Overview

Grief is a normal human reaction to losing a loved one and the severe agony that follows loss. Grief is not confined to the loss of a person, but it can be made worse by sad feelings after losing a loved one, particularly if the connection is strained.

The grieving process can manifest itself in several ways. The phases of grief include shock, confusion, and denial, followed by anger and guilt, the search for solace, and finally, coming to terms with the loss. Grief pain can also interfere with your physical well-being, making eating, sleeping, or even thinking complex. These are common responses to loss; the greater the loss, the stronger your grieving will be.

Grief is a typical emotion for both the deceased person and the survivors. Survivors’ grieving process might last many years, and a person may mourn for months or even years due to prolonged grief. In general, suffering lessens over time as the bereaved people adjust to living without a loved one, receiving a terminal diagnosis, or realizing that someone they care about might pass away.

It’s uncertain just how often grief is in the United States. These data, however, provide some insight into this comparable experience.

• Grief strikes older people more frequently than it does younger people or children. It is because older folks often lose their spouses, friends, siblings, and cousins.
• Each year, 2.5 million people pass away in the United States, leaving behind five mourners on average.
• By the age of 15, 1.5 million children (or 5% of children in the US) are thought to have lost one or both parents.

Consult a healthcare provider if you’re unsure how severe your grieving process is. Outside assistance might be helpful when trying to rehabilitate and adjust after a loss or receiving a terminal illness diagnosis.

Causes of Grief

One of life’s most significant problems is coping with a loved one’s death or the demise of something you love. Although a traumatic event frequently causes the most acute sort of grief, any loss can trigger complicated grief, including:

• Miscarriage
• Severe and prolonged health problems
• A serious illness of family members
• Loss of a close friend
• Death of a beloved pet
• Extended unemployment or sudden job loss
• Financial instability
• Retirement
• Foreclosure of home
• Break up from a relationship or divorce
• Failure to complete a treasured dream
• Past trauma and triggered safety issues

Even small losses in life can spark grief in the right or wrong way. You may experience grief, for instance, if you move away from home, graduate from college, or switch careers.

Types of grief

You may need grief counseling if you’re going through any of the following types of grief.

1. Normal grief

You can feel various emotions as you go through the grief process. While some may be physical or behavioral, others may be emotional or social.

2. Complicated grief

When your mourning process does not progress through all of the stages of intense grief, it is said to be complicated. It can last long and become considerably more substantial, negatively influencing your functioning capacity. Your natural response and behavior will probably last incredibly long with little to no improvement, as you may feel more depressed and anxious. A mental health expert should usually be consulted for assistance if you are experiencing complicated grief, as complicated grief will not go away independently.

3. Anticipatory grief

If you anticipate losing a close family member or friend soon, anticipatory grieving or mourning may be typical. You might start attempting to picture life without them to mentally prepare for the coming loss. It may frequently occur when a loved one suffers from a terminal illness.

If you are experiencing anticipatory grieving, you could try to imagine how you will feel after losing a friend or a loved one. You might experience acute grief, extreme fear, or intense feelings for the dying individual.

4. Delayed grief

Even if your loved one passed away long ago, delayed mourning might occur if you still have intensely intense sensations of sadness and desire. Many of the ideas, feelings, and emotions connected to the loss might get blocked by your mind as a coping mechanism until you’re ready to analyze and deal with them. Mental health experts may identify such grief as prolonged grief disorder or delayed grief.

5. Chronic grief

Chronic grief and loss ensue when extraordinarily emotional reactions to loss don’t pass. You will experience enormous distress that only worsens due to these emotions, which will linger for a very long period. You won’t be able to make much, if any, progress toward healing from your grief.

6. Distorted grief

A particularly strong or disproportionate response to a loss is known as distorted grief. There will usually be a discernible change in conduct, and self-destructive behavior is also expected. One of the most typical emotional signs of misdirected mourning is anger and lashing out at oneself and others.

7. Exaggerated grief

Exaggerated grief involves more powerful emotional responses than are generally seen with other types of loss. Your feelings and behaviors could stand out more and be more disruptive when exaggerated. Self-destructive behavior, aberrant fears, self-harm or suicide ideas, drug or alcohol misuse, and nightmares are some possible symptoms you may identify in your daily life in normal circumstances. Additionally, heightened grieving may occasionally lead to the emergence of psychiatric disease.

8. Cumulative grief

When you suffer a second loss soon after or while you’re still mourning a previous loss, it’s called cumulative grief. This type of grief, also known as grief overflow or bereavement overload, can be one of the more challenging types to overcome. However, with proper counseling and guidance, you can go through any grieving process, including cumulative.

9. Masked grief

Masked grief can manifest as bodily signs or actions that interfere with or obstruct daily functioning. Most of the time, you won’t be able to identify these things as the effect of a loss or even see how they’re connected.

10. Secondary loss grief

Secondary loss grief may develop when a loss impacts other aspects of your life. The end outcome can be that you suffer several losses related to the initial loss you endured.

11. Traumatic grief

When additional trauma is brought on by a horrible, unanticipated loss or violent death, traumatized grief is frequently the result of the attempt to process grief. Your ability to operate your daily life routine may be impacted.

12. Disenfranchised grief (Ambiguous)

Grief can become disenfranchised when you believe others have not acknowledged your loss. This may occur if a culture, community, or specific group of people fails to recognize your loss. Disenfranchised grief may arise if a loss isn’t accepted or you don’t feel heard or seen in how you’re experiencing and grieving.

It’s essential to remember that disenfranchised grief can also happen when a loss isn’t caused by death. Instead, it results from a traumatic brain injury, substance misuse, or a mental health condition fundamentally changing a relationship.

13. Inhibited grief

You may experience such grief if you aren’t displaying any overt or evident signs of it. This frequently goes on for a long time, making it difficult to progress through the stages of mourning. If you’re suffering suppressed grieving, you’ll probably eventually experience physical repercussions due to not dealing with your emotions.

14. Absent grief

You are not exhibiting any of the standard grief symptoms if you are absent from mourning. Maybe you’re acting like you haven’t lost anything at all. It frequently occurs when a loss is abrupt or unexpected and can be caused by extreme shock or total denial. Even though absent grieving can be expected, it must be addressed if it lasts long.

15. Abbreviated grief

Short-term replacement of the deceased by someone or something fresh in your life can cause abbreviated grieving. In general, being able to accept the initial loss rapidly may impact this. Or it might be because there wasn’t a deep bond or relationship with the lost person.

16. Collective grief

Collective grief occurs when a disaster impacts a whole community or large group. It frequently occurs after significant natural disasters that might have long-lasting effects and during the conflict. Other instances of communal grieving include the aftermath of a terrorist attack, the death of a well-known public figure, a mass casualty, or a major catastrophe.

Stages of grief

The several stages of grief are expected, and experts encourage grieving persons to accept that they have no control over the process. Talking to people and attempting to settle problems that cause intense emotional anguish, including experiencing guilt for a loved one’s passing, can help alleviate suffering.

The stages of the grieving process are described slightly differently in various research; however, the following five stages are the most prevalent:

1. Denial – Emotions like astonishment, disbelief, panic, or uncertainty are frequent in this situation. Thoughts might be expressed – “How is this possible?” and “That can’t be true.”
2. Anger – It is a prevalent emotion, as are the thoughts and actions of “Why me?” “This isn’t fair,” and “I don’t deserve this.”
3. Depression – It is characterized by feelings like “everything is a battle,” “what’s the point?” and “everything is a fight,” as well as a sense of exhaustion, helplessness, and perspective loss.
4. Bargaining – Guilty thoughts frequently come with expressions like, “If only I had done more,” “If only I had been…”
5. Acceptance – This means realizing the significance of the loss and the new circumstances and being ready to move forward in a new direction. It does not imply that one enjoys the situation or is just or fair.

Some people experience some stages of grief while others do not, and these stages do not necessarily present in the same order for everyone. Progressing through other stages first, or vice versa, can be possible. It may also happen that some patients may go through grieving entirely outside of the cycle.

Symptoms of grief

• Trauma and denial – It might be challenging to accept a loss immediately after a loss. You may feel numb, have a tough time believing the loss has happened, or ultimately deny that the unfavorable event has ever happened.
• Sadness – Feeling immensely sad is possibly the most universally experienced symptom of grief following a loss. You may encounter many emotions like despair, emptiness, loneliness, or yearning. Moreover, you may find yourself crying uncontrollably or becoming emotionally vulnerable.
• Guilt – After a loss, you may blame yourself for it or regret taking certain actions and the ones you didn’t. Besides, you may feel guilty for sighing relief after someone has died due to a long and fatal disease. As a result, you call yourself negligent or feel bad for not doing enough to prevent the death from happening, even though there was hardly anything you could do to salvage the situation.
• Anger – You may feel angry and bear deep resentment for the loss, even if it was nobody’s fault. If you lose someone very close, you could be angry with God, the doctors, or even the one who died for forsaking you. You’d seek a person or thing to vent out your anger for the injustice meted out to you.
• Fear – A major loss can invite a range of worries, fears, and insecurities. This could further lead to anxiousness, helplessness, or insecurity. Additionally, you could experience panic attacks. With the loss of a loved one, you could contemplate your impending mortality, or fear facing the world alone, or even shrug off taking up the responsibilities you till now shared with the deceased person.
• Physical symptoms – Grief is usually considered to pass following a strictly emotional process triggered by the loss of someone or something exceptional. However, grief also brings in a lot of other physical maladies like nausea, fatigue, reduced immunity, sudden weight loss or gain, insomnia, and pain.

Effects of grief

Patients with grief can experience severe physical, mental, emotional, and social effects:

Physical effects of grief

• Tearfulness
• Nausea
• Less energy
• Weakness
• Restlessness
• Heart palpitations
• Chest pain and tightness

Mental effects of grief

• Hallucination about the dead person
• Absent-mindedness
• Forgetfulness
• Confusion

Emotional effects of grief

• Shock
• Denial
• Irritability
• Anger
• Numbness
• Loneliness

Social effects of grief

• Relationship issues
• Avoiding family, colleagues, and friends
• Increased substance abuse
• Increased dependency on others
• Neglecting yourself but caring for others

Diagnosis

Each person’s experience with grieving is unique, and it can be challenging to tell when normal grief turns into complicated grief. How long before severe grieving can be diagnosed is a topic on which mental health experts are still divided.

When the depth of your grieving hasn’t subsided in the months following the death of a loved one, you may be experiencing complicated grief. Some mental health practitioners identify grief as complicated grief when it is intense, persistent, and incapacitating after a year.

Complicated grief and major depression share many characteristics, but they can differ significantly. Clinical depression and complicated grief can occasionally coexist. A thorough physical and psychological examination is frequently performed since determining the proper diagnosis is crucial for receiving the right treatment.

Diagnosis of prolonged grief disorder

Distress over separation is the main symptom of prolonged grief disorder. This shows up as an excessive concern with the deceased or the circumstances surrounding their death and a deep yearning for the dead person. In a nutshell, chronic sorrow is a type of prolonged grief disorder. The state is frequently described as “being stuck” in grief.

According to estimates, 7%–10% of people who lose a loved one experience extended mourning disorder; nevertheless, this condition is much greater in parents who have lost children and in people who have experienced unexpected, violent deaths. While between 30 and 50 % of people with prolonged grief disorder will solely show signs of that disease, it has a significant comorbidity rate with other mental disorders.

7% to 10% of bereaved adults will continue to experience the symptoms of extended grief disorder (Szuhany et al., 2021). After losing a loved one, 5% and 10% of kids and adolescents will have depression, posttraumatic stress disorder (PTSD), and/or prolonged grief disorder (Melhem et al., 2013).

In DSM 5 and ICD11, the latest versions of official diagnostic standards, “Prolonged Grief Disorder,” has been accepted as a diagnosis. This is the condition we’ve been referring to as complicated grief.

ICD11

The World Health Organization certified Prolonged Grief Disorder as a new diagnosis in 2018. A “persistent and pervasive grief response” that is “characterized by longing for the deceased or persistent preoccupation with the deceased accompanied by intense emotional pain (e.g. sadness, guilt, anger, denial, blame, difficulty accepting the death, feeling one has lost a part of one’s self, an inability to experience positive mood, emotional numbness, difficulty engaging in social or other activities)” is one of the criteria for this diagnosis. You may read the complete guideline here.

DSM-5

The American Psychiatric Association accepted Prolonged Grief Disorder (PGD) as a new diagnosis in 2020. The diagnostic criteria for this disease are more precise, but research shows they are consistent. DSM-5 PGD requires the occurrence of a persistent and pervasive grief response characterized by constant yearning and/or preoccupation with the deceased and at least three of eight additional symptoms, including disbelief, intense longing for support, emotional pain, identity confusion, avoiding reminders of the loss, feelings of numbness, extreme loneliness, meaninglessness, or difficulty engaging in daily life.

Clinicians will now be authorized to charge insurance companies for treating individuals diagnosed with Prolonged Grief Disorder due to the condition’s inclusion in the DSM-5.

For an adult to be diagnosed with extended grief disorder, a loved one’s death had to have happened at least a year prior, and for kids and adolescents, it had to have occurred at least six months earlier. Additionally, the mourning person had to have experienced at least three symptoms listed below almost daily for at least the previous month before the diagnosis.

Symptoms of prolonged grief disorder (APA, 2022) include:

• An intense sensation of disbelief about someone’s death.
• Avoiding any references to the deceased’s passing.
• Intense emotional suffering due to death, getting angry, feeling bitterness and sadness.
• Facing issues in reintegration (for example – problems making friends, following interests, or making future plans).
• Emotional numbness (lack of emotional feeling).
• Believing that life has no purpose anymore.
• Extreme loneliness (a sense of being cut off from people).
• Disruption of identity (for example – a sharp sensation that a part of you is dead).

Additionally, the grief experience lasts longer than expected, considering social, cultural, or religious conventions.

Differential diagnosis

Most frequently, PGD is mistaken for depression. Depression has symptoms such as “free-floating,” sadness, and a loss of interest/pleasure. In comparison, signs of PGD show persistent desire and concern for the deceased person. This distinction is significant since there is strong evidence that with professional help, specific grief treatment is considerably more effective than treatment for depression. So, a proper diagnosis is necessary for differentiating between grief and depression.

Treatment

Various coping options are offered through grief therapy techniques. Any individual’s optimal course of treatment will depend on multiple factors, including whether or not they are experiencing prolonged grieving.

Sometimes, using multiple grief treatment techniques and approaches will yield better results. Your specific symptoms and situation are considered by your doctor or mental health expert when selecting which therapy is most likely to be effective for you.

Grief therapy & techniques

1. Cognitive behavioral therapy (CBT)

To change your negative thought patterns, cognitive behavioral therapy teaches you how to recognize them. This therapy is founded on the core idea that you may reduce symptoms and lead a daily better, more productive life by learning to manage your negative thoughts and behaviors. Numerous studies have shown that CBT is one therapy that significantly improves the quality of life. It’s just as beneficial as some other forms of therapy, if not more so.

CBT for grief works by assisting you in being aware of your negative thought patterns. These tendencies may result in actions that make it challenging to deal with sadness. During CBT sessions, a therapist may ask about your thoughts or feelings regarding your sorrow. You can better understand how these negative thought patterns influence your behavior by gradually recognizing them.

CBT grief therapy tools may include:

• Cognitive Reframing or Restructuring – You can become aware of harmful thought patterns or distortions by using cognitive reframing or restructuring. You must work through sessions to identify your negative thought patterns to start changing them.
• Focusing on behaviors – It includes addressing undesirable or unhelpful habits or behaviors and substituting constructive ones.
• Constructing a new narrative – This technique helps build a fresh narrative of your loss. Instead of letting bad feelings and thoughts linger, it eases them.

2. Acceptance and commitment therapy (ACT)

Acceptance and Commitment Therapy teaches you to accept unpleasant feelings and circumstances to establish healthy practices later. It focuses on your capacity to increase psychological flexibility to embrace your sensations rather than attempting to deny them, feel wrong about them, or altogether avoid them.

Severe grief tends to push negative emotions toward your mind and impacts your normal response to other emotions. By practicing mindfulness, you can utilize acceptance and commitment therapy (ACT) to process your grief and accept the loss. This kind of treatment can be helpful for complicated or prolonged grief that persists for a year or longer following a loss. ACT aids in the emotional reprocessing of a loss. It also enables you to start processing whatever feelings you might have been putting off.

ACT employs several grief treatment methods to attain acceptance and healing. These may consist of the following:

• Accepting negative emotions and feelings
• Avoiding unpleasant thoughts and feelings to comprehend them better
• Keeping the present in mind
• Identifying your values
• Observing how you behave in various situations and conditions
• Overcoming obstacles by utilizing these techniques

3. Complicated grief therapy (CGT)

CGT entails gaining knowledge of how to handle complicated grief symptoms. This type of grief can bring on feelings of hopelessness and protracted, severe sadness. Complicated grieving can cause a person to become fixated on the deceased or the passing circumstances. Acceptance and commitment therapy is an essential parts of CGT.

However, it is tailored specifically for complicated grief. Psychotherapy techniques used for depression and PTSD are similar to this therapy. Both an individual and a group therapy session for this disorder may be effective.

While in therapy, you might:

• Find out what complicated grieving is and how it’s handled.
• Examine issues including complicated grieving symptoms, coping with loss, and rethinking your life goals.
• To lessen your grief, have imaginary talks with the person and recount the events of their demise.
• Examine and reframe your ideas and feelings.
• Develop coping skills.
• Reduce your sense of guilt and blame.

4. Traumatic grief therapy

You can process a sudden trauma-related loss, such as an unexpected demise of a loved one, through trauma grieving therapy. This type of therapy examines the grieving process following a tragic (often unanticipated) loss.

5. Group therapy

Small support groups or religious organizations organize group therapy for grief to discuss their experiences and thoughts with others who are also mourning. People in such groups are frequently recovering from comparable situations. You can share and heal by joining support groups in a private, encouraging, and caring setting.

6. Play therapy

Grieving children might use play therapy to process their feelings by engaging in imaginative or other sorts of play. It gives kids a safe space to vent their emotions when they feel overwhelmed and provides them with emotional self-regulation resources. Children respond naturally to play therapy because they usually feel uncomfortable expressing their feelings, emotions, and concerns, especially after a significant loss. Giving them a means of expression through professional support can be helpful in their grieving process.

7. Art therapy

You can utilize art therapy to process your grief and encourage recovery. It can aid in, enhance, and reinstate functioning and a feeling of well-being. The concept underlying art therapy is the notion that our ability to express ourselves creatively and artistically fully can be therapeutic. During art therapy sessions, people paint, sketch, color, create collages, and even sculpt.

Medications

Little conclusive evidence supports using psychiatric drugs to manage complicated grief apart from grief counseling. Antidepressants, however, could be beneficial for those going through a grieving process and clinical depression.

The antidepressants, anxiety medicines, and sleep supplements of today are better than ever. When given by a psychiatrist in the proper dosages, they can be helpful for numbing the pain. Many patients with anticipatory or acute grief have found that medication can reduce their discomfort. They can better communicate and evaluate their emotions and progress toward moving past their loss.

Making the distinction between depression and grieving is essential when providing medicine. Many mourning symptoms can also be depressive symptoms. Checking to see if there has been any recent loss is one method to tell if someone is grieving or depressed.

Antidepressants aren’t recommended for treating normal grief. But sometimes medications might prove beneficial and provide relief from the symptoms of grief, even though they cannot rectify the cause, that is, the loss itself.

Coping and support

These strategies will help people cope with grief and loss:

• Contact a psychiatrist or therapist – You can seek help from a mental health professional with training in grief therapy and clinical psychology if your grief is too great to handle on your own in the early stages. Consider examination and therapy options with your psychiatrist if you cannot function and feel immobilized due to grief.
• Follow your treatment plan – Show up for therapy appointments on time, and use the skills you’ve acquired in therapy. Take drugs as prescribed, if necessary.
• Practice stress management – Learn how to manage stress better by practicing it. Depression, binge eating, and other unhealthy thoughts and behaviors can result from unmanaged stress.
• Take good care of yourself – Get enough sleep, eat a balanced diet, and relax as much as possible. Try to breathe freely whenever you feel stressed. Stress, depression, and anxiety can all be reduced by physical activity. Talk to an expert, but don’t seek solace in alcohol or recreational drugs.
• Seek emotional support — Even if you pride yourself on being tough and independent, you must rely on those who can care for you during this difficult time.
• Socialize with people – Engage in as much social interaction as possible by maintaining contact with those you find enjoyable. They can provide comfort, a shoulder to cry on, or shared laughter to lift your spirits.
• Plan for important dates or anniversaries – It is because holidays, special occasions, and anniversaries might bring up difficult memories of your loved one. Find fresh experiences to remember, celebrate, or honor the loved one that gives you solace and inspiration.
• Learn new skills – If, for instance, you heavily rely on a loved one to handle the cooking or the money, consider learning how to do these things on your own. As needed, seek advice from family, friends, or experts. Find community resources and classes as well.
• Work with a support group — Even when surrounded by family members and friends, grieving can make you feel incredibly alone. Sharing your grief with people who have suffered losses can be therapeutic. Talk about your emotions with others and see how others overcame similar unpleasant experiences. You can search for a grieving support group in your area or contact nearby hospitals, cemeteries, and counseling services.
• Follow God’s lead — If you practice a religion, participate in the grief-associated customs. Attending church, praying, or engaging in other spiritual practices can be calming. If you adhere to religious traditions or practices, rituals or spiritual leader guidance may bring you solace.

Help yourself and others

• Despite your best efforts, you won’t be able to hold back your grief for very long. You must therefore accept the suffering if you want the healing process to begin. Stressing your feelings of sadness and loss will only make the recovery process take longer. Other linked concerns, such as depression, anxiety, substance addiction, and health issues, may result from suppressed and unresolved grief.
• No one, including yourself, should be able to tell you how to feel. Nobody else has the right to judge whether it’s time for you to “move on” or “get over it” since your pain is your own. Allow yourself to experience whatever you feel without shame or criticism. It’s acceptable to be enraged, to curse the sky, to cry, or not to cry. It’s also OK to find moments of happiness, laugh, and let go when the time is right.
• The body and mind are intertwined. You’ll handle difficult emotional situations more easily when you’re physically fit. You can fight stress and weariness by getting adequate sleep, eating well, and exercising. Do not artificially uplift your mood or dull the pain of grief with booze or drugs.
• Put your sentiments into words or something creative. Even if you cannot discuss your grief with others, writing down your thoughts and emotions in a notebook, for instance, might be helpful. You might also create a scrapbook or donate your time to a cause of your loss to express your feelings.
• Try to keep up your interests and hobbies. Routine provides solace, and returning to the pursuits that make you happy and knit you to others might help you accept your loss and hasten the mourning process.
• Allow others to communicate, encourage them to express their sorrow, and share their recollections of the deceased.
• Don’t give phony solace. Saying, “It was for the best,” or “you’ll get over it in time,” doesn’t help the mourning individual. Instead, simply express your sorrow while taking the time to listen.
• Help out in a practical way. A person going through a grieving process can benefit from help with babysitting, cooking, and errands.
• Be tolerant. Remember that recovering after a significant loss might take time. Make yourself accessible to speak with.
• Encourage seeking expert assistance when necessary. Never be afraid to suggest professional assistance when you believe someone is in too much pain to handle alone.

Grief FAQs