Complicated bereavement in children

Complicated Bereavement (also known as complicated mourning, complicated bereavement, prolonged grief) is the concept used when a bereaved person appears to be “stuck” in their grief process or their grief has become a way of life.

Grief is a natural response to the death of someone close and everyone will experience grief in a unique and individual way. Although there are no limits as to how long grieving should last and what it should consist of, practitioners, healthcare professionals and academics agree that if a bereaved person is unable to move forward through their grief, then they are most likely exhibiting complicated bereavement. Both anticipated bereavement (when a person is expected to die as a result of a terminal illness) and unexpected bereavement can be further complicated for children and young people by a number of factors, including:

This article also gives some general advice, how you can help, and key points to remember.

Relationship factors

The relationship that the child or young person had with the person who has died is extremely important. For example, complicated grief is more likely to occur if the person who has died was the child’s parent, sibling or best friend. If the child or young person was dependent upon the person who has died or has been diagnosed with mental health problems then the risk of complicated grief increases.

Circumstantial factors

If the death was sudden and unexpected or as a result of suicide the child or young person is at greater risk of experiencing complicated grief. The bereaved child or young person may feel responsible for not being able to prevent the death and in the case of suicide may be acutely aware of social stigma.

Multiple losses

This means that a child or young person who has experienced other deaths previously or has experienced a number of people close to them die in one instance (for example a terrorist attack, natural disaster or road traffic accident with one or more people close to the child or young person involved) are more vulnerable to complicated grief. Also, if before or after the death a child or young person has suffered other losses such as a change in school or the divorce of parents, this too can make complicated grief more likely.

Personality factors

How emotionally resourceful or resilient a child or young person is may determine if that child or young person will experience complicated grief. If a child or young person has poor coping skills, is culturally isolated or financially deprived this can increase the likelihood of complicated grief.

Social factors

If a bereaved child or young person is exposed to poor housing, substance misuse, domestic violence and poverty they can be at risk of complicated grief. The probability of complicated grief is increased if the bereaved child or young person does not have access to social networks and appropriate support systems.

General advice

It is important to remember that not all children and young people who experience any of these factors will automatically experience complicated grief. Anyone can be at risk of complicated grief and not necessarily because of these factors.

The British Medical Journal has described complicated grief as, “…the persistent and disruptive yearning, pining and longing for the deceased.” The following are what the BMJ stated as being symptomatic of complicated grief,

  1. Frequent trouble accepting the death.
  1. Inability to trust others since the death.
  1. Excessive bitterness related to the death.
  1. Uneasiness about moving on with life.
  1. Detachment from other people to whom the bereaved person was previously close.
  1. The prolonged feeling that life is meaningless
  1. The view that the future will never hold any prospect of fulfilment.
  1. Excessive and prolonged agitation since the death.

As the nature of grief is so individual it can be difficult to identify possible complicated grief. The process of grief can move quickly or can proceed slowly but no change at all can be worrying. An indicator of complicated grief is grief that appears to be stuck or frozen and the bereaved child or young person cannot move towards acceptance of the death. The grief becomes the child or young person’s life and they can appear reluctant or anxious to progress on their journey through bereavement.

Complicated grief often requires support therefore if you think that a bereaved child or young person is exhibiting signs of this you may want to contact Cruse.

How can I help?

  • Remember that the grieving process differs from person to person and therefore complicated grief can be difficult to identify.
  • If you are concerned that your child or young person has become “stuck” in their grief contact Cruse Bereavement Care for support and advice.
  • Encourage your child or young person to talk about their feelings and what they are thinking. Talking can help the bereaved child or young person process their grief and feel supported.
  • If your child or young person has mentioned taking their own life speak with your GP immediately.
  • Don’t be embarrassed to ask for help, you are doing the right thing for your child or young person.

Key points to remember

  • Complicated grief occurs when the bereaved child or young person becomes stuck within their grief.
  • Certain factors such as the relationship the bereaved child or young person shared with the person who has died or the presence of good support systems can increase / decrease the likelihood of complicated grief.
  • Complicated grief can be observed when a bereaved child or young person’s mourning has become the all consuming feature of their life.
  • Bereaved children and young people experiencing complicated grief will require support.
  • Grief is a natural response to bereavement but grief that is complicated can be unhelpful and potential damaging to the mourner.