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Section 8
Complicated Grief

Question 8 | Test | Table of Contents

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In the last section, we discussed the final two challenges of a grieving child.  The fourth and fifth challenges we discussed were staying connected and resuming childhood.   

In the next two sections, we will discuss complicated mourning.  As you are aware, when normal grief gets distorted or breaks down and affects children negatively it is referred to as complicated mourning.  Aspects of this concept that I will describe in the next two sections are risk factors of complicated mourning and signs of complicated mourning. 

In this section, we will discuss risk factors of complicated mourning.  As you likely know, many children can fall into a pattern of complicated mourning.  However, in my practice I have noticed that some children run a much greater risk. Therefore I will describe six risk factors of complicated mourning. 

They are traumatic deaths, the caretaker is not functioning well, the child had a love-hate relationship with the deceased, the child experienced multiple losses, the deceased had an extensive illness, and the child has other mental health issues.  As I list the six risk factors of complicated mourning, you can use the information as a checklist to evaluate your clients. 

#1 Traumatic Deaths
The first risk factor of complicated mourning is traumatic deaths.  Clearly, if a child witnesses the trauma, he or she may experience complicated mourning.  Have you found that children isolated from the trauma may experience patterns of complicated mourning if he or she overhears extensive details of the traumatic event? 

Conversely, children who do not receive any information about the traumatic event may use their imagination to supply the missing information.  As we discussed in section 1, a child’s imagination may be more frightening than reality.

♦ #2 The Caretaker Is Not Functioning Well
The second risk factor of complicated mourning is if the caretaker is not functioning well.  Have you had experience treating a grieving child whose primary caretaker is not functioning well?  If so, you probably know that if the caretaker is not providing proper support for normal mourning, then the child may be at risk for complicated mourning.  Clearly, with a caretaker who is not functioning well, the child’s environment may become chaotic and lack discipline. 

#3 Love-Hate Relationships
In addition to traumatic deaths and the caretaker not functioning well,  the third risk factor of complicated mourning is if the child had a love-hate relationship with the deceased.   You have probably had experience treating families who suffer from afflictions such as alcoholism or abuse. 

Clearly, these problems can leave a child with mixed feelings.  When grieving children struggle with mixed emotions such as love and hate, they are at risk for complicated mourning.  However, in my practice I have seen less severe family conflicts like divorce or normal teen struggles put children at risk for complicated mourning.

♦ #4 Multiple Losses
The fourth risk factor of complicated mourning is the child has experienced multiple losses.  Multiple losses such as divorce, moving, illness or a series of deaths can obviously affect children in difficult ways. 

First, as you know, children process losses repeatedly as they pass through the different stages of development.  Therefore, children who experience multiple losses, may experience an increase in grief over time. 

Second, multiple losses can negatively impact a child’s view of the world and encourage unhealthy coping skills.  For example, Christine turned 4 a few months after her older brother died in a bicycle collision with a car.  Six months later, her younger brother died from meningitis.  After three years of grieving, Christine’s parents decided to have another child.  They worried about Christine’s reaction, but were relieved that she continued her life as normal after the baby was born. 

Several months later, however, they realized that Christine hardly acknowledged the baby.  Christine never talked to or played with the baby.  She only helped when specifically asked to help by her parents.  When I treated Christine, I asked her why she refused to acknowledge her baby brother.  Christine stated, "Why should I?  He’s just going to die anyway." 

Think of your Christine.  Has she or he developed problematic coping skills as a result of experiencing multiple losses?  Later in this course, we will discuss a technique which is useful in developing more productive coping skills in children.

♦ 5 Extensive Illness
The fifth risk factor of complicated mourning is the deceased had an extensive illness.   I have found that extensive illness tends to wear down a family’s coping resources.  Parents may eventually tire out, having little emotional energy left to support their grieving children.  Without that support, children are increasingly at risk for complicated mourning.

♦ 6 Other Mental health Issues
In addition to traumatic deaths, the caretaker is not functioning well, the child had a love-hate relationship with the deceased, the child experienced multiple losses and the deceased had an extensive illness the sixth risk factor of complicated mourning is if the child has other mental health issues. 

Have you had experience... counseling a child who contends with depression, anxiety, ADD/ADHD, or another mental health issue?  If so then you are already aware of how these grieving children may be at risk for complicated mourning. 

♦ Do you agree that loss can divert the internal coping resources of a child with mental health issues to grief.  This diversion of resources may allow pre-existing mental health issues to get worse.  Even if the child has already completed therapy for an ongoing mental health concern, extra therapy work may provide the additional support needed.  If you counseled a grieving child with mental health issues, how would you interact with other therapists involved with the child?

In this section, we have discussed risk factors of complicated mourning.  I have identified six risk factors of complicated mourning.  They are traumatic deaths, the caretaker is not functioning well, the child had a love-hate relationship with the deceased, the child experienced multiple losses, the deceased had an extensive illness, and the child has other mental health issues.

In the next section, we will discuss six signs of complicated mourning.   The six signs of complicated mourning that we will discuss are continuous hyperactivity, ongoing and significant changes in performance, persistent regression, ongoing depression, self-destructive behavior and chronic anger.
Reviewed 2023  

Peer-Reviewed Journal Article References:
Bellet, B. W., LeBlanc, N. J., Nizzi, M.-C., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020). Identity confusion in complicated grief: A closer look. Journal of Abnormal Psychology, 129(4), 397–407.

Diminich, E. D., & Bonanno, G. A. (2014). Faces, feelings, words: Divergence across channels of emotional responding in complicated grief. Journal of Abnormal Psychology, 123(2), 350–361. 

Grassetti, S. N., Williamson, A. A., Herres, J., Kobak, R., Layne, C. M., Kaplow, J. B., & Pynoos, R. S. (2018). Evaluating referral, screening, and assessment procedures for middle school trauma/grief-focused treatment groups. School Psychology Quarterly, 33(1), 10–20.

Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229. 

Sierra Hernandez, C. A., Piper, W. E., Ogrodniczuk, J. S., Joyce, A. S., & Weideman, R. (2016). Use of referential language in short-term group psychotherapy for complicated grief. Group Dynamics: Theory, Research, and Practice, 20(1), 1–15.

QUESTION 8
What are the six risk factors of complicated mourning? To select and enter your answer go to Test.

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