Ambiguous loss in relatives of missing or disappeared persons

Ambiguous loss is characteristic of the situation faced by relatives of missing persons. Symptoms of posttraumatic stress disorder, depression, and prolonged grief disorder may accompany ambiguous loss. No treatment guidelines are available on how to address these symptoms. We performed a literature review aimed at identifying empirically based treatment interventions applicable across a variety of settings. In relatives of missing persons with high levels of distress, holding on to hope that the loved one will return may be seen as a strategy to avoid emotions associated with the thought that the separation is permanent. However, pressure for closure paradoxically leads to increased resistance and may in the context of enforced disappearance serve politically repressive aims. Symptoms of posttraumatic stress disorder, depression, and prolonged grief may be addressed using empirically supported interventions, including psycho-education, mobilizing social support, exposure, and behavioral activation. Exposure-based interventions for ambiguous loss should not focus on closure or coming to terms with the irreversibility of the loss, but on tolerating the ambiguity surrounding the loss.