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Section 16
Childhood Traumatic Grief

Question 16 | Test | Table of Contents

Childhood traumatic grief (CTG) is conceptualized as a grief response distinct from what would be expected or normative following a death. The response follows the death of a loved one in a way that is subjectively or objectively perceived as traumatic. A child with CTG has symptoms of reexperiencing, avoidance, and arousal that are characteristic of posttraumatic stress disorder (PTSD) and that interfere with bereavement. In CTG, positive memories or reminders associated with the trauma, the loss (e.g., a photo of the deceased), and change (e.g., no longer playing ball with the deceased) segue into upsetting thoughts and memories, triggering the use of avoidant or numbing strategies. These PTSD-like reactions impinge on the child’s ability to complete the tasks of uncomplicated bereavement.

Children and adolescents with CTG may also show signs of depression and anxiety, which are the most often cited diagnoses following a death. In addition, CTG may be expressed differently in children of different ages, with adolescents more vulnerable to internalizing and externalizing behavior problems. Reactions to the loss of a parent from death and from divorce are often thought to be similar due to the issue of separation. Servaty and Hayslip found, however, that parentally bereaved adolescents suffered more "interpersonal sensitivity" problems than teens from divorced families. Parentally bereaved adolescents feel dissimilar from, and may feel stigmatized by, peers from both intact and divorced families.

Adolescence seems to be a time of particular vulnerability for the long-term negative impact of death involving trauma. Goenjian and colleagues found that six months after the 1998 hurricane that killed 4,000 people in Nicaragua, severe PTSD and depressive reactions in adolescents were related to their proximity to the most affected region and also to the rate of injury and death among family members. Desivilya and colleagues found that teens who had survived being held hostage while on a high school trip when other students were killed, exhibited psychiatric symptoms and still suffered effects of the ordeal seventeen years later. Bachar and colleagues found that the suddenness and meaninglessness of events resulting in traumatic deaths, such as a vehicular accidents, were factors in adolescents’ reactions to such events.

Bereavement and Adolescent Development
Adolescence has been found to be a challenging stage of life associated with tremendous physiological and psychological change. The psychological meaning of loss (in the broadest sense) and its interaction with symptom formation figure prominently in some developmentally oriented theories on adolescence. Loss, in the form of relinquishing childhood dependency, is thought necessary for development of age appropriate independence. This loss has been characterized as loss of the "infantile object" and also as loss of the "fantasized self." The normative response to this developmentally necessary psychological loss is the stereotypical "difficult teenager" that Garber describes as having dysphoric affect with mood swings and antisocial behavior. Such normal attitudes and behaviors can be intensified by grief, with the result that it may prove difficult to distinguish between what is developmentally appropriate and what is, instead, a grief-related problem.

Adolescent-parent conflict is another hallmark of adolescent development that may be exacerbated by parental bereavement. As the parent and adolescent grieve, symptoms in each may well affect their relationship, roles, and naturally occurring separation process. The surviving parent may become overly dependent on the adolescent, who, in turn, suppresses emotion to protect the parent. This breach in the necessary parent-child relationship, coupled with a bereaved adolescent’s feelings of stigmatization, can interrupt identity formation. In addition, bereaved adolescents may express their grief by cultivating interests similar to those of the deceased parent or by adopting an increased sense of responsibility to the family—again to the potential detriment of development.

Traditional Treatment for Bereavement, Trauma, and CTG
Unlike early, stage models of grief, the contemporary view of treatment for normal bereavement is based on developmental processes and on the mastery of tasks that require ongoing adjustment and adaptation. Clark and colleagues describe this course of change as a lifelong and fluid one that focuses on positive growth rather than pathology. Among the tasks to be mastered are accepting and experiencing feelings related to the death, adjusting one’s identity, developing new relationships, engaging in life-affirming activities, maintaining an appropriate attachment to the deceased (as through memories), and continuing with developmental tasks. Interventions aimed at addressing bereavement tasks are many and have included the following: support groups; self-help groups; efforts in schools; family, play, and art therapy; and individual therapy. With minimal research on treating CTG, methodologies must rely on the literature concerning children exposed to trauma or experiencing grief. Thus, due to similarities of symptoms of children with CTG and those experiencing abuse or violence, current research is investigating what components of validated treatment for trauma or grief might best apply to CTG.
- Goodman, R. F., Ph.D, Juriga, S., Ph.D, & Brown, E. J., PhD. (2004). Letting the Story Unfold: A Case Study of Client-Centered Therapy for Childhood Traumatic Grief. Harvard Review of Psychiatry, 12(4), 199-212. doi:10.1080/10673220490509534

Update
Developmental Manifestations
of Grief in Children and Adolescents:
Caregivers as Key Grief Facilitators

- Alvis, L., Zhang, N., Sandler, I. N., & Kaplow, J. B. (2022). Developmental Manifestations of Grief in Children and Adolescents: Caregivers as Key Grief Facilitators. Journal of child & adolescent trauma, 16(2), 447–457.

Peer-Reviewed Journal Article References:
Donohue, M. R., & Tully, E. C. (2019). Reparative prosocial behaviors alleviate children’s guilt. Developmental Psychology, 55(10), 2102–2113.

Kiser, L. J., Miller, A. B., Mooney, M. A., Vivrette, R., & Davis, S. R. (2020). Integrating parents with trauma histories into child trauma treatment: Establishing core components. Practice Innovations, 5(1), 65–80.

Marshall, A. D., Roettger, M. E., Mattern, A. C., Feinberg, M. E., & Jones, D. E. (2018). Trauma exposure and aggression toward partners and children: Contextual influences of fear and anger. Journal of Family Psychology, 32(6), 710–721. 

QUESTION 16
What is loss of the "infantile object" or loss of the "fantasized self"? To select and enter your answer go to Test.

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