Natalie D’Annibale, a licensed marriage and family therapist in Los Angeles, tells SurvivorNet that grief is a complex emotion.

“Reconciliation within interpersonal relationships may or may not benefit the survivor at the time of a family member’s or former friend’s passing,” she says.

She explains that it is normal to experience feelings of remorse or regret if the survivor had caused emotional (or physical) harm to the person who died, particularly if apologies were not extended to and/or apologies were not accepted by the deceased.

“Conversely, there might be a great relief following the passing of someone who has caused great harm to the survivor,” she explains. “If the person who abused you in life by way of emotional, physical, and/or sexual abuse passes away, there can be great relief and finality at the time of their death.”

D’Annibale says that a loved one with a long-term illness may create “compassion fatigue.” At the time of passing, “there is relief that the loved one is no longer in pain and that their responsibilities have lessened.” The variables involved include the type of relationship, the ages of the parties, the length of their relationship, the years out of communication, and the willingness to accept responsibility, are all additional factors to consider in how one might feel surviving the loss of another.

“Most importantly, would be for the survivor to take the time to explore and understand the stages of grief. Those would include shock and denial, guilt, anger, bargaining, depression and ultimately acceptance,” she says. “It is quite common to experience the stages repeatedly during the first year of loss. Reminders, holidays, birthdays, special events, etc., will continue to trigger the survivor and may reengage memories that are either positive or negative of the person who died.”

Finding a licensed therapist who specializes in grief and loss as well as grief and loss support groups is most beneficial for the individual survivor to explore their feelings.

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Updated: May 16

The Trauma Bond

Trauma bonding is similar to Stockholm Syndrome, in which people held captive come to have feelings of trust or even affection for the very people who captured and held them against their will. This type of survival strategy can also occur in a relationship. It is called trauma bonding, and it can occur when a person is in a relationship with a narcissist.

Within a trauma bond, the narcissist's partner—who often has codependency issues—first feels loved and cared for. However, this begins to erode over time, and the emotional, mental, and sometimes physical abuse takes over the relationship.

The codependent understands the change, but not why it is occurring. They believe they just need to understand what they are doing wrong in order to bring back the loving part of the relationship.

If they do manage to break free, all the narcissist has to do is go back to that courtship phase to win them back. The more the codependent reaches out to the narcissist for love, recognition, and approval, the more the trauma bond is strengthened. This also means the codependent will stay in the relationship when the abuse escalates, creating a destructive cycle.

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  • Jon E. Grant, JD, MD, MPH Jon E. Grant, JD, MD, MPH , Brian L. Odlaug , Suck Won Kim, MD

Impulse control disorders (ICDs) are common psychiatric conditions in which affected individuals typically report significant impairment in social and occupational functioning, and may incur legal and financial difficulties as well. Despite evidence of ICDs being fairly common, they remain poorly understood by the general public, clinicians, and persons with the disorders. Pharmacotherapy studies, although limited, have demonstrated that some ICDs respond well to treatment; however, there has been either very limited or, for some ICDs, no research into potential treatments. In addition, further research is needed to substantiate many of the studies that have been conducted.

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Formal ICDs include pathological gambling (PG), kleptomania, trichotillomania (TTM), intermittent explosive disorder (IED), and pyromania; these disorders are characterized by difficulties in resisting urges to engage in behaviors that are excessive and/or ultimately harmful to oneself or others.1 Diagnostic criteria have also been proposed for other disorders categorized as ICDs not otherwise specified (NOS) in DSM-IV-TR: pathological skin picking (PSP), compulsive sexual behavior (CSB), and compulsive buying (CB). ICDs are relatively common among adolescents and adults, carry significant morbidity and mortality, and can be effectively treated with behavioral and pharmacological therapies. The purpose of this review is to provide a clinical picture of these ICDs, including co-occurring psychiatric conditions (Table 1), and to review the evidence for the pharmacological treatment of these disorders (Table 2).

Core characteristics of impulse control disorders

Although the extent to which ICDs share clinical, genetic, phenomenological, and biological features is not completely understood, many ICDs share core qualities: (1) repetitive engagement in a behavior despite adverse consequences; (2) diminished control over the problematic behavior; (3) an appetitive urge or craving state prior to engagement in the problematic behavior; and (4) a hedonic quality experienced during the performance of the problematic behavior.2 These features have led to a description of ICDs as behavioral addictions.

ICDs also appear to have some clinical overlap with compulsive behaviors although this relationship is not yet completely understood. The domains of impulsivity (defined as a predisposition toward rapid, unplanned reactions to either internal or external stimuli without regard for negative consequences)3and compulsivity (defined as the performance of repetitive behaviors with the goal of reducing or preventing anxiety or distress, not to provide pleasure or gratification)1 have been considered by some as lying at opposite ends of a spectrum. Compulsivity and impulsivity may, however, occur simultaneously in a disorder or at different times within a disorder, thereby complicating both our understanding and treatment of certain behaviors.

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