The Interplay between Posttraumatic Stress and Grief Reactions in Traumatically Bereaved Adolescents: When Trauma, Bereavement, and Adolescence Converge

Background and Scope of the Problem. High prevalence rates of deaths by accidents, suicides, and homicides, coupled with expanding social networks, place adolescents at significant risk for traumatic bereavement occasioned by the traumatic deaths of their friends, romantic partners, and family members. Conceptual Analysis. This conceptual paper focuses on the interplay between posttraumatic stress symptoms and grief reactions that can arise following traumatic bereavement in adolescence. We begin with a review of “building block” key concepts needed to construct a scientifically sound and clinically useful theory of traumatic bereavement in adolescence. We briefly review earlier conceptual contributions and discuss the utility of unpacking and distinguishing between trauma exposure and bereavement as theorized causal risk factors, and posttraumatic stress reactions and grief reactions as their respective primary causal consequences. Multidimensional Grief Theory. We introduce multidimensional grief theory as a useful framework for conceptualizing a broad range of grief reactions, both adaptive and maladaptive, in traumatically bereaved adolescents. We use the theory to explore the interplay between posttraumatic stress and grief reactions, including ways in which each set of reactions may exacerbate the other and contribute to adverse outcomes. Implications for Evidence-based Assessment. We conclude with recommendations for trauma- and bereavement-informed risk screening, clinical assessment, and case formulation of potential consequences of traumatic bereavement in adolescence across multiple psychosocial domains. These domains include posttraumatic stress and grief reactions, school functioning, suicide ideation and behavior, risk-taking behavior, and developmental progression.