Grief: Different Reactions and Timelines in the Aftermath of Loss - PTSD: National Center for PTSD
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Grief: Different Reactions and Timelines in the Aftermath of Loss

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Grief: Different Reactions and Timelines in the Aftermath of Loss

Learn about common grief reactions, the course of grief, and how to recognize prolonged or complicated grief reactions that may require mental health treatment.

Common Grief Reactions

After loss, there is no specific way of grieving that is right or wrong, and there is not a "normal" length of time to grieve. While everyone experiences grief differently, there are many common grief reactions:

  • Physiologically, grief may disrupt sleep patterns, cause changes in stress hormones and health, and lead to physical symptoms such as weakness, trouble breathing, restlessness and immune system changes.
  • Emotionally, strong feelings of sadness, loneliness, fear, anxiety or resentment and anger can occur. Some people who are in mourning may feel a sense of guilt when they start to re-engage in activities and relationships, as if they are somehow betraying the person who died.
  • Mentally, the bereaved person may have trouble accepting the loss, difficulty concentrating and making decisions, changes to their sense of identity or the belief that their future is disrupted. They may sometimes avoid thinking about the loss, while at other times they may be unable to stop thinking about it. They may find themselves making special efforts to include the person's memory in their life. They may fear forgetting the person who died, or fear losing fond memories of their time with that person.
  • Socially, the bereaved person may experience loneliness, boredom, social withdrawal, lack of confidence, emotional sensitivity (or feeling "overemotional"), self-consciousness, as well as difficulties developing new relationships.

While these reactions are common after the loss of someone close, the extent to which they occur depends upon many factors. The nature of the relationship with the deceased, the grieving person's personality style and typical coping strategies and the environment in which the person works or lives can all play a role. Some people do not appear to need to grieve as deeply as others, even for those they most love. In addition, the bereaved can sometimes feel as much relief as sorrow, especially when the person who died had been suffering or in pain.

The Course of Grief

The amount of time a person grieves will depend on many factors, including the circumstances of the death, the nature of their relationship to the deceased and their own personal needs. The popular "stage theory," in which grief passes through five stages—denial, anger, bargaining, depression, and acceptance—may be appealing in that it makes it seem that loss can be controlled. However, research suggests that grief doesn't follow a set of stages. It's a more complicated, ongoing process that comes in waves.

As time goes by, the intensity of grief may lessen, but the person may still have periods when they feel intense emotions. Over time the cycle widens, with a gradual return to a more balanced state. Intense emotions tend to come and go. A 35-year study found that for some, grief fades only gradually, after many years have passed. Reflective thoughts and memories happen less frequently over time, but they may not stop completely, and many bereaved individuals maintain the sense of having an internal ongoing relationship with the person who died.

Prolonged or Complicated Grief

Approximately 10% of the population (or 1 out of every 10 people) experiences a prolonged, impairing reaction when they are grieving. This is called prolonged or complicated grief. This type of grief reaction is sometimes a combination of posttraumatic stress reactions and separation distress. It can include:

  • Yearning or longing for the deceased
  • A feeling that life is unbearable
  • Preoccupation with or difficulty accepting the death
  • Intrusive, disturbing images, a sense of hopelessness
  • A wish to die to join the deceased
  • Avoidance of reminders of the death

The person may feel guilty about their behavior toward the deceased in life, or for living when the deceased person is not. They may feel that they caused or contributed to the death, that they should have prevented the death or that they should have been the one who died.

Complicated grief can be accompanied by:

  • Emotional numbness
  • Difficulty planning the future
  • Loss of identity
  • Feeling the future is cut short
  • Retreat from others
  • Anger and guilt over not having more typical grief reactions

If these reactions linger for months, cause significant distress or interfere with functioning, mental health treatment can help.

Sources

  • Bonanno, G. A., & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21(5), 705-734. https://doi.org/10.1016/S0272-7358(00)00062-3
  • Bonanno, G. A. (2009). The other side of sadness: What the new science of bereavement tells us about life after loss. Basic Books.
  • Jordan, A. H., & Litz, B. T. (2014). Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice, 45(3), 180-187. https://doi.org/10.1037/a0036836
  • Kliem, S., Lohmann, A., Mößle, T., Kröger, C., Brähler, E., & Kersting, A. (2018). The latent nature of prolonged grief - A taxometric analysis: Results from a representative population sample. Psychiatry Research, 260, 400-405. https://doi.org/10.1016/j.psychres.2017.11.087
  • O'Connor, M. F. (2013). Physiological mechanisms and the neurobiology of complicated grief. In M. Stroebe, H. Schut, & J. van den Bout (Eds.), Complicated grief: Scientific foundations for health care professionals (pp. 204-217). Routledge.
  • Prigerson, H. G., Frank, E., Kasl, S. V., Reynolds III, C. F., Anderson, B., Zubenko, G. S., Houck, P. R., George, C. J., & Kupfer, D. J. (1995). Complicated grief and bereavement-related depression as distinct disorders: Preliminary empirical validation in elderly bereaved spouses. American Journal of Psychiatry, 152(1), 22-30. https://doi.org/10.1176/ajp.152.1.22
  • Roulston, A., Clarke, M. J., Donnelly, M., Candy, B., McGaughey, J., Keegan, O., & Duffy, M. (2018). Psychological therapies for major depressive disorder and prolonged grief in bereaved adults. Cochrane Database of Systematic Reviews, 2018(12), Art No.: CD013237. http://doi.org/10.1002/14651858.CD013237
  • Simon, N. M., Hoeppner, S. S., Lubin, R. E., Robinaugh, D. J., Malgaroli, M., Norman, S. B., Acierno, R., Goetter, E. M., Hellberg, S. N., Charney, M. E., Bui, E., Baker, A. W., Smith, E., Kim, H. M., & Rauch, S. A. M. (2020). Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and Veterans. Depression and Anxiety, 37(1), 63-72. https://doi.org/10.1002/da.22911
  • Stroebe, M., Stroebe, W., Schut, H., & Boerner, K. (2017). Grief is not a disease but bereavement merits medical awareness. The Lancet, 389(10067), 347-349. https://doi.org/10.1016/S0140-6736(17)30189-7

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