The grieving process involves accepting and adapting to a loss, whether it be a loved one, an object, or a situation (Herrera, 2018). It has been observed that children are particularly sensitive to changes and losses. Therefore, according to Herrera (2018), pathological grief in children manifests as a true maladaptation syndrome that can have profound consequences for their development and well-being.
What is Pathological Grief in Children?
A normal grieving process is defined as a vital stage in which a person reacts to a loss, understands its implications, reorients their life without the presence of the loved one, and accepts the loss (Herrera, 2018). In this process, the memory of the loved one does not provoke significant emotional reactions. The duration of this process is subject to significant controversy. Instead of establishing a temporal criterion, scientists and mental health professionals have agreed on an adjustment criterion. Thus, according to Herrera (2018), it has been established that normal grief should not be a debilitating complication in any case.
On the other hand, pathological grief in children is defined as a condition in which the feeling of sadness extends beyond the period considered normal (García, 2018). This feeling of sadness, which is a natural response to loss, can persist for years if not properly addressed with the help of a specialist. Death is a natural process, and grief is an integral part of it. It is crucial to be alert if symptoms persist and to remember that for children, this process can be not only painful but also confusing. Furthermore, in line with García (2018), it is important to note that although grief generally occurs when a close person dies, it can also result from other situations, such as parental separation.
Symptoms
Pathological grief in children is characterized by intense and prolonged sadness that exceeds the expected duration, affecting the child's normal functioning emotionally, cognitively, physically, and socially (Menéndez, 2018). As a result, the child may show a prolonged inability to perform activities they used to do before the loss. According to Menéndez (2018), as research on pathological grief in children has progressed, it has been recognized that it is uncommon for children to experience extreme grief symptoms that result in persistent distress and impairment in their functioning.
Some professionals recommend grouping symptoms into different domains (Menéndez, 2018). According to Menéndez (2018), in the cognitive domain, symptoms may include rumination about the circumstances of the death, frequent disbelief or inability to accept the death, separation anxiety, persistent and intense yearning for the deceased person, frequent feelings of loneliness or emptiness, negative thoughts about life without the deceased or a recurring need to join the deceased, and troubling thoughts about the deceased that impair daily functioning.
Regarding feelings, symptoms may include a persistent sense of shock, numbness, or emotional numbness since the death, recurrent feelings of anger or bitterness about the death, difficulty trusting or caring for others since the loss, experiencing pain or other somatic symptoms, hearing the deceased's voice or seeing the deceased person, and intense emotional reactions to memories of the deceased (Menéndez, 2018). Finally, in the behavioral domain, symptoms may include excessive concern or avoidance of places, people, and things related to the death. As a consequence, these symptoms can interfere with the child's normal functioning, causing significant distress in academic, social, and family areas. Additionally, in line with Menéndez (2018), both the intensity and duration of this type of grief are clearly disproportionate.
Types of Pathological Grief
There are four types of pathological grief in both children and adults (Herrera, 2018). The first is chronic grief, characterized by disabling pain that persists even after a year in adults and six months in children. In this case, the individual has difficulty adapting to their new reality. The second type is delayed grief. Here, the individual initially shows only some emotions after the loss. However, over time, they experience intense emotional burden that had not been previously manifested. The third type is exaggerated grief. In this case, the pain is so overwhelming that the individual resorts to self-destructive behaviors. Moreover, this type of grief can increase the likelihood of developing other psychological disorders. Finally, the fourth type is masked grief. According to Herrera (2018), this type of grief can be difficult to identify, as the individual may present physical and emotional problems without being aware that these problems are a manifestation of their grief.
Pathological Grief According to Age
It is important to note that symptoms manifest differently and in different proportions depending on the child's age (Menéndez, 2018). In preschool and school-aged children, exaggerated fears, attachment problems with primary caregivers, traumatic play, and persistent regression may be present. On the other hand, in preadolescents and adolescents, risk behaviors, suicidal ideation and behavior, inability to create a narrative about the loss, and a very negative perspective on the future and inability to set goals may be observed. Some studies suggest that, in general, younger children more frequently exhibit fear and attachment problems, while older children more commonly show risk behaviors. According to Menéndez (2018), it is essential to consider these differences to effectively address pathological grief in children.
Controversy
There is considerable controversy around the concept of pathological grief in children (Herrera, 2018). There are professionals and scientists who reject this diagnostic category, which is included in the DSM-5, arguing that each individual processes, interprets, and manifests their emotions uniquely. For these psychologists, doctors, and psychiatrists, including pathological grief as a psychopathological disorder would be equivalent to labeling a person who is simply sensitive to their loss as sick. However, there is a school of thought that has gained ground against this idea, recognizing the importance of categorizing these particular symptoms. According to Herrera (2018), the goal of this categorization is to obtain more information about the clinical picture, the course, and the prevalence of the problem, as well as to investigate effective treatment.
Recommendations
Currently, effective psychological treatments are recognized for addressing pathological grief (Herrera, 2018). Therefore, it is advised to establish contact with a psychology professional to treat this condition. However, there are some recommendations that can be followed to help children experiencing pathological grief. Maintaining open communication is essential, providing honest and understanding answers to their questions and concerns. It is important to create a safe and trusting environment where the child can freely express their feelings and thoughts. It is beneficial to provide them with appropriate information about death and the implications of the deceased's absence in their daily life. Additionally, it is useful to ask if they have any doubts, fears, or insecurities and how they can be helped to overcome these feelings. Throughout the grieving process, according to Herrera (2018), it is crucial to show them understanding and patience, providing trust and a secure attachment.
References
García, F. M. (2018, diciembre 12). El duelo patológico en los niños. Eres Mamá. https://eresmama.com/el-duelo-patologico-en-los-ninos/
Menéndez, M. (2018). Duelo Patológico en Niños: Síntomas y Tratamiento. Psicología Online. https://www.psicologia-online.com/duelo-patologico-en-ninos-sintomas-y-tratamiento-3902.html
Peña Herrera, B (Herrera, 2018). (2018, diciembre 26) (Herrera, 2018). Duelo patológico en niños (Herrera, 2018). La Mente es Maravillosa (Herrera, 2018). https://lamenteesmaravillosa.com/duelo-patologico-en-ninos/
