Categories That Contribute
to Complicated Grief in Children
Sudden or traumatic death
or traumatic death can include murder, suicide, fatal accidents, or a sudden fatal illness. Immediately an unstable environment
is created in the child's home. Children feel confusion over these kinds of death. Desire for revenge is often experienced
after a murder of fatal accident. Rage and/or guilt emerges against the person who has committed suicide. Terror of violence
and death unfolds, and the child feels shock and disbelief that suddenly this death has occurred.
2. Social stigma of death
Social stigma and shame frequently accompany deaths
related to AIDS, suicide, and homicide. Children as well as adults often feel too embarrassed to speak of these issues. They
remain silent out of fear of being ridiculed or ostracized. These suppressed feelings get inwardly projected towards themselves
in the form of self hatred. Often times these kids feel lonely and isolated. They cannot grieve normally because they have
not separated the loss of the deceased.
3. Multiple losses
losses can produce a deep fear of abandonment and self-doubt in children. The death of a single parent is a good example of
a multiple loss. When the only remaining parent of a child dies, the death can cause this child to be forced to move from
the home, the rest of his or her family and friends, the school, and the community. The child is shocked at this sudden and
complete change of lifestyle and surroundings, and may withdraw or become terrified of future abandonment. Nightmares and/or
bed-wetting could appear.
Past relationship to the deceased
When a child has been abuse, neglected, or abandoned by a loved one, there are often ambivalent feelings when the
loved one's death occurs. A five-year-old girl whose alcoholic father sexually abused her felt great conflict when that parent
died. Part of her may have felt relieved, even glad, to be rid of the abuse yet ashamed to say those feelings out-loud. She
may carry the secret of the abuse and become locked into that memory and be unable to grieve. Children often feel guilt, fear,
abandonment, or depression if grief of a loved one is complicated by an unresolved past relationship.
5. Grief process of the surviving parent or caretaker
If the surviving parent
is not able to mourn, there is no role model for the child. A closed environment stops the grief process. Many times the surviving
parent finds it too difficult to watch his or her child grieve. They may be unable to grieve themselves, or unwilling to recognize
their child's pain. Feelings become denied and expression of these feelings withheld. The surviving parent might well become
and absentee parent because of his or her own overwhelming grief, producing feelings of abandonment and isolation in the child.
Children often fear something will happen to this parent or to themselves and as a result become overprotective of the parent
and other loved ones.
the Silence (1996) Linda Goldman
Activities to help young children with
stories to children that allow them to project their feelings onto the story characters. This opens a dialogue with a child
in a way that is not threatening.
- Allow children
to visualize their hurt, fear or pain. Then can then draw, make use clay, or imagine these symbolic feelings being able to
talk. If the hurt could talk, eight year old Nancy explained, it would say "Why me?" Nancy had experienced multiple
losses, including the death of her younger sister. Feelings of having bad luck or being punished began to emerge.
- Invite children to make a Loss Time-line, filling it in with people and
dates in chronological order according to when they died. This Loss Time-line becomes a concrete representation of all the
losses one has experienced.
- Create with children
a geneogram of family tree using a circle and square to represent those people still living and those people who have died
in their life. Kids can not only see the extent of the losses they've had, but the support system of the people that are still
By helping children put their feelings outside of themselves we can facilitate their healing. Sharing feelings diminishes
the hurt. - Breaking the Silence (1996) Linda Goldman
Grief Disorder (Proposed Criteria for DSM-V) by Dr.
Holly Prigerson, 2007
Criteria A: Bereavement
has to follow a significant loss
Criteria B: Separation Distress
person must experience at least 1 of 3 separation distress symptoms, such as:
1. Intrusive thoughts related to the deceased
2. Intense pangs of separation distress
3. Distressing long yearnings for that which was lost
Criteria C: Cognitive,
Emotional and Behavioral Symptoms
The bereaved person must experience 5 of the following 9 symptoms
daily or to an intense or disruptive degree:
- Feeling emotionally numb
- Feelings stunned or shocked
- Feeling that
life is meaningless
- Confusion about one's role in
life, or diminished sense of self
- Mistrust of others
- Difficulty accepting the loss
- Avoidance of the reality of the loss
- Bitterness over the loss
with moving on with life
Criteria D: Duration
Symptomatic disturbance must endure at least six months
(Assessing and Treating Trauma and PTSD, by Linda