Bereavement reactions by age group | Kidshealth
How you react to death can be affected by many things: The type of relationship you had with the person: The new loss may remind you of earlier losses you've. How grief can affect relationships. Grief can create a whole variety of difficulties when it comes to actually trying to support someone. It's very common for. It is not unusual for grief to resurface later on, even well after the death. personality; ways they usually react to stress and emotion; relationship with the person so adults can assume they are not properly aware of the death, or affected by it.
A child may ask the same questions about the death over and over again, not so much for the factual value of the information as for reassurance that the story has not changed. A four- or five-year-old might resume playing following a death as if nothing distressing had happened. Such behavior reflects the cognitive and emotional capacity of the child and does not mean that the death had no impact.
Losses are so painful and frightening that many young children—able to endure strong emotions for only brief periods—alternately approach and avoid their feelings so as not to be overwhelmed. Because these emotions may be expressed as angry outbursts or misbehavior, rather than as sadness, they may not be recognized as grief-related.
Furthermore, because their needs to be cared for and related to are intense and immediate, young children typically move from grief reactions to a prompt search for and acceptance of replacement persons. Unlike adults who can sustain a year or more of intense grieving, children are likely to manifest grief-related affects and behavior, on an intermittent basis, for many years after loss occurs; various powerful reactions to the loss normally will be revived, reviewed and worked through repeatedly at successive levels of subsequent development.
Thus, in dealing with chil dren who have sustained a loss it is important to be aware of the special nature of grieving in children and not to expect that they will express their emotions like adults or that their overt behaviors will necessarily reveal their internal distress.
As noted later in this chapter, the delayed working through of bereavement may require specialized assistance if development seems blocked or psychopathologic symptoms appear. Although there is no doubt that even very young children react to loss, there is considerable controversy about when children have the developmental prerequisites for complete "mourning" and about the likelihood of achieving a healthy outcome if bereavement occurs prior to this time.
Generally it is agreed that prior to age 3 or 4 children are not able to achieve complete mourning and it is agreed that by adolescence youngsters can mourn but are still more vulnerable than adults because they are experiencing so many other losses and changes. The controversy centers on the years in between: A number of studies have been conducted in recent years e.
A fairly standard view was put forth by Nagy in Analyzing the words and drawings of a relatively large sample of Hungarian children who had been exposed to considerable trauma and death in the preceding few years, she conceptualized a three-stage model of awareness and linked the stages to approximate chronological ages.
Prior to about three years of age, children's cognitive and language development is too immature for them to have any concept of death. According to Nagy's stage 1 roughly agesdeath is seen as reversible; the dead are simply considered "less alive," in a state analogous to sleep. Young children functioning at what Piaget termed the "preoperational" level of development will not generally recognize the irreversibility of death.
In the third stage after age 10the causes of death can be understood, and death is perceived as final, inevitable, and associated with the cessation of bodily activities. As is true in all child development, there is considerable age variation in attainment of the different stages and children may regress when emotionally threatened.
Bereavement reactions by age group
Prior to about six months of age, infants fail to respond to separation from their mothers because they have not yet developed the capacity for memory of a specific personal relationship. This reaction suggests that an infant is developmentally capable of retaining memory traces of his mother and is capable of responding to her absence with displeasure and depression.
Observational studies of children between about four years of age and adolescence have led psychiatrists to conflicting conclusions about the nature of children's grieving and about their ability to achieve a healthy outcome.
Some psychoanalysts 34275, maintain that it is not until adolescence that children have the capacity to tolerate the strong painful affects necessary for completing the separation process and that children are more likely to use immature defense mechanisms, such as denial, that interfere with adequate resolution of loss.
Thus these observers view children's reactions to loss as qualitatively different from adult reactions. Others believe that after object constancy has been achieved at three to four years of agebereavement need not necessarily lead to enduring psychopathology.
Increasingly, it is being recognized 275581 that if the child has a consistent adult who reliably satisfies reality needs and encourages the expression of feelings about the loss, healthy adjustment can occur.
Furthermore, the biologic unfolding inherent in development naturally pushes children toward increasing cognitive and emotional maturity.Social Media: The Death of Relationships?
This "developmental push" is seen as an asset that contributes to children's potential resiliency under favorable circumstances. Some psychiatrists, most notably Bowlby, 24 emphasize the similarities between adults' and children's responses to loss and see an evolutionary basis for them.
In Bowlby's view, the argument about children's capacity for "mourning" is in large part terminological, with many psychoanalysts restricting the use of "mourning" to psychological processes with a single outcome—detachment—and others using it more broadly ''to denote a fairly wide array of psychological processes set in train by the loss of a loved person irrespective of outcome. In his opinion it would be more fruitful to have a detailed understanding of the bereavement process in children so that those who interact with children can be most responsive and helpful.
On the other hand, random samples of bereaved children that provide more methodologically reliable data do not offer the same depth of information. In addition, relatively few use control groups, making it impossible to know what the base rates of particular behaviors or symptoms might be in the general population. Where controls are used, it is often unclear whether they are matched for age and sex. Most of the data on very early below the age of five childhood loss are not specific to bereavement but are based on observations of institutionalized children e.
It is not clear if the children's responses in these studies were based on parental loss itself, on the multiple other losses associated with removal from the home environment, or the unfamiliar and sometimes chaotic circumstances associated with institutional placement. Because these children were not followed over a very long period of time, neither is it known whether pathologic or disturbing reactions endured. Studies of the long-term effects of bereavement during childhood are abundant, but they are highly controversial because they almost always rely on retrospective data see Gregory 63 for a discussion.
In addition these studies often fail to consider the impact of intervening life events, rely too heavily on data based on patients' memories, and use inappropriate control groups.
A handful of prospective studies describe intermediate effects, but many of these have methodologic flaws, such as a failure to use nonbereaved control groups, 78a lack of direct assessment of bereaved children, and a failure to follow children over a sufficiently long pe riod of time. Different methods have been used to study outcomes of childhood bereavement and, partly because of the variation in approach, studies have yielded different results.
Few studies provide precise definitions of key terms, such as "depression, "exaggerated responses, " "pathologic grief, " "anger, '' and "sadness," so it is difficult to know whether all authors are referring to the same specific reactions.
Studies on childhood loss tend to rely exclusively on interview data or material in case files; standardized instruments that permit greater generalization across studies have rarely been used in the assessment of children. In fact, such instruments have only begun to be developed in the past few years. It should be noted that, because of the way this chapter is organized, a number of studies are cited several times, perhaps giving the impression that there are more empirical data than is really the case.
The particular symptoms and syndromes associated with childhood bereavement are generally considered in terms of the immediate reactions that occur in the weeks and months following the death, the intermediate reactions that can appear later in childhood or adolescence, and the long-range or "sleeper" effects that may appear in adulthood either as enduring consequences or delayed reactions to the loss.
Although these long-range effects are of most concern, the research evidence in this area is probably the weakest. Major Studies of Childhood or Adolescent Bereavement. Immediate Reactions Children, like adults, experience a range of emotional and behavioral reactions immediately following parental or sibling death. Studies of both patient and nonpatient samples report that children respond to loss with similar symptoms.
People who interact with recently bereaved children find them sad, angry, and fearful; their behavior includes appetite and sleep disturbances, withdrawal, concentration difficulties, dependency, regression, restlessness, and learning difficulties.
They also note that initial symp tom patterns depend largely on the age at which the child is bereaved. For example, children under age five are likely to respond with eating, sleeping, and bowel and bladder disturbances; those under age two may show loss of speech or diffuse distress. School-age children may become phobic or hypochondriacal, withdrawn, or excessively care-giving. Displays of aggression may be observed in place of sadness, especially in boys who have difficulty in expressing longing.
Adolescents may respond more like adults, but they may also be reluctant about expressing their emotions because of fear that they will appear different or abnormal.
A few investigators have suggested a link between loss experiences and subsequent precipitation or "activation" of specific diseases, such as thyrotoxicosis, rheumatoid arthritis, and diabetes. Some studies found increased physical symptoms, especially abdominal pain. In a community sample of Israeli children who had lost their fathers, no objective findings about these physical symptoms were established and the investigators concluded that the responses were largely attention-seeking.
A number of psychological symptoms, most prominently neurosis and depression, appear to correlate with parental or sibling death. Signs of continuing emotional distress have been noted in both community and patient samples of children who lost a parent or sibling. Behavioral problems, amounting to an average of nine handicapping problems per child e. Three and a half years after the loss, 65 percent of the total clinical symptoms persisted at a medium to severe level.
Assessing the chil dren at 6, 18, and 42 months postbereavement, the authors found that nearly 70 percent of the children showed signs of severe emotional disturbance in at least one follow-up period. Fewer than one-third had achieved satisfactory family, school, and social adjustment throughout the entire three and a half years of the study. A subsequent study of this sample 46 suggested that children with preexisting emotional difficulties and those who came from families marked by marital discord were at greater risk for more severe pathologic developments than were children from stable families with no prior emotional problems.
An unevenness in the development of bereavement reactions among these Israeli children was noted. Although those with symptoms of marked emotional impairment during the early months of bereavement appeared to develop the most severe and prolonged type of pathologic grieving, others revealed no special pathology during the early months but deteriorated emotionally during the second to fourth years.
Thus, the timing of severe and persistent clinical symptoms that significantly impaired the child's psychosocial functioning varied in onset and duration. In a study comparing bereaved kibbutz and urban children, Kaffman and Elizur 78 found that 48 percent of the kibbutz children and 52 percent of those in cities showed persistent symptoms of "pathological grief" which the authors define as "the presence of multiple and persistent clinical symptomatology of sufficient severity to handicap the child in his everyday life within the family, school, and children's group, persisting for a minimum of two months" and displayed signs of marked distress, emotional insecurity, and psychological imbalance 18 months after notification of their fathers' deaths.
That normal kibbutz children did not fare a great deal better than city children suggests that the social supports available in the kibbutz setting and the perceived less central role of the parents did not protect the youngsters from stress.
Thus, while the father within a kibbutz is neither the family provider nor principal supplier of material needs, he is still a central attachment figure in his child's emotional life.
These findings highlight the importance of the psychological meaning of parental loss and its impact on a child. Such findings in general community samples are echoed in studies of psychiatric patients. Studies by both Rutter and Arthur and Kemme 7 found neurotic illness was excessive in disturbed children who had lost a parent. The latter found that 52 percent of their sample were experiencing autonomy conflicts, 27 percent felt panicky over relationships and dependent on others, and 39 percent had problems in defining their relationship with the opposite-sex parent four months to two years after parental loss.
Forty percent had prolonged or anniversary hysterical identification with the dead sibling's prominent symptoms. A striking finding of both Van Eerdewegh et al. Severe depressions were most likely in subjects whose mothers were already depressed prior to their husbands' deaths, suggesting children's emotional states may be linked to identification with the surviving parent rather than a pure response to loss.
Stone suggests that parental death may precipitate a depressive disorder in adolescents already at risk for manicdepressive disorder of the depressive type. There is general agreement among clinicians that parental bereavement has an adverse impact on school functioning, both in academic performance and social behavior.
Several studies of Australian, Israeli, and American children 13 months to 6 years postbereavement showed evidence of examination failure, school refusal, a decreased interest in school activities, and drop-out. Delinquency has been found to correlate with parental bereavement, particularly in adolescents. Raphael notes that loss generates longing for comforting and reassurance in girls, leading to sexualized relationships that provide a sense of ego fusion with another, whereas boys are more likely to engage in petty theft, car-stealing, fights, drug-taking, or testing of authority systems.
Long-Term Delayed Effects A number of researchers have conducted retrospective studies to investigate a hypothesized link between childhood bereavement and vulnerability during adulthood to a variety of serious disorders, including neurosis, psychosis, physical illness, depression, schizophrenia, and antisocial behavior.
Specific findings from these studies are contradictory, but they generally point to an increased vulnerability to physical and mental illness later in life. Findings from the one prospective study conducted by Fulton and his colleagues 1296 also suggest that bereaved children suffer long-term vulnerabilities. Raphael points to a number of retrospective studies suggesting that persons who have experienced such loss are more likely to demonstrate symptomatology, increased health care utilization, and complaints of ill health in adult life.
She cites Seligman et al. Bendikson and Fulton's prospective study 12 of a cohort of parentally bereaved Minnesota ninth graders also suggests a possible predisposition to later illness. When these individuals were observed in their thirties they were significantly more susceptible to serious medical illnesses than the control subjects, and experienced significantly more emotional distress. Unfortunately, the exact nature of the illnesses and distress was not specified.
Substantially more work has been done on the possible association between early loss and mental illness, with the majority of investigators reporting a positive relationship between childhood bereavement and adult-life mental illness.
Most of these researchers used psychiatric patients as subjects, although community samples have also been studied in more recent years. The emphasis has generally been on the consequences of parental death, with some attempt to further specify risk factors in terms of the sex of the deceased parent and the age and sex of the bereaved child. The evidence is contradictory, but many investigators find a significant increase of both neurosis and psychosis 9 in persons who experienced early bereavement when compared with controls.
Links are suggested between early loss and adult-life impairment in sexual identity, development of autonomy, and capacity for intimacy.
For example, Barry and Lindemann 10 found that girls who lose a mother between birth and age 2 are at greatest risk for neurosis whereas in Norton's sample, loss of the father before age 10 was most significant. Recent studies suggest that sample characteristics may influence apparent outcome. For example, in a study comparing Scottish psychiatric hospital admissions with a control group of general practice patients matched for age and sex, Birtchnell 17 found that loss of the mother before age 10 was an etiologic factor in the subsequent development of mental illness.
This finding was not replicated in his later work, 18 however, which drew upon a community sample. Individuals who lose a parent or sibling in childhood have been considered to be most at risk for subsequent depressive disorders. Based on his clinical observations, Bowlby 27 concludes that profound early loss renders people highly vulnerable to subsequent depressive disorders, with each subsequent loss triggering an upsurge of unresolved grief initially related to the early bereavement.
Research data examining the link between early loss and adult depression are only suggestive, however. In addition, in seven out of eight controlled studies, 11153157,early loss was correlated with severity of depression. Parentally bereaved subjects were more likely to experience psychotic-rather than neurotic-level depression. They also found that 66 percent of those diagnosed as psychotically depressed had a history of early loss compared with only 39 percent of the neurotic depressives.
There is also some suggestion that depressions associated with early bereavement tend to be reactive 57 rather than endogenous; studies that have included the more biologically predisposed bipolar manic-depressive disorders typically have not established a connection between them and early bereavement.
Birtchnell found that twice as many depressed suicide attempters were parentally bereaved compared with nonsuicidal depressives Birtchnell 18 suggests that additional factors, such as the quality of the relationship with subsequent caretakers, may be more influential in determining risk for later depression than simply the experience of bereavement in and of itself. Evidence regarding bereavement as an etiologic factor in the development of schizophrenia is less convincing than that on depression.
Dennehy, 41 Hilgard, 69 and Rosenzweig and Bray report positive findings, while Granville-Grossman 61 and Gregory 65 find no significant correlation. Research findings are suggestive of a link between childhood loss and subsequent criminality. In Markesun and Fulton's prospective community study, 96 men who had been bereaved in childhood had more offenses against the law when in their twenties than did controls.
In samples of both male and female prisoners 3032 the histories revealed an excess of parental death; the ''affectionless criminal" appears to be most strongly represented. Based on clinical observations of psychotherapy patients of the BarrHarris Center for the Study of Separation and Loss During Childhood, in Chicago, Altschul and Beiser 4 have noted difficulties in parenting when the bereaved child grows up and has children of his or her own.
These difficulties seem to occur more often if the loss happened when the child was between 7 and 12, and if the deceased parent was of the same sex. They hypothesize that these problems have their roots in identifications with the dead parent and in the "lack of experience with the dead parent in developmental stages that go beyond the point of loss. Conclusions About Outcomes It is difficult to draw conclusions about the long-term consequences of bereavement during childhood or adolescence.
The data suggest potential difficulties, but there is a lack of specificity regarding what places a bereaved youth at risk. Concerning intermediate-term consequences, the existing literature suggests that early bereavement greatly increases a child's susceptibility to depression, school dysfunction, and delinquency. Given the immaturity of the child's personality, it seems likely that even a minor depression of 13 months' duration might inhibit or interfere with normal ego development, thereby disrupting or distorting psychological growth.
Although specific manifestations of distress and the dura tion of responses vary by age and by individual, children like adults have been observed to go through a relatively predictable series of phases of bereavement responses. Based on his observations of young children in a residential nursery who were separated from maternal figures, Bowlby 24 - 27 identified three sequential phases in response to separation and loss.
When a healthy child over the age of six months was taken from his mother, a period of "protest" ensued, characterized by loud, angry, tearful behavior suggesting an expectation of and demand for reunion. This stage might last for as long as a week or more. When attempts at reunion failed to produce the desired results, a phase of "despair" set in, marked by acute pain, misery, and a sense of diminishing hope.
Following this came the final stage of "detachment," during which children behaved as if they no longer cared whether or not their mothers returned; upon actual reunion, their initial reaction might be to continue avoidance behavior and withdrawal. Elizur and Kaffman's work 45 with kibbutz children described the course of grieving during the first four years following paternal bereavement. The immediate reaction was one of pain and grief.
During the first year, the children began to examine the meanings and implications of the loss and to ask realistic questions to gain understanding of "dead" and "alive.
In order to cope, they became more dependent on their mothers and were more demanding; aggressive behavior, discipline problems, and restlessness intensified. During the third and fourth years, manifestations of overdependence still characterized two-thirds of the sample, but anxiety level and augmented aggressiveness were reduced. Despite a general trend toward greater adjustment, however, 39 percent of the previously normal sample continued to show signs of emotional distress four years after their fathers had died.
Shifts in Self-Concepts Following Bereavement A major area of concern regarding psychological functioning following bereavement relates to negative shifts in self-concepts and selfesteem. Rochlin - and Kliman 83 have observed that children often assess themselves more negatively after a parent's death than before. Children who interpret a parent's death as desertion because the parent did not love them may believe that they are unlovable, which may result in a persistent sense of low self-esteem.
It is possible that this image of being frighteningly small and helpless is the most disruptive and disorganizing view of the self that can emerge subsequent to parental death. Based on their extensive clinical experience with bereaved children, Erna Furman 54 and Robert Furman 56 have observed that while there is a fairly universal tendency toward self-blame following bereavement, it may be that the resultant sense of guilt is less threatening than is the defended-against view of the self as helpless.
If someone feels responsible for a death at least that person feels some sense of control over the environment. The sense of being ineffectual in controlling life events impinging on the self may lead to a kind of passivity, apathy, and depression, similar to the mental state described by Seligman in his theory of "learned helplessness" as the precursor of depression.
The tendency of children to think in egocentric, magical ways and to equate thought with deed may lead to the belief that their destructive impulses or angry feelings destroyed the parent or sibling.
This can lead to a hostile image of the self, especially if there was a great deal of competition and hostility in the prior relationship, as is likely to be true of siblings.
The Role of Identification in Grieving Identification with a deceased person has been described as more common and dramatic in children than in adults. Because of this fear, Wolfenstein believes that genuinely adaptive identifications in children are rare. Johnson and Rosenblatt 76 have noted that a socially inappropriate identification with a deceased parent may be an expression of incomplete or pathologic grief.
If a child identifies too closely with adults, peers may be rejecting or critical, with a resulting loss of social supports. In addition, when such replacement roles are fostered by adults they can be felt as rather frightening pressure by the child. For example, if a new widow tells her young son that he is now "the man of the house," he may feel some literal responsibility and become anxious at the prospect of having to assume all the roles of the deceased parent e.
If his mother later remarries, the stress on the little "man of the house" is magnified by the fact that she has chosen to "replace" him. Likewise, a child may attempt to replace a deceased sibling as a means to help the parent s cope with loss feelings, thereby compromising the youngster's own identity development. Too often the tendency to idealize the dead also makes it difficult for surviving siblings to deal with their anger at the deceased or at their parents e.
This too may form a basis for overidentification, if the child attempts to secure affection by adopting the traits of the deceased. Common Thoughts, Concerns, and Fantasies As with adults, 88 a number of common themes emerge in bereaved children, typically associated with or underlying feelings of sadness, rage, fear, shame, and guilt. There are at least three questions, whether directly articulated or not, that will occur to most children following a loss: Did I cause this to happen?
Will it happen to me? Who will take care of me now or if something happens to my surviving caretaker? It is important to provide answers to these questions and to hear how the child understands those answers, because misunderstandings may give rise to feelings of anger or fear. Perceptions that the parent or sibling's death was a deliberate abandonment, associated with feelings of rage, tend to undermine a child's badly needed sense of being cared for. This was indeed the reaction of 20 percent of the parentally bereaved patients studied by Arthur and Kemme.
Bowlby 27 notes that fears about whom death may claim next may underlie anxious clinging or obstinate behavior. The belief that the world is a safe, predictable place may be destroyed, resulting in disruption of a child's capacity for basic trust.
Elizur and Kaffman 45 found that bereaved children fantasized in an attempt to maintain the illusion that the deceased parent was still nearby. Denial may help ward off painful feelings and a conscious consideration of the loss.
Wolfenstein has commented on a defensive and often maladaptive splitting of the ego in bereaved children that allows them to acknowledge a parent's death as a reality while simultaneously denying its finality.
She suggests that the good moods that may be observed in bereaved children following parental death represent an affective counterpart of denial. When depressed moods occur, particularly in adolescents, they are usually isolated from thoughts of the dead parent.
Let them know, somehow, that the death of your mum or dad or sister or brother is having a huge impact on you. It might seem that other family members or even friends are trying to replace the connection you had with the person you lost. This may make you angry — no one can replace them. But remember that they may just be trying to make sure that you have support when you need it.
Just let them know when you think they have over-stepped the mark. New partners, new families If your Mum or Dad has died, at some stage in the future you may have to deal with your other parent thinking about, or in fact doing something about, finding a new partner.
This may cause all sorts of conflicting emotions and challenges.
Common reactions to death | Grief and loss | ReachOut Australia
While you may understand, in your head, their right to do this, in your heart it might be a whole different story.
Living with the death of your parent or brother or sister which you can download or order here. Relationships with your friends When someone in your family dies, you may find that even your closest friends have no idea what to say or do. They may even avoid you as they are scared of saying the wrong thing. Things to remember You may have to make the first move.