Teenagers are able to understand the abstract, and recognize that death is final and personal. Dealing with death can be difficult for adolescents and have an impact on all aspects of their daily lives. Their mood and overall coping can be profoundly affected. This can include alterations in their sleep pattern, how they interact with people around them and also their ability to concentrate at school. The teenage years are a time of self-exploration. Adolescents want to gain independence, but at the same time they may envy younger children who have no hesitation in seeking out physical affection and freely talking about their feelings. These experiences can bring out new emotions, which adolescents may struggle to understand and attempt to control.

It is also important to keep in mind that grief can be emotionally and physically overwhelming, and that individuals react in very different ways. Typical grief behaviors or feelings experienced by teens include:

• emotional numbing
• guilt
• anger
• inability to concentrate
• overwhelming sadness/anxiety
• depression
• being disruptive in school
• dwelling on the person that has died
• eating/sleeping disturbances
• at times appearing unaffected by the death
• increased risk taking behaviors
  

Every teenager will process a death in their own way and there is no rushing it along. By the age of 13 and older, peers have become an important part of life. Therefore, finding positive support from their friends is crucial and should be encouraged. Because of this connection with peers, support groups can be a great place for adolescents to meet others who are grieving. They realize they are not alone in their grieving and can find support in others who are experiencing similar circumstances. At the same time, teens may not want to stand out as being different from their peers, so they may avoid talking frankly with their friends about their feelings.

Dealing with death, especially a sudden or unexpected death, can be particularly difficult for adolescents. They are trying to make sense of a situation that they have not encountered before and cannot understand how something so devastating can happen to someone so close to them. These emotions can be a struggle, and often manifest in anger and a feeling of helplessness.

Helpful activities for grieving teens may include keeping a journal or having an opportunity to remember their friend who has died. This may include putting a memory book together, providing written memories to the deceased teens parents, or initiating the placement of a tree on the school grounds in memory of his friend. Being involved in something that will commemorate his friend may be an avenue to express emotions.

Although typical grief behaviors are highlighted above, there are signs that grief might be more complicated and require some intervention or assistance from professionals. These behaviors include the following:

• Persistent anger
• Destructive or negative thoughts
• Physical assaults on others
• Cruelty to animals
• Extreme or disturbing changes in behavior
• Unhealthy or extreme risk taking behavior
• Thoughts of suicide
• Frequent panic/anxiety attacks
• Persistent physical illness
• Denial that the death has occurred
• Physical complaints that persist
• Significant depression
  

If you require assistance in your practice to understand teen grief or a place to refer this patient, explore the resources available through the local hospice or palliative care program, adolescent mental health program, or children’s hospital. There are also resources available online.