisingly, plenty of prevailing grief theories have also failed to recognize the unyielding impact of secondary losses.
Stroebe and Schutt, 1999 explained the impact of secondary loss as ”a lack of recognition of the range of stressors, the diversity of losses, integral to the bereavement experience. Not only is there the loss of the person, but adjustments have to get made concerning many aspects of life.”
Grief types
Research suggests that secondary losses are related to ”other types of loss” including:
Bereavement specialist Ken Doka coined the term ”disenfranchised grief” describing it as:
”Grief that person’s experience when they incur a loss that is not or cannot be openly acknowledged, socially sanctioned or publicly mourned.”
When a loss gets considered disenfranchised, it means that the person isn’t getting the validation or support they need.
Unfortunately, non-death losses often go unacknowledged and unsupported.
This often results in people viewing their losses as obstacles to overcome rather than things that need to be grieved.
Ambiguous loss
Ambiguous loss is a similar bereavement process to disenfranchised grief; when something is ambiguous, a person is uncertain about what (or who) was lost or whether a loss has occurred at all.
This type of grief usually occurs in scenarios where
1) a loved one has a terminal health condition (like dementia),
2) a person is physically present. Still, a significant aspect of their identity has changed, or
3) when a person is physically absent but possibly still alive.
In both these instances, there has been a dramatic change that induces feelings of loss.
However, a person might feel confused and conflicted about whether or not they should grieve these losses since the person they love is still alive, and there is often a sense of hope that things will eventually return to normal.
Recovery
The words ”recovery” and ”loss” often feel incompatible, particularly in early grief. Is it possible to ever get over losing a son, a dad, our parents? Probably not.
However, there is often a way for people to get unstuck from the clutches of raw, unrelenting grief usually present every day in the early weeks, months (sometimes years) following a significant loss.
The road to recovery involves many aspects, one of them being the acceptance that life will be different without the presence of the people that once filled it. There will always be a void in many ways, one that can eventually get filled again in the future, but with something entirely different.
Contact us
If you or a loved one are struggling to come to terms with a bereavement, get in touch with a member of the team today who will be able to help.
We all have thoughts or certain habits that we sometimes seem to frequently repeat. However some people have thoughts or compulsions that seem to obstinately take over their lives – this is obsessive-compulsive disorder (OCD).
OCD was originally classified as an anxiety disorder due to the intense anxiety linked to its symptoms. But the American Psychiatric Association decided it needed its own classification in 2013.
One reason is that it is a mental health condition that has seen a significant rise in the number of sufferers. Presently, OCD affects more than two million Americans.
OCD is defined as having a pattern of unwanted fears and thoughts – known as obsessions – that lead someone to perform repetitive behaviors – compulsions. These compulsions and obsessions interfere with daily life and cause a great amount of suffering.
Many people with OCD have both compulsions and obsessions. Despite attempts to ignore, control or be rid of such urges and intrusive thoughts, sufferers feel powerless over them.
Trying to stop them or at least ignore them only normally leads to anxiety and distress. So to ease these overwhelming negative feelings, someone with OCD feels increasingly compelled to do the compulsions and pay attention to the obsessions – and they end up in a vicious cycle of OCD.
To mask or numb such negative feelings means it’s more likely that an addiction might develop to such as alcohol or a behavioral addiction. As well, people can become very depressed about their situation.
Compulsions include things like counting items, repeatedly checking to see if a window or door is locked, cleaning and excessive hand washing. Even though most people with OCD know their behaviors don’t make any real sense, they still feel compelled to do them.
When there are obsessive thoughts it can cause extreme anxiety, sorrow, or pain. This is due to the fact that when certain disconcerting thoughts keep coming into their mind they are not certain they will not actually act on them – and this can cause self-esteem problems or even lead the person to loathe themselves.
What are OCD symptoms?
People suffering from OCD have obsessive thoughts or compulsive behaviors that:
Use up at least one hour every day.
Disturb daily living, such as social life, work, studies or parenting.
Are not pleasurable. People do them because they feel they cannot stop.
Feel totally out of control.
OCD presents in many different forms, but most cases will involve some sort of:
Ordering and symmetry.
This is the compulsive need to do things in a specific order or to have items lined up in a certain way. For example, perhaps all tins of food in a cupboard or bathroom items have to have their front label showing. Or it could be that all books must be in a certain order, or clothes hanging in a wardrobe in a very particular way.
If one is left out of place by another family member or a visitor it can lead the person with OCD to feel angry or even physically sick. Their heartbeat can quicken and they can develop a cold sweat. They may swiftly get up to put the item in the order they feel that it has to be, and this can be viewed as bizarre behavior by onlookers.
Checking.
This includes repeatedly checking that such as an alarm is set; an oven is turned off; that all light switches are not left on; that taps are not running; that doors and windows are locked; that an email or other message has been sent, or repeatedly checking personal items have not been stolen or lost from pockets and bags.
Contamination fear.
This is when someone has extreme fear and anxiety about germs. They can have an obsessive, almost frenzied at times, compulsion to clean – even if everyone else thinks somewhere looks clean.
Their fear of germs is much more intense than most people’s (that is a natural part of our survival instincts). It might be that they don’t want to sit down on a chair that someone else might have sat on at some point or they always feel an overwhelming need to keep windows open even if it’s cold. They may also avoid, for instance, using public toilets or shaking hands with anybody.
As well as the fear of germs, there can also be terrific anxiety about other health risks such as potentially fatal impairments that could be encountered. Contamination fear can be so extreme it means some people avoid going to places where there could be any other people.
Obsessive thoughts.
This could be constantly thinking about and being aware of various body sensations such as blinking or breathing. There might be a constantly perturbing suspicion about a partner being unfaithful, with no actual evidence for it. For some people with OCD, there are thoughts that seem relentless that can be violent or disturbing, including sexual thoughts with intrusive images.
Some mental health conditions are similar to OCD. These involve obsessions with:
Collecting things (hoarding disorder).
Picking at skin (excoriation).
Pulling out and/or eating hair (trichotillomania).
How somebody looks (body dysmorphic disorder).
Abnormal body odors (olfactory reference syndrome).
Physical illness (hypochondriasis).
Mental health experts have no definitive reason as to why some people get this disorder. But it has been observed that many people diagnosed with OCD have experienced trauma, including physical or sexual abuse, that was frequently during childhood. It could be that they are attempting to create order on the outside as they battle their internal chaos.
People struggling with OCD are often reluctant to seek the help they need because they feel embarrassed or ashamed. But there are proven methods to successfully treat OCD.
Narcissism is a household word today. It’s a character trait used to describe many people and their behavior – and narcissistic personality disorder (NPD) is a recognized mental health condition.
As narcissism is on a spectrum, that means that not every narcissist has NPD. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) between 0.5 and one percent of the population is diagnosed with NPD. Up to 75 percent of people with NPD are male.
It is a behavior that sees extreme selfishness and self-centeredness, an exaggerated sense of self-importance, excessive need to be admired, conceitedness, and a lack of or no empathy. Because a narcissist has little or no empathy they cannot see the world from anyone else’s point of view.
Consequently, they never understand the negative impact their behavior has on others around them. It makes it difficult for a narcissist to seek the treatment they desperately need, since asking for help does not fit their image.
For this reason, some experts believe in fact that up to five percent of the US population has NPD to some degree. As with all personality disorders, NPD can make daily living extremely difficult – especially with family, social, and work relationships.
Allure of image
An ancient Greek myth from where the word “narcissist” derives fully reveals this destructive fixation with oneself, a detrimental love of self-image.
Narcissus was a young man known for his beauty. But he rejected anyone who wanted any romance with him.
Then one day he saw his reflection in a pond. He fell deeply in love with it.
He simply could not move from the allure of his image. But eventually, he melted from the passion burning inside him and turned into a white and yellow flower that still bears his name today.
History of NPD
In 1898 psychologist Havelock Ellis used the term “narcissus-like”, referring to excessive masturbation when someone becomes their own sex object. A year later psychiatrist Paul Näcke used the word “narcissism” in a study of sexual perversions.
Then in 1911, psychoanalyst Otto Rank published the world’s first psychoanalytical paper specifically about narcissism. Three years later, renowned psychotherapist Sigmund Freud published a paper entitled: “On Narcissism: An Introduction.”
In 1980, NPD was officially recognized as a disorder in the DSM. While the DSM does not state any specific categories of the condition, it is generally accepted that there are two distinguishable types of NPD.
Narcissism types
These two types frequently have common characteristics – but are believed to derive from different childhood backgrounds. They can also indicate different ways a narcissist will behave in their relationships with others.
– Grandiose Narcissism
People with this type of narcissism have an image of being better than anyone else. They are grandiose and often deluded with their importance, act elite, ostentatious, lack any empathy, take advantage of others and are aggressive, arrogant, and dominant.
During childhood, they were most likely treated as if – and constantly told – they were superior and better than anyone else.
– Vulnerable Narcissism
People with this type of narcissism are neurotic, carry feelings of shame, hypersensitive and their behavior is to protect them against the feelings of inadequacy they have deep down. So they fluctuate between feeling superior and inferior to others.
Yet they suffer from anxiety and are resentful and defensive when other people do not treat them as if they are superior. Their conflict is that they are desperate for love and approval from everybody, so if it’s not given they will often withdraw and suffer from low self-esteem.
Someone with vulnerable narcissism – also known as covert narcissism – is more likely to develop alcohol or drug addiction or indulge in behavioral addiction. This is to mask or numb the negative feelings that frequently arise in them.
Their parents may have been unreliable – and they often struggle with toxic shame and a “failure of love”. They were often abused or neglected and suffered trauma during childhood.
Major signs of narcissism
Since many narcissists and people with NPD will never reach out for treatment, it is still being looked into by mental health experts. But there are some definite character traits that narcissistic people frequently display.
Using others.
Narcissists exploit others to gain something for themselves. They often find and surround themselves with people who will feed their enlarged egos. These relationships are shallow. In order to keep in control, a narcissist will keep people at a distance and go to almost any lengths to stay completely in charge at all times.
Ostentatious and pretentious.
They often have to own lots of flashy material things such as cars, homes, showy watches, jewelry and clothes that they think tell the world just how successful and wonderful they are. Their need for these things is frequently an overwhelming drive that if they were honest they would admit is out of control.
Oversensitive.
Even though they seem full of themselves, narcissists need constant attention and relentless admiration and praise to reinforce their fragile inner selves. This means that they are extremely sensitive and swift to anger if they are criticized or perceive something to be a criticism.
Sense of entitlement.
A narcissist insists on – and expects – special treatment because they have formed an image of themselves as being better and more important than anyone else. They will disregard rules – insisting that those are for people who are not as special as them, which in their mind is everyone else. They will demand that everybody always does exactly what they want and desire.
Manipulative.
A narcissist can be extremely charismatic and charming – at first. This is because they have become masters of manipulation in order to lure someone in and then get what they want from that relationship. So while a narcissist will attempt to impress and please in the beginning, it’s only so that as soon as they can they will put their own needs first and use the other person to that end.
Envy.
Many narcissists have an obsession with success and power. This is not only because they need to feed the overinflated image they have of themselves and to maneuver themselves into positions of control – but it’s also because they suffer from extreme envy and jealousy. Therefore, they are driven to make others envious and jealous of them instead.
Relentless need for praise and attention.
This is one of the major signs of a narcissist – a constant need for praise and admiration. They cannot get enough and will never be satisfied.
Lack of empathy.
A narcissist is unable to empathize with other people. They can only see the world through their eyes. So they have no humility or compassion – and cannot see anything wrong with their behavior or consequently take any responsibility for it. Frequently, a narcissist will never say the word “sorry”.
Arrogance.
Because they really believe they are superior to others, they will frequently be obnoxious, rude, and abusive when they get treatment or attention that they think is less than someone of their superiority deserves. Even if they are treated well or in a superior manner they will often act and speak rudely and be dismissive of others because they think the other people are inferior. A narcissist will have an overvalued (often deluded) sense of their own achievements and abilities.
Clearly, none of this makes for positive loving, and balanced relationships with anyone. If you recognize that you could be in a relationship with a narcissist, there are certain aspects that can be looked at and specific changes you can make.
It’s important to speak with someone with expertise in these matters as soon as possible. A narcissist will not see any problem in grinding someone down, including a partner, to get what they want.
Therapy can be especially challenging for people with NPD because they are often unwilling or unable to even acknowledge the disorder. But there are proven successful methods to treat it and help anyone with the condition.
Most people who take prescription drugs do so responsibly. But it is possible to become dangerously addicted to them.
In fact, millions of Americans already are addicted. Many of those abusing them don’t realize that these medications can have the same serious health consequences as illegal street drugs.
Just because some drugs are prescribed by a medical expert does not make them less of a risk to health or any less potentially addictive. Prescription drug addiction can cause exactly the same problems and tragedy as addiction to alcohol or illegal drugs such as cocaine and heroin.
According to the 2017 National Survey on Drug Use and Health, around two million Americans misused prescription pain relievers for the first time within the previous 12 months. In addition, 1.5 million people misused tranquilizers; more than a million misused prescription stimulants, and 271,000 misused sedatives for the first time.
Prescription drug abuse is highest among adults aged 18 to 25, with nearly 15 percent using a medication in a non-medical manner. Several studies have found clear connections between prescription drug abuse and heavy alcohol use, higher rates of cigarette smoking, as well as the use of marijuana, cocaine, and other illegal drugs.
Addiction issues are just the same whether the drugs are prescribed or illegal. Beating the addiction can be just as difficult.
What are the most commonly abused prescription drugs?
Some prescription drug abusers begin after being given legitimate prescriptions for a medical issue. But they then get addicted to the medication, and take more than prescribed and more frequently than has been recommended.
But others will get them in another way: such as with forged prescription notes or from a dealer. Prescribed drugs that are most regularly abused are:
Opioids
Most often prescribed for pain, opioids produce a euphoric sedative effect. This includes such as tramadol that an increasing number of people are getting addicted to each year. Meperidine is another form of opioid sold under the brand name Demerol that’s used to treat moderate to severe pain.
Fentanyl
A synthetic opioid, it’s prescribed for acute pain. It creates feelings of euphoria and is up to 50 times stronger than heroin. But it is increasingly being used as a “recreational” drug frequently mixed with methamphetamine, cocaine or heroin.
Codeine
Used to treat mild to moderate pain as well as cold and flu symptoms in such as cough syrup. It can cause altered consciousness and has a sedative effect. Increasingly it is being used in a recreational drug cocktail known as “lean”, “purple drank” or “sizzurp”.
Alprazolam
Commonly sold under the brand name Xanax, alprazolam is a benzodiazepine (tranquilizer) used to treat anxiety and panic disorders. But it’s also misused for its swift sedating effects. It’s one of the most highly addictive prescription drugs.
Clonazepam & diazepam
These are benzodiazepines that are also used to treat panic disorders and anxiety. Clonazepam is most often sold under the brand name Klonopin; diazepam is mostly sold as Valium. But they are also often misused for their sedative effects and people can get highly addicted very quickly.
Amphetamine
Adderall is a prescription drug that creates similar effects to methamphetamine and so it is used as a stimulant for alertness and to increase productivity. According to a report in The Washington Times, an estimated five million Americans are illegally using prescription stimulants.
Methylphenidate
Mostly sold under the brand name Ritalin, methylphenidate boosts the brain’s dopamine levels. It’s used to treat ADHD (attention deficit hyperactivity disorder). But people abusing it can become highly addicted.
Major signs of prescription drug addiction
Prescription drug addiction can be harder to spot or admit than with illegal drugs or alcohol. This is because someone, for instance, addicted to a strong prescribed painkiller for a bad back may justify their abuse due to their physical condition.
Yet if they were to get honest with themselves they would admit they were addicted to the high the medication gave them. Prescription drug abusers can be very ingenious when it comes to hiding and denying their addiction.
However, there are some common signs that can show someone has a prescription drug addiction. These include:
Becoming defensive or angry when challenged about their use of prescription drugs.
Shopping online for prescription drugs.
Frequently visiting their physician.
Work, studies and/or home life suffers.
Less pride about personal appearance.
Constantly bringing attention to and complaining about health conditions that give them reason for taking prescription drugs.
Side effects can include mood swings, increased anxiety, sleep problems, drowsiness, being unsteady, memory issues and poor decision-making.
A hidden danger with prescription drug addiction is the mistaken belief that because doctors prescribe them they must be safe. But these drugs are prescription-only because they can be addictive and have serious health consequences.
If you think you might have a problem with prescription drugs or think someone you know has, it’s vitally important to seek immediate professional help.
