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Perspectives - Vol. 5, No. 1 - An Argument for Love Trauma Syndrome: An Important and Often Underrecognized Form of Traumatic Grief

Richard B. Rosse, MD, Department of Psychiatry, Georgetown University School of Medicine

In 1980, when I was still in my psychiatric residency doing a rotation at a Veterans Administration hospital, I evaluated a Vietnam combat veteran and made a diagnosis of Posttraumatic Stress Disorder (PTSD) -- a diagnosis then recently introduced to the psychiatric nomenclature in third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). A supervisor at the time chastised me for making the diagnosis of PTSD, and he instructed me that "PTSD was not a 'real' diagnosis, but rather a 'political diagnosis,' a concession to certain Vietnam veterans who had been making loud 'noises' since the mid-1970's." "Vietnam veterans were not recognized for their efforts on the battlefield," announced this supervisor, "but now they want to be recognized through disability." I was then treated to a lecture on "disability syndromes," "compensation neurosis" and the like.

By the mid 1980's psychiatric studies have proven this attending's assertions to be ludicrous. PTSD is a disorder with established validity, there are emerging neurobiologic markers for the condition, and there appear to be unique brain imaging (e.g., PET) findings that separate the afflicted from the non-afflicted (e.g., Southwick, et al., 1994). Medications have proven useful in the treatment of PTSD, and the Food and Drug Association has just approved PTSD as an indication for the use of the antidepressant Zoloft (sertraline). We should be thankful to the "noisy" Vietnam veterans who showed us the light, and help us to develop ways to treat those made so miserable by the condition. More recently, it has been argued that chronic and seriously disabling PTSD-like conditions can also occur in persons who have lost a loved one due to non-traumatic death (e.g., after a prolonged illness); this condition has been termed "traumatic grief" (Prigerson et al., 1999).

One of the contentions of my supervisor was that it was now 1980, and the traumas these Vietnam veterans were complaining about occurred a decade earlier. The notion that a single trauma that occurred in adulthood would have a persistent effect on someone's thinking and feelings so long after the event was suspect in his mind -- especially when in the intervening years the patient had no documentation of any specific PTSD symptoms. For many clinicians and researchers, the often long time lag between trauma and illness presentation -- and the often complex co-morbidity which included substance use, mood and personality disorders (Hryvniak and Rosse, 1989) -- made PTSD a difficult diagnosis to accept.

In my work with a large population of older men and women over the years, I have become increasingly aware of another PTSD-like syndrome in persons who suffered what they experienced as a "traumatic" romantic failure. Like PTSD, I am concerned that the condition is underrecognized, in part because of its frequently "masked" presentations, and also because many people trivialize romantic failure as a "common problem of living." I have described the condition in a recently published book titled "Love Trauma Syndrome" (Rosse, 1999). I have proposed that Love Trauma Syndrome is a form of traumatic grief (e.g., Prigerson et al., 1999) that does not have to involve the death of a desired and loved person. Like its diagnostic cousins PTSD and traumatic grief, many patients with "Love Trauma Syndrome" present "on the surface" with more conventional diagnoses such as depression, anxiety and substance use disorder. And like PTSD and traumatic grief, I have found that Love Trauma Syndrome can be a serious condition with considerable psychosocial impairments.

When Love Trauma Syndrome is "complicated" by other conditions, such as substance use disorder and other "acting out behaviors," the behavioral complications are usually brought on by the afflicted person's ill-fated attempts to deal with the condition. Sometimes, Love Trauma Syndrome (like PTSD) is associated with suicidal or homicidal ideation. For instance, in one recent high school shooting, Luke Woodham shot and killed two of his classmates -- his ex-girlfriend Christina Menefee and her friend, Lydia Dew. Woodham said his primary motive was revenge against Menefee -- who had broke up with him a year earlier. Love Trauma Syndrome can also precipitate "homicide-suicide," or so-called "dyadic death," where the afflicted end up killing the people most dear to them, and then kill themselves. One dyadic death victim was Richard Hartman, the Saturday Night Live comedian and showman, whose wife shot and killed him before turning the gun on herself. He was reportedly preparing to leave his wife. These notorious cases aside, most people with Love Trauma Syndrome suffer quietly without inflicting pain on others.

Love Trauma Syndrome and PTSD share certain characteristics. For instance, both include intrusive thoughts, memories about the trauma. They differ in the nature of the trauma involved. In Love Trauma Syndrome, the emotional "trauma" occurs usually at "the point of discovery" of the end or threat to the valued romantic relationship. In PTSD the onset of the condition is traced to the occurrence of the life-threatening trauma the patient witnessed or survived. Both Love Trauma Syndrome and PTSD can be associated with corrosive effects on the patient's self-esteem, and often desperate psychological attempts are made by the patient to contain their self-respect.

PTSD typically is associated with greater amounts of dissociation and exaggerated startle response, but Love Trauma Syndrome can also be associated with considerable dissociation and symptoms of hyperarousal (e.g., insomnia). And while both Love Trauma Syndrome and PTSD can be associated with anger, irritability, and revenge fantasies, Love Trauma Syndrome seems a more potent stimulus for "Amok"-like syndromes. In these Amok-like syndrome, patients engage in considerable uncontrollable acting-out behaviors (e.g., random violence against others), usually in the context of some degree of dissociation (e.g., Rosse, 1999, American Psychiatric Association, 1994; Rosse, Martin, Morihisa, 1989). The Amok-precipitated behaviors typically can be stopped only after external restraining forces are applied (e.g., subdued by others, police intervention).

Many psychiatrists have been trained in an era where it was believed that mental illnesses such as depression were "destiny." Depression -- and other mental ills -- were viewed as primarily the result of "endogenous" brain forces that were not necessarily associated with a "psychosocial" precipitant. Once, after I interviewed a patient in front of an audience, another attending advised me to "stop always looking for a 'stressor,' because "depression usually 'just happens.'" Fortunately, psychiatric clinicians and researchers are "rediscovering" the impact stressful life events have on mental functioning, as well as the need to understand the meaning the patient attaches to those stressors.

At least in my psychiatric practice, Love Trauma Syndrome is epidemic and its recognition and treatment has resulted in the amelioration of much distress and dysfunction. Even more than with PTSD, or traumatic grief related to the death of a loved one, Love Trauma Syndrome is sometimes harder to elicit when taking a history from a patient because of the patient's shame and humiliation related to the love trauma event. And in this era of managed care, where clinicians are pressured to see patients in ever briefer visits, there is simply no time to permit the development of a trusting therapeutic relationship where issues tainted with shame and humiliation can be revealed and discussed.

Preclinical and clinical studies are now beginning to clearly demonstrate the dramatic physiologic and brain changes that occur when desired romantic relationships are established -- and are threatened (e.g., Marazziti et al, 1999; Young, Wang and Insel, 1998; Stefanski, 1998). The overwhelming influence that romance and reproductive strategies has had on human brain evolution and evolved behaviors is being increasingly articulated in the literature (e.g., Price et al., 1994). Clearly some people are more susceptible than others to suffer from Love Trauma Syndrome in the face of a love trauma event. This susceptibility (or its opposite, resistance) is due to some combination of yet unspecified genetic (i.e., heritable) an learned (i.e., environmental) influences.

I can assure you that patients respond more readily when their distress caused by romantic failure is called a Love Trauma Syndrome or even "traumatic grief," rather than an "adjustment disorder not otherwise specified," or major depression, or worse yet, "dysthmic disorder." For most patients, these latter designations do not resonate with their sense of what is happening to them, and the more technical diagnoses do not adequately convey a sense to patients that they are understood and that help is on the way.

Some clinicians and researchers might still believe that love traumas lead to trivial conditions not worthy of attention by mental health resources. They might think that love trauma material is perhaps better suited for words to popular songs and other forms of "ear candy." In this brief piece I have tried to argue otherwise. And while the media provides us with an ongoing stream of famous cases of Love Trauma Syndrome, such as Monica Lewinksy's well publicized case that almost brought down a Presidency, we must not forget the less obvious cases of the condition that bring down the chances for happiness for far too many patients. I believe I need to make the case for Love Trauma Syndrome victims in the same way that Vietnam veterans made the case for PTSD. Love Trauma Syndrome is a potentially serious mental health condition that deserves increased attention from mental health clinicians and researchers.

References:

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington DC, American Psychiatric Association, third edition. 1980

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Washington DC., American Psychiatric Association, third edition., 1994; p 845

    Hryvniak MR, Rosse RB. Concurrent psychiatric illness in inpatients with posttraumatic stress disorder. Military Medicine 154; 399 - 401, 1989

    Marazziti D, Akiskal HS, Rossi A, Cassano GB. Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine 29, 741 - 745, 1999

    Price JS, Sloman L, Gardner R Jr, Gilbert P, Pohde P: The social competition hypothesis of depression. Br J Psychiatry 164: 309 - 315, 1994

    Prigerson HG, Shear MK, Jacobs SC et al. Consensus criteria for traumatic grief. A preliminary empirical test. Brit J Psychiatry 174; 67 - 73, 1999

    Rosse RB. The Love Trauma Syndrome. Plenum Press, New York, NY, 1999

    Rosse RB. Stress violence running "Amok" in America. USA Today, p 10A, August 3, 1999

    Rosse RB, Martin MB, Morihisa JM. Treatment of atypical psychosis. In: American Psychiatric Association Treatments of Psychiatric Disorders: A Task Force Report of the American Psychiatric Association. Washington, DC, American Psychiatric Association, 1989 1697 - 1722

    Southwick SM, Bremner D, Krystal JH, Charney DS: Psychobiologic research in post-traumatic stress disorder. Psychiatr Clin North Am 17: 251 - 264; 1994.

    Stefanski V: Social stress in loser rats: opposite immunological effects in submissive and subdominant males. Physiol Behav 63: 605 - 613; 1998

    Wang Z, Hulihan TJ, Insel T. Sexual and social experience is associated with different patterns of behavior and neural activation in male prairie voles. Brain Res 767, 321 - 332, 1997

    Young LJ, Wang Z, Insel TR. Neuroendocrine bases of monogamy. Trends Neurosci 21; 71 - 75, 1998

Reference
Rosse, Richard (2000). An Argument for Love Trauma Syndrome: An Important and Often Underrecognized Form of Traumatic Grief. [Online]. Perspectives. [2000, February 1].