MHM Magazine

38 | MENTALHEALTHMATTERS | Issue 4 | 2021 MHM difficulties in schoolwork and relationship problems among peers within the family and at school. DIFFERENT EXPRESSIONS OF BEREAVEMENT: Within western culture, the expectation is for people who have experienced significant loss to show extreme initial distress which declines over time. However, this is just one of several forms of expression of bereavement seen in clinical practice. After the traumatic loss of a parent or other family member children may show: • Extreme denial and apparent absence of grief • Grief in which emotions such as anxiety and anger rather than sadness are most noticeable • Persistent grief reactions with evident sadness, yearning, and preoccupation • Delayed grief, with prominent grief responses only a substantial time after the loss • Traumatic grief reactions in which grief occur alongside post traumatic stress disorder (PTSD) symptoms CHILDREN STRUGGLING WITH BEREAVEMENT PROCESS: Children struggling with bereavement may have a yearning to be with the deceased and may present in the child earnestly searching for the person who has died or running away from the home in a quest to find the person who has died. The child may also seek out family members or friends in an attempt to locate the dead person. During this process children who have lost someone close to them might report seeing or being visited by this person. Some children may be seen having conversations with the deceased person flowing over into a psychotic presentation. Children may behave as if the dead person is still alive or even include the person in their plans. They can experience extreme anguish, misery, and depression. Along with the intense sadness the child might have difficulties with sleep, struggle with concentration, over or under eating, and withdrawal from others. The child might feel deserted in the absence of the person who has died. Young children may regress and struggle with developmental milestones that previously mastered (wetting their beds or sucking their thumb) - expressing a need to be taken care of in a way a parent would take care of a younger child. Children can present with anger outbursts, oppositional or defiant behaviour, substance abuse, school refusal or refusing to complete schoolwork, and/or breaking rules and the law. They may be communicating their anger for the person abandoning them forever. Children can be afraid that the person who died will punish them for inappropriate behaviour or fear of the dark or to be alone. Some of their fears might be based on reality and they might be afraid they will die from similar causes. If the person died from an illness, they might believe they’re themselves seriously ill or if the person died in an accident, they might be afraid to leave the house. They may blame themselves or experience guilt for possibly instigating or not preventing the death. They might feel that if they themselves died the deceased person would return. These children might present with self-injury behaviour and/or suicidal ideations. All these reactions to loss are, to an extent, normal and expected Children can be afraid that the person who died will punish them for inappropriate behaviour or fear of the dark or to be alone.