Traumatic Loss and the LGBTQ+ Experience: Healing the Layers
- Dr. Weston Donaldson
- May 7
- 5 min read
When I meet new clients, I ask them about experiences they’ve had that they consider traumatic. Often, they describe the death of a loved one—a person or a cherished pet.
While these experiences or their symptoms don’t always meet the full clinical criteria for Post-Traumatic Stress Disorder (PTSD), they are very real. Clients often struggle with intrusive images of the death or find themselves caught in a loop of "what ifs"—replaying what they could have done differently or what they should have said.
Understanding the Spectrum of Grief and Trauma
It is important to recognize that a death or other type of loss can trigger symptoms consistent with PTSD, such as a constant sense of "high alert" or intrusive memories that feel like they are happening in the present. In these cases, specialized trauma treatment is often the most direct path to relief. However, even if you don’t meet every clinical checkbox for a formal diagnosis, your suffering is still valid, and you can benefit deeply from trauma-informed grief support.
Unlike traditional grief counseling, which focuses primarily on the emotions of loss, a trauma-informed approach prioritizes your nervous system's safety. It provides tools to help you manage the panic or numbness that often accompany a sudden or violent loss.
Furthermore, for those who find that their grief remains just as intense, identity-disrupting, and life-altering more than a year after the loss, it may be recognized as Prolonged Grief Disorder (PGD). Think of PGD not as a sign that you are "grieving wrong," but as an indication that your healing process has become "stuck" or frozen in time. Naming these experiences—whether it's PTSD, PGD, or sub-clinical distress—isn’t about labeling your character; it’s about identifying the specific keys that can guide you (and your therapist) to the best pathway for your healing.
The Intersectional Lens: Why This Hits Harder for LGBTQ+ Folks
As an LGBTQ+ focused provider, I know these experiences don't exist in isolation. I know that many of the people I see have experienced significant, even traumatic, non-death losses. Because of this, people in our community often carries a history of ambiguous loss and "disenfranchised grief"—losses that aren't always recognized by society. These might include:
The loss of a religious community.
Estrangement from non-affirming family members.
Loss of employment or educational opportunities due to gender identity or sexual orientation.
These experiences layer on top of one another. This "Minority Stress"—the chronic stress faced by members of stigmatized groups—can change your worldview and make you more vulnerable to PTSD symptoms.
The core features of post-traumatic stress often include:
reliving the experience, as in nightmares or in flashbacks
significant distress when reminders of the experience show up in daily life
avoiding those reminders at all costs
feeling decreased trust, safety, or sense of control, or self-esteem
Many people experience traumatic events, including death and loss, without developing post-traumatic stress symptoms. For the percentage of people who do, it is not about "weakness" or anything they did "wrong."
While an estimated 6% of people in the general population experience PTSD in their lifetime, these numbers are significantly higher for our community: 48% for LGB individuals and 42% for transgender and gender-diverse people.* This isn't a sign of weakness; it is a reflection of the violence and systemic discrimination our community survives.
In spite of these layers of trauma and loss, our community is defined by a profound, collective resilience—a historical and personal strength that allows us to keep seeking healing and reclaiming our joy.
How Do I Recover from Traumatic Loss?
I always like to share with my clients that post-traumatic stress is treatable. After decades of research, we know that there is a good menu of tried-and-true treatment options that help people recover from trauma, at any stage of life. These include some you may have heard of:
Prolonged Exposure (PE)
Eye Movement Desensitization and Reprocessing (EMDR)
While each of these approaches is distinct and offers a different path toward healing, they all incorporate the basic ingredients of trauma treatment: 1) exposure to the distressing memories and daily triggers 2) retraining the nervous system to feel less reactive when faced with them. There's more to it, of course, but those are the essentials.
"Do I have to relive it?"
People are often already reliving or re-experiencing the memories of the traumatic loss: the circumstances leading up to a person's death, finding a pet who was deceased, imagining what a person saw or felt before they died. With these treatments, the goal is to help the brain re-integrate the experience and process it in a way that allows the emotional charge to dissipate.
Contrary to what many believe, these treatments allow the client to choose how much they share about the experience. I thoroughly discuss these options with my clients before starting treatment, and often say that even while we are going to talk about the hard stuff, it might be "the last worst time" remembering the experience. As people help their brains reprocess the events, the distress surrounding the memories fades.
How do I start healing from a traumatic loss?
Addressing the brain's stored memories of the experience and the beliefs, behaviors, and other patterns that grew out of them is the first step.
After completing treatment for the post-traumatic stress, that is where the grief work can begin. Once a person has stopped avoiding reminders, or coping in unhelpful ways with the distressing memories, they can start discussing the common themes associated with grief journeys (e.g., anger, bargaining, acceptance). Some if that may start during treatment for PTSD, but it becomes much more effective once a person feels better able to engage in those discussions. Once the trauma symptoms—like avoidance and hyperarousal—are managed, you can more effectively engage in William Worden’s Four Tasks of Grieving:**
Accept the reality of the loss
Process the pain of grief
Adjust to a world without the deceased
Find an enduring connection while embarking on the rest of life
Processing the pain of a loss is difficult if the brain still perceives the loss as an active, ongoing threat. PTSD treatment helps to "close the file" on the trauma so the heart can finally open the file on the grief. Engaging in those tasks of grieving becomes even more possible after addressing the post-traumatic stress associated with loss.
Take the Next Step in Your Healing
Post-traumatic stress is treatable, and you don’t have to navigate the complexities of intersectional grief alone. To help you decide which evidence-based approach—like CPT or ART—is right for you, you can use this interactive decision tool.***
Each person's grief journey is personal and individualized, and is best navigated with support. Ready to start the work? I specialize in trauma-informed care tailored specifically for LGBTQ+ people who are coping with grief and loss. Together, we can help your brain process these memories so you can focus on the journey of grief and healing.
*Goldstein, R. B., Smith, S. M., Chou, S. P., Saha, T. D., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Huang, B., & Grant, B. F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Social Psychiatry and Psychiatric Epidemiology, 51(8), 1137-1148. https://doi.org/10.1007/s00127-016-1208-5
**Worden J.W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner. 5th ed. New York: Springer Publishing Company.
***Note: This tool is hosted by the VA, but the information on treatments like EMDR and CPT applies to everyone, regardless of Veteran status.
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