Understanding Grief and Loss

What is Grief?

Grief can be a difficult concept to explain, and as such, it has been defined many different ways with some definitions short and simple and others long and complex.¹ While multiple definitions of grief exist, many share the key component that grief is an emotional response to a significant loss in one's life. For example, it has been defined as a mental, emotional, and behavioral response to loss¹ and a psychological and social response to a loss.² While grief in response to loss can be tied to the death of a loved one, it can also be a reaction to any meaningful loss.³ That could be the loss of a job or a relationship, for example, through a divorce or a falling out with a close friend, or the loss of independence or identity when you are forced to take on new responsibilities that you haven't had to before.

Grief can look many different ways and there are also different types of grief.

• Common Grief is what is commonly thought of when someone refers to grief or the grieving process. It consists of different emotional responses after a loss including emotional distress, shock, numbness, and denial.⁴
• Anticipatory Grief elicits a similar emotional response to common grief but occurs in anticipation of a loss (e.g. when a loved one is dying or very ill).⁴
• Complex Grief differs from common grief in that is a reaction to a loss that is deemed somewhat atypical. It could be not displaying any negative emotions to the loss, experiencing negative emotions long after the loss, or experiencing extreme symptoms.⁴
• Prolonged Grief occurs when the emotional response to a loss persists for longer than 12 months and is usually accompanied by a consistent, intensive, emotional response.⁴
• Ambiguous Grief relates to the feelings experienced when a loss is not as clearly defined as death. Ambiguous loss is separated into two categories: 1) when a person is physically absent but psychologically present (e.g. a parent who no longer lives at home, a deployed family member) and 2) when a person is physically present but psychologically absent (e.g. a family member with deteriorating mental capacities, a parent struggling with substance use).⁵

Common Feelings associated with Grief and Loss

Grief is not a single emotion, but is instead a mixture of thoughts, feelings, and behaviors. You may have heard of the five stages of grief which outlines the different common reactions associated with grief: denial, anger, bargaining, depression, and acceptance.⁶⁴ While moving through these stages is not uncommon, it is important to remember that many people will not experience all of these stages and certainly not always in this order.⁷ Instead, it can be helpful to recognize that the grieving experience is different for different people. The experience of grief is also very different depending on the developmental stage of the individual. For example, children often experience similar emotions to adults, but the feelings can manifest in different ways (e.g., extreme mood swings).⁸ Grief often leads to physical, emotional, behavioral, and cognitive responses. While this is certainly not an exhaustive list, here are examples of common responses when experiencing grief.

• Physical Responses: decreases in energy, changes in sleep patterns, sore or tight muscles, loss of appetite, nausea, and headaches.
• Emotional Responses: sadness, anger, shock, helplessness, guilt, loneliness, and relief.
• Behavioral Responses: withdrawing from social events, changes in activity level, avoidance of certain places, and seeking out reminders of the loss.
• Cognitive Responses: confusion, disbelief, trouble shifting attention, and difficulty concentrating.⁹

Managing Grief and Loss in a Healthy Way

Sadly, grief is an unavoidable, inevitable part of life that is experienced by everyone.¹⁰ Think of your own life, as well as the lives of your family members and closest friends. It is extremely likely that you, and the people you care most about, have experienced a deep loss and spent time grieving that loss. Experiencing grief and loss is associated with increased risk for deteriorating mental and physical health, and as such, is important that it is managed in healthy ways. While people deal with grief in different ways, one thing is clear. Grief demands to be felt. Attempting to avoid feelings of grief, bottling up your emotions, or simply trying to forget the cause of your grief is not an effective way of coping and can instead lead to prolonged and intense grief. Here are some healthy ways to grieve that will allow you to process your emotions effectively.

• Take care of yourself. Try to get enough exercise and sleep and eat healthily. Your wellbeing matters!¹¹
• Find support. It is important that you are able to talk about your feelings and what you are going through. This can be with a significant other, close friend, or through a support group.¹¹
• Seek out help when needed. If you find your grief to be very difficult to bear or that you aren't receiving the support you need, it can be beneficial to work through your feelings with a professional. This could be your personal doctor or a licensed therapist.¹¹

While there isn’t a "right" or "wrong" way to grieve, it is important that you prioritize your health and well-being. You may feel alone with your loss but remember that everyone grieves, and you do not need to go through it alone. Reach out for support, especially when you feel yourself struggling. Remember also that grieving takes time and can be an extremely difficult process. Trying to rush through your grief, may actually have the opposite effect, and lead to prolonged, intense grief. Finally, it can be helpful to acknowledge your feelings. Grieving typically comes from a place of love. Being able to recognize this and talk openly about how your feeling, is an extremely important part of the grieving process.¹¹

References

1. Wolfelt, A. D. (2003). The journey through grief: Reflections on healing. Companion Press.
2. Rando, T. A. (2018). Grief and mourning: Accommodating to loss. In Dying (pp. 211-241). Taylor & Francis.
3. Papa, A., & Lancaster, N. (2016). Identity continuity and loss after death, divorce, and job loss. Self and Identity, 15(1), 47-61.
4. PDQ Supportive and Palliative Care Editorial Board. (2024). Grief, Bereavement, and Coping with Loss (PDQ®): Health Professional Version. In: PDQ Cancer Information Summaries. Bethesda, MD. 
5. Betz, G., & Thorngren, J. M. (2006). Ambiguous loss and the family grieving process. The Family Journal, 14(4), 359-365.
6. Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. Simon and Schuster.
7. Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. OMEGA-Journal of Death and Dying, 74(4), 455-473.
8. Revet, A., Bui, E., Benvegnu, G., Suc, A., Mesquida, L., & Raynaud, J. P. (2020). Bereavement and reactions of grief among children and adolescents: Present data and perspectives. L'encephale, 46(5), 356-363.
9. Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., ... & Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM‐5. Depression and Anxiety, 28(2), 103-117.
10. Jacobsen, M., & Petersen, A. (2020). Exploring Grief. Taylor and Francis.
11. NIH News in Health. (2017). Coping with grief: Life after loss.