Grief, Bereavement, and Coping with Loss: Types of Grief Reactions

Anticipatory Grief

Anticipatory grief may occur when a death is expected.

Anticipatory grief occurs when a death is expected, but can occur before it happens. It may be felt by the families of people who are dying and by the person dying. Anticipatory grief helps family members get emotionally ready for the loss. It can be a time to take care of unfinished business with the dying person, such as saying "I love you" or "I forgive you."

Like grief that occurs after the death of a loved one, anticipatory grief involves mental, emotional, cultural, and social responses. However, anticipatory grief is different from grief that occurs after the death. Symptoms of anticipatory grief include the following:

• Depression
• Feeling a greater than usual concern for the dying person
• Imagining what the loved one's death will be like
• Getting ready emotionally for what will happen after the death

Anticipatory grief may help the family, but not the dying person.

Anticipatory grief helps family members cope with what is to come. For the patient who is dying, anticipatory grief may be too much to handle and may cause him or her to withdraw from others.

Anticipatory grief does not always occur.

Some researchers report that anticipatory grief is rare. Studies showed that periods of acceptance and recovery usually seen during grief are not common before the patient's actual death. The bereaved may feel that trying to accept the loss of a loved one before death occurs may make it seem that the dying patient has been abandoned. Also, grief felt before the death will not decrease the grief felt afterwards or make it last a shorter time.

Normal Grief

Normal or common grief begins soon after a loss, and symptoms go away over time.

During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do. Common grief reactions include

• Emotional numbness, shock, disbelief, or denial (These often occur right after the death, especially if the death was not expected.)
• Anxiety over being separated from the loved one (The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Images of death may occur often in the person's everyday thoughts.)
• Distress that leads to crying, sighing, having dreams, illusions, and hallucinations of the deceased, and looking for places or things that were shared with the deceased
• Anger
• Periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life (The bereaved's day-to-day life may be affected.)

In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery does not happen in a set period of time. For most bereaved people having normal grief, symptoms lessen between six months and two years after the loss.

Many bereaved people will have grief bursts or pangs.

Grief bursts or pangs are short periods (20 to 30 minutes) of very intense distress. Sometimes these bursts are caused by reminders of the deceased person. At other times they seem to happen for no reason.

Grief is sometimes described as a process that has stages.

There are several theories about how the normal grief process works. Experts have described different types and numbers of stages that people go through as they cope with loss. At this time, there is not enough information to prove that one of these theories is more correct than the others.

Although many bereaved people have similar responses as they cope with their losses, there is no typical grief response. The grief process is personal.

Complicated Grief

There is no right or wrong way to grieve, but studies have shown that there are patterns of grief that are different from the most common. This has been called complicated grief. Complicated grief reactions that have been seen in studies include the following:

• Minimal grief reaction is a grief pattern in which the person has no, or only a few, signs of distress or problems that occur with other types of grief.
• Chronic grief is a grief pattern in which the symptoms of common grief last for a much longer time than usual. These symptoms are a lot like ones that occur with major depression, anxiety, or post-traumatic stress.

Factors that Affect Complicated Grief

Researchers study grief reactions to try to find out what might increase the chance that complicated grief will occur. Studies have looked at how the following factors affect the grief response.

Whether the Death Is Expected or Unexpected

It may seem that any sudden, unexpected loss might lead to more difficult grief. However, studies have found that bereaved people with high self-esteem and/or a feeling that they have control over life are likely to have a normal grief reaction even after an unexpected loss. Bereaved people with low self-esteem and/or a sense that life cannot be controlled are more likely to have complicated grief after an unexpected loss. This includes more depression and physical problems.

The Personality of the Bereaved

Studies have found that people with certain personality traits are more likely to have long-lasting depression after a loss. These include people who are very dependent on the loved one (such as a spouse), and people who deal with distress by thinking about it all the time.

The Religious Beliefs of the Bereaved

Some studies have shown that religion helps people cope better with grief. Other studies have shown it does not help or causes more distress. Religion seems to help people who go to their place of worship often. The positive effect on grief may be because they have more social support from their faith community.

Whether the Bereaved Is Male or Female

In general, men have more problems than women do after a spouse's death. Men tend to have worse depression and more health problems than women do after the loss. Some researchers think this may be because men have less social support after a loss.

The Age of the Bereaved

In general, younger bereaved people have more problems after a loss than older bereaved people do. They have more severe health problems, grief symptoms, and other mental and physical symptoms. Younger bereaved people, however, may recover more quickly than older bereaved people do, because they have more resources and social support.

The Amount of Social Support the Bereaved has

Lack of social support increases the chance of having problems coping with a loss. Social support includes the person's family, friends, neighbors, and community members who can give psychological, physical, and financial help. After the death of a close family member, many people have a number of related losses. The death of a spouse, for example, may cause a loss of income and changes in lifestyle and day-to-day living. These are all related to social support.

Link opens in a new windowGrief, Bereavement, and Coping with Loss (PDQ®)—Patient Version was originally published by the National Cancer Institute.