Grief and Grieving

Topic Overview

What is grief?

Grief is your emotional reaction to a significant loss. The words sorrow and heartache are often used to describe feelings of grief. Whether you lose a beloved person, animal, place, or object, or a valued way of life (such as your job, marriage, or good health), some level of grief will naturally follow.

Anticipatory grief is grief that strikes in advance of an impending loss. You may feel anticipatory grief for a loved one who is sick and dying. Similarly, both children and adults often feel the pain of losses brought on by an upcoming move or divorce. This anticipatory grief helps us prepare for such losses.

What is grieving?

Grieving is the process of emotional and life adjustment you go through after a loss. Grieving after a loved one's death is also known as bereavement.

Grieving is a personal experience. Depending on who you are and the nature of your loss, your process of grieving will be different from another person's experience. There is no "normal and expected" period of time for grieving. Some people adjust to a new life within several weeks or months. Others take a year or more, particularly when their daily life has been radically changed or their loss was traumatic and unexpected.

What are common symptoms of grief and grieving?

A wide range of feelings and symptoms are common during grieving. While feeling shock, numbness, sadness, anger, guilt, anxiety, or fear, you may also find moments of relief, peace, or happiness. While grieving is not simply sadness, "the blues," or depression, you may become depressed or overly anxious during the grieving process.

The stress of grief and grieving can take a physical toll on your body. Sleeplessness is common, as is a weakened immune system over time. If you have a chronic illness, grieving can make your condition worse.

Although it may be possible to postpone grieving, it is not possible to avoid grieving altogether. If life circumstances make it difficult for you to stop, feel, and live through the grieving process, you can expect grief to eventually erupt sometime in the future. In the meantime, unresolved grief can affect your quality of life and relationships with others.

How is grieving treated?

Social support, good self-care, and the passage of time are usually the best medicine for grieving. But if you find that your grief is making it difficult to function for more than a week or two, contact a grief counselor or bereavement support group for help.

If you have trouble functioning for longer than a couple of weeks because of depression or anxiety, talk to your doctor. Treatment with medicines or counseling can help speed your recovery.

Frequently Asked Questions

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	Grief: Coping with grief
	Grief: Helping children with grief
	Grief: Helping older adults with grief
	Grief: Helping teens with grief

Cause

Grief and grieving are the natural response to a major loss. But any loss can cause feelings of grief, sometimes when you least expect it.

Grief is typically triggered by a sudden loss caused by a traumatic or unanticipated event. Examples of such events include:

• Death of a loved one.
• Being diagnosed with a chronic or terminal disease.
• Disability from a severe accident or illness.
• Divorce.
• Miscarriage or stillbirth.
• The birth of a child with a birth defect.
• A diagnosis of infertility.
• Learning that your child or teen has developed a behavior problem, learning disability, or substance abuse disorder.
• A move from a familiar home. This is especially hard for older adults.
• Job loss.
• Loss of independence after a serious accident or illness.
• An act of violence or a natural disaster.

Grief can be also triggered by a loss related to a normal, seemingly positive life change. Examples of such life events include:

• Starting school (loss of the comfort of home and familiar surroundings).
• Gaining increasing independence and self-responsibility in the late childhood and teen years (loss of dependence on parents).
• Marriage (loss of independent decision making).
• Birth of a child (loss of independence).
• Retirement (loss of income, work-related identity, and daily social contact).
• Aging and maturing (loss of physical strength and youthful appearance).

You may find that old feelings of grief from past loss can be triggered by current experiences or anniversaries of that loss. This is normal.

Symptoms

Your experience of grief is likely to be different from another person's. Similarly, you will probably grieve somewhat differently each time you experience a significant loss. Your reaction to loss is influenced by the relationship you had with the lost person, object, or situation, and your general coping style, personality, and life experiences. How you express grief is influenced in part by the cultural, religious, and social rules of your community.

Grief is expressed physically, emotionally, socially, and spiritually.

• Physical expressions of grief often include crying and sighing, headaches, loss of appetite, difficulty sleeping, weakness, fatigue, feelings of heaviness, aches, pains, and other stress-related ailments.
• Emotional expressions of grief include feelings of sadness and yearning. But feelings of worry, anxiety, frustration, anger, or guilt are also normal.
• Social expressions of grief may include feeling detached from others, isolating yourself from social contact, and behaving in ways that are not normal for you.
• Spiritual expressions of grief may include questioning the reason for your loss, the purpose of pain and suffering, the purpose of life, and the meaning of death. After a death, your grieving process is influenced by how you view death.

Grief can cause prolonged and serious symptoms, including depression, anxiety, suicidal thoughts and actions, physical illness, post-traumatic stress disorder, and traumatic grief.

Intense grief can bring on unusual experiences. After a death, you may have vivid dreams about your loved one, develop his or her behaviors or mannerisms, or see or hear your loved one. If you feel fearful or stressed by any of these experiences, talk to your health professional and a mental health professional or clergy person experienced in grief counseling.

Age and emotional development influence the way a person grieves a death.

• Children younger than age 7 usually perceive death as separation. They may feel abandoned and scared, and fear being alone or leaving people they love. Grieving young children may not want to sleep alone at night, or they may refuse to go to day care or school. Children under age 7 usually are not able to verbally express their feelings; instead, they tend to act out their feelings through behaviors, such as refusing to obey adults, having temper tantrums, or role-playing their lives in pretend play. Children younger than age 2 may refuse to talk and be generally irritable. Children between the ages of 2 and 5 may develop eating, sleeping, or toileting and bed-wetting problems.
• Children between the ages of 7 and 12 often perceive death as a threat to their personal safety. They tend to fear that they will die as well and may try to protect themselves from death. While some grieving children want to stay close to someone they think can protect them, others withdraw. Some children try to be very brave or behave extremely well; others behave terribly. A grieving child may have problems concentrating on schoolwork, following directions, and doing daily tasks. Children in this age group need the reassurance that they aren't somehow responsible for the death they are grieving.
• Teens perceive death much like adults do. But they may express their feelings in dramatic or unexpected ways. For example, they may join a religious group that defines death in a way that calms their feelings. They may try to defy death by participating in dangerous activities, such as reckless driving, smoking cigarettes, drinking alcohol, taking illegal drugs, or having unprotected sex. Like adults, preteens and teens are capable of suicidal thoughts when grieving. Warning signs of suicide in children and teens may include preoccupation with death or suicide or giving away belongings.

What Happens

Grieving a significant loss takes time. Depending on the circumstances of your loss, grieving can take weeks to years. Ultimately, passing through the major stages of grieving helps you gradually adjust to a new chapter of your life.

Becoming aware of a loss

Full awareness of a major loss can happen suddenly or over a few days or weeks. While an expected loss (such as a death after a long illness) can take a short time to absorb, a sudden or tragic loss can take more time. Similarly, it can take time to grasp the reality of a loss that doesn't affect your daily routine, such as a death in a distant city or a diagnosis of a cancer that doesn't yet make you feel ill.

During this time, you may feel numb and seem distracted. You may search or yearn for your lost loved one, object, or way of life. Funerals and other rituals and events during this time may help you accept the reality of your loss.

Feeling and expressing grief

Your way of feeling and expressing grief is unique to you and the nature of your loss. You may find that you feel irritable and restless, are quieter than usual, or need to be distant from or close to others, or that you aren't the same person you were before the loss. Don't be surprised if you experience conflicting feelings while grieving. For example, it's normal to feel despair about a death or a job loss, yet also feel relief.

The grieving process does not happen in a step-by-step or orderly fashion. Grieving tends to be unpredictable, with sad thoughts and feelings coming and going, like a roller-coaster ride. After the early days of grieving, you may sense a lifting of numbness and sadness and experience a few days without tears. Then, for no apparent reason, the intense grief may strike again.

While grieving may make you want to isolate yourself from others and hold it all in, it's important that you find some way of expressing your grief. Use whatever mode of expression comes to mind-talking, writing, creating art or music, or being physically active are all ways of expressing grief.

Spirituality often enters into the grieving process. You may find yourself looking for or questioning the higher purpose of a loss. While you may gain comfort from your religious or spiritual beliefs, you might also be moved to doubt your beliefs in the face of traumatic or senseless loss.

Grieving problems. In this complex and busy world, it can be difficult to fully grieve a loss. It is possible to have unresolved grief or complications associated with grieving, particularly if you:

• Had several major losses in a short period of time.
• Are grieving permanent losses caused by chronic illness or disability.
• Lost someone very important in your life. You may feel that you will never get over the loss of someone special.
• Experienced the unexpected or violent death of a loved one, such as the death of a child or a death caused by an accident, a homicide, or a suicide.
• Have special life circumstances that act as obstacles to grieving, such as having to return to work too soon after a death, or needing sedative medicine to cope with overwhelming emotion.
• Have a history of depression or anxiety.

Adjusting to a loss

It can take 2 or more years to go through a grieving process. The length of time spent grieving depends on your relationship with the lost person, object, or way of life. Even after 2 years, you may reexperience feelings of grief, especially over the loss of your loved one. Be prepared for this to happen during holidays, birthdays, and other special events, which typically revive feelings of grief.

Some grief experts consider grieving to be the slow recovery from a crisis of attachment: After losing something or someone to whom you are deeply attached, your sense of self and security is disrupted. As you adjust to a major loss, your goal is therefore to develop or strengthen connections with other people, places, or activities. These new parts of your life are not meant to replace what you have lost. Instead, they serve to support you as you begin to start a new phase of your life.

Treatment Overview

Grief itself is a natural response that doesn't require medical treatment. But sometimes people need help getting through the grieving process.

Initial grief

• Medicine. During the initial days of grief, anxiety or sleeplessness can make it difficult to function. If you suffer more than a few days of severe agitation, talk to your health professional about whether a short-term prescription sedative medicine can help you. (Health professionals disagree about the usefulness of medicines for people who are grieving; some health professionals believe that giving medicines for anxiety or sleep may interfere with the ability to grieve.)
• Counseling. If you find that obstacles to grieving are making it difficult to function after a loss, talk to a grief counselor, attend a bereavement support group, or both. Counseling and support groups can also help you work through unresolved grief from a past loss.

Chronic grief and complications

If you or someone you know exhibits suicidal behavior, call 911 or other emergency services immediately.

If you find that a major loss has caused ongoing complications, such as depression, prolonged anxiety, post-traumatic stress disorder (PTSD), or severe grief, see your health professional and a grief counselor for treatment.

If you have a chronic medical condition that has been made worse by the emotional and physical stress of grief, see your health professional immediately.

When to Call a Health Professional

If you or someone you know develops complications of grief such as disturbing or suicidal thoughts, depression, or anxiety, get help.

Call 911 or other emergency services if:

• You think you cannot stop yourself from harming or killing yourself.
• You hear voices that frighten you, especially if the voices tell you to hurt yourself or other people.
• Someone who is grieving tries to harm himself or herself or someone else.
• Someone who is grieving threatens to hurt someone else or makes threats of suicide.

Call a health professional if:

• You feel hopeless and detached for more than a couple of weeks.
• You cannot stop yourself from thinking about death or suicide.
• You have a sudden change in your behavior that concerns you, such as drinking more alcohol than you normally do.
• You have been grieving longer than you think is good for you.
• Someone you know has symptoms of depression.

Who to See

Counseling is best done by a mental health professional with experience in grief counseling, such as a:

• Clinical social worker.
• Psychologist.
• Licensed professional counselor.
• Psychiatrist, who can prescribe medicine to control symptoms. Some psychiatrists also offer counseling.

Health professionals who can help you if you are having medical or mental health problems requiring medicine include:

• General practitioners.
• Family medicine doctors.
• Internists.
• Physician assistants.
• Nurse practitioners.

Home Treatment

Coping with grief

Home treatment plays an important role in working through the grieving process. Talking about the loss, sharing cares and concerns, and getting support from others are very important components of healthy grieving.

If you are caring for a dying loved one, it is important to take good care of yourself as well. When you know that a loss is approaching, especially if you are able to participate in the care of a loved one who is dying, you may be better able to recognize and deal with your feelings of grief. It is important that you get caregiver support to help you care for your loved one as well as to help you prepare for your loss.

If you have just had a major loss in your life, it is important to:

• Get enough rest and sleep. During sleep, your mind makes sense of what is happening in your life. Not getting enough rest and sleep can lead to physical illness and exhaustion. Try activities to help you relax, such as meditation or guided imagery.
• Eat nourishing foods. Resist the urge not to eat or to eat only those foods that comfort you. If you have trouble eating alone, ask another person to join you for a snack or meal. If you do not have an appetite, eat frequent small meals and snacks. Consider taking a multivitamin daily.
• Exercise. If nothing else, take a walk. Brisk walking and other forms of exercise, such as yoga or tai chi and qi gong, can help release some of your pent-up emotions.
• Comfort yourself. Allow yourself the opportunity to be comforted by familiar surroundings and personal items that you value. Special items, such as photos or a loved one's favorite shirt, may also give you comfort. Treat yourself to something you enjoy, such as a massage.
• Maintain your normal activities. Staying involved in activities that include your support network, such as work, church, or community activities, may help you as you grieve.

To help you work through the grieving process, make sure you:

• Surround yourself with loved ones. You may feel lonely and separate from other people when you are grieving. You may think that no one else can understand the depth of your feelings. Surrounding yourself with loved ones and talking about your feelings and concerns may help you feel more connected with other people and less lonely.
• Get involved. Participate in the activities that occur as a result of the loss. These may include making funeral arrangements after the death of a loved one, making plans for seeking new work after losing a job, or participating in a good-bye party for a beloved friend who is moving.
• Avoid quick fixes. Resist the urge to drink alcohol, smoke cigarettes, or take nonprescription medicines (such as sleeping aids). When you are under emotional stress, these may only add to your unpleasant feelings and experiences and may mask your emotions and prevent you from normal, necessary grieving.
• Ask for help. During times of emotional distress it is important to allow other people to take over some of your responsibilities. Other people often feel the need to show you how much they care about you.

For more information, see:

Grief: Coping with grief.

Helping others cope with grief

There are many ways that family members and other people close to a person who is grieving can give help and support. The best way to help a grieving person often depends on how well the person was prepared for the loss, the person's perception of death, and his or her personality and coping style. The person's age and stage of emotional development are also important to consider when helping a person who is grieving.

If someone you know is grieving:

• Encourage the person to grieve at his or her own pace. The grieving process does not happen in a step-by-step or orderly fashion. There will be good days and bad days. Do not try to "fix" the person's grief. Provide support and be willing to listen.
• Be sensitive to the effect of your words.
• Recognize that this person's life has changed forever. Encourage the person to participate in activities that involve and build his or her support network.
• Respect the person's personal beliefs. Listen to his or her feelings, without making judgments. Do not try to change the person's beliefs or feelings.

Helping young children who are grieving can be challenging for adult caregivers. The best way to help a child varies according to age and emotional development. For more information, see:

Grief: Helping children with grief.

Teens may need special consideration and care when they are grieving. Many times it is difficult to know how to approach and help a teen in these circumstances. For more information, see:

Grief: Helping teens with grief.

Older adults may not express grief in the same way as other adults. Older adults are more likely to become physically ill after a major loss. They may already have a chronic physical illness or other conditions that interfere with their ability to grieve or that become worse when they are grieving. In addition, older adults may be likely to develop complications associated with grieving. Older adults may be more likely than other people to experience several losses in a short period of time. For more information, see:

Grief: Helping older adults with grief.

Other Places To Get Help

Online Resources

Organizations

Support Groups

Related Information

• Care at the End of Life
• Depression
• Depression in Children and Teens
• Family Life Cycle

References

Other Works Consulted

• Zisook S, Zisook SA (2005). Death, dying, and bereavement. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 2367-2393. Philadelphia: Lippincott Williams and Wilkins.

• Bonanno GA, Kaltman S (2001). The varieties of grief experience. Clinical Psychology Review 21(5): 705-734.

• Cordts GA, et al. (2007). Care at the end of life. In LR Barker et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 192-207. Philadelphia: Lippincott Williams and Wilkins.

• Shear K, et al. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293(21): 2601-2608.

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