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Categories That Contribute to Complicated Grief in Children

1. Sudden or traumatic death

Sudden 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

Multiple 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.

4. 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.

Breaking the Silence (1996)  Linda Goldman

Activities to help young children with complicated grief


  1. Read 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.
  2. 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.
  3. 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. 
  4. 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 remaining.


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

Prolonged Grief Disorder (Proposed Criteria for DSM-V) by Dr. Holly Prigerson, 2007 

Criteria A: Bereavement

The reaction has to follow a significant loss

Criteria B: Separation Distress

The bereaved 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: 


  1. Feeling emotionally numb
  2. Feelings stunned or shocked
  3. Feeling that life is meaningless
  4. Confusion about one's role in life, or diminished sense of self
  5. Mistrust of others
  6. Difficulty accepting the loss
  7. Avoidance of the reality of the loss
  8. Bitterness over the loss
  9. Difficulty with moving on with life


Criteria D: Duration

Symptomatic disturbance must endure at least six months 

(Assessing and Treating Trauma and PTSD, by Linda Schupp, PhD)

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