Decreasing the Risk of Complicated Bereavement and Future Psychiatric Disorders in Children

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2005 by Kirwin, Kathleen M, Hamrin, Vanya

Conceptual Framework

The trauma of loss has a direct effect on children who are trying to cope with the death of a parent. The theories regarding the trauma of loss are becoming more developed (Black, 1998; Bowlby, 1980; Geis et al., 1998; Worden, 1991). Researchers and clinicians have utilized several theoretical concepts to provide meaning to the grief process.

In 1961, Bowlby developed phases of grief from his attachment theory. His theory helps others understand that there are reasons for the ways humans react to grief. During the development of healthy humans, instinctive attachments are developed, first between the child and parent, then between adults. The goals of attachment behaviors are to maintain a homeostatic relationship with loved ones (Rando, 1984, p. 21).

Black (1998) relates that infants come into the world with complex behavioral systems already in place. One system involves the infant engagement of the caretaker in a mutual bonding by using instinctively the behaviors of smiling, cooing, and crying. This system is an important source of security throughout a person's life. Another system involves the development of mutual bonding behavior that ensures that the child does not stray from a caretaker. Later in toddlerhood, this typically leads the child to go exploring only to return and check on the caretaker's presence.

When faced with the separation and loss of an attachment figure, infants and toddlers will protest loudly. If the attachment figure or caregiver does not return as a result of death, illness, or divorce, then the child is likely to show a great amount of despair and detachment. The young child may display grief reaction by developing feeding problems, bed-wetting, constipation, and sleeping problems (Black, 1998).

Worden (1991) states that Bowlby's attachment theory gives us a way of conceptualizing the tendency in human beings to make strong, affectionate bonds with others, and to understand those bonds. It is also a way for us to understand the strong emotional reaction that occurs when those bonds are threatened or broken. Worden (1991) utilizes the ethologic theory to further state that animals, as well as humans utilize attachment as a way to survive. Geis et al. (1998) point out that if the attachment to a loved one is lost through death, then grief follows in response to the separation. Separation anxiety can be observed in both humans and animals. Worden (1991) cited a study carried out by Lorenz where he describes grief-like and separation anxiety-like behavior in the separation of a greylag goose from his mate.

The behavioral theory (Stroebe & Stroebe, 1987 as cited in Geis et al., 1998, p. 74) is based on the idea that behaviors elicit reinforcement from others. When someone we love dies, certain behaviors no longer produce the same rewards. In addition, there is an increase in the number of aversive events associated with the loss. This produces sadness and other unpleasant feelings. This change in reinforcement and the increase in aversive events produce the symptoms of grief.