Most people think of the grieving process as something experienced only after the death of a loved one. But we grieve for many reasons—be it the loss of a loved one, the loss of a job, the end of a relationship or the loss of good health. In fact, even events of a wider scale, such as natural disasters or terrorist attacks, can cause people to grieve at the loss of their sense of safety and security.
Anytime something significant is taken away from us, we're left coping with grief. And that grieving process can trigger a host of unfamiliar and confusing emotions and behaviors.
Ultimately, most of us find a way to carry on after a loss. But the process we go through to do that can be complicated and emotionally messy. The journey can be so overwhelming that some people fail to recover from it sufficiently enough to make good choices for themselves.
Knowing how to cope with grief in a healthy way can help you stay on the path to recovery.
How did you react to a recent loss?
Think about the last time you experienced a loss and think about how you reacted. Do any of the following emotions or reactions sound familiar?
- "I just don't feel like myself. I feel disconnected and different from everyone."
- "I sometimes feel overwhelmed and disoriented."
- "I'm really scattered, and I’m having trouble focusing on work or daily activities."
- "I'm driving my family nuts because I've been so overprotective, and I constantly fear for their safety."
- "I feel like I'm going crazy because I sometimes think I hear my spouse's voice, even though he is no longer here."
Some of these emotions and behaviors can feel alarming. Are they normal grief symptoms or are they emotionally unhealthy reactions? Compare your specific responses with those listed below to find out whether they match the typical reactions associated with normal grief, complicated grief or depression.
Normal grief symptoms
Physical reactions
- Crying spells
- Lack of energy and feeling physically drained
- Changes in sleeping or eating patterns
- General feelings of malaise
Emotional reactions
- Numbness
- Sadness
- Anger, general irritability
- Guilt
- Fear or anxiety
Behavioral reactions
- Withdrawn/less productive
- Unable to sit still
- Lacking attention or concentration
- Struggling to think clearly or remember things
- Seeing or hearing the voice of the deceased
Over time, you should feel a gradual reduction in the above grief symptoms as you begin to accept the loss and adjust to a new sense of normalcy. However, when you are in the midst of such reactions, be extra cautious about your health choices. Studies suggest added stress can limit your ability to control unwanted behaviors, leading you to make poor dietary choices, forget exercise and indulge more in overeating, smoking and caffeine consumption. Getting enough rest and exercise, proper nourishment and consistent social support is vital to coping with grief in a healthy way.
Complicated grief symptoms
Physical reactions
- Continued sleep disturbances from frequent nightmares and intrusive memories
- Physical symptoms or psychosomatic symptoms related to the loss
- Significant weight loss or gain
Emotional reactions
- Inhibited or absent grief
- Prolonged hostility and aggression
- Panic attacks, phobias or irrational fears
- Constant yearning for what was lost
Behavioral reactions
- Progressive isolation and withdrawal from social contact
- Self-destructive behavior
- Prolonged avoidance of tasks reminiscent of what was lost
- Continued loss of interest in activities
Note: Experiencing any one of these symptoms, or several for only a short time, may not indicate complicated grief. Depending on the number, intensity, and duration of your grief symptoms, your experience may fall within the expected normal reaction to a loss.
Complicated grief
Although complicated grief is difficult to identify after a loss, certain factors may increase your risk of it, such as:
- Experiencing a sudden or traumatic loss such as the violent death of a loved one
- Being female
- Having a limited social support network
- Losing a person with whom you had a complicated relationship, for example, someone with whom you had an intense, extremely close, or very strained relationship
- Experiencing multiple losses
Complicated grief develops over several months and is usually not diagnosed unless symptoms continue for at least six months after the loss. Individuals with complicated grief often are either unable to recognize their condition or unable to take steps to address it. As a result, experts believe the condition is largely underdiagnosed.
Unfortunately, when left untreated, complicated grief can drastically interfere with daily life and have a negative impact on health and well-being. Studies suggest that complicated grief is associated with clinical depression, suicidal thoughts or actions, substance abuse, strained relationships and cardiovascular illness.
If you or someone you know seems stuck in their grief process and several months go by with little or no progress, professional counseling may help. A healthcare provider (HCP) or psychiatrist can assess the situation. Recent studies suggest that a new intensive type of psychotherapy in which therapists simultaneously help people focus on their loss and on rebuilding their lives is effective in treating complicated grief.
Symptoms of depression
Physical reactions
- Chronic physical complaints
Emotional reactions
- Irritability expressed as complaining, not directly express anger
- Generalized feelings of guilt
- Pervading sense of doom
- Chronic sense of emptiness and despair
- Constant feelings of worthlessness and hopelessness
- Loss of self-esteem
Behavioral reactions
- Does not accept support
- Has no hope for the future
Although the sadness and sorrow of normal grief is often mistaken for depression, one of the key distinguishing factors is that with depression, rather than connecting your feelings and reactions to a specific loss, your emotions relate to all facets of your life. You rarely enjoy any activity and have few positive thoughts. You may also experience many of the emotions of normal grief, but rather than coming in waves, they remain constant despite any comfort and support you may receive from others.
It is difficult to judge who will or won't suffer depression after a loss. However, you may have a greater risk if you have:
- A history of depression
- Few social supports
- Little experience with loss
Because grief may sometimes turn into depression, it is important to acknowledge the pervasive feelings of sadness or hopelessness or chronic feelings of emptiness and seek help before the condition hinders your health. Depression not only affects how you think, but it also affects your immune system, your sleep and many of the natural processes that keep your body in working order, both physically and mentally.
Several studies have revealed connections between depression and hypertension, stroke, heart disease, diabetes, obesity and asthma. If you or someone you know may be suffering depression, make an appointment with an HCP. They will assess whether the symptoms are explained by grief.
Your grief is unique
Regardless of the type of loss you experience, how you cope with grief will be different from that of other people, even people experiencing the same loss. Just as each person's life is unique, so, too, is their grief experience. You react to loss in your own way, depending on your personality, the situation surrounding your loss, previous losses, your social support network and the nature of your relationship with the person lost or your attachment to what was lost.
You may experience several or only a few of the feelings and clinically defined stages of grief, and there is no set order in which they should occur. Often, the physical, emotional and behavioral changes are more intense and frequent shortly after a loss. Over time, these changes should gradually subside, becoming less intense, lasting for shorter periods and happening less frequently.
The stages of grief
In the late 1960s, psychiatrist Elisabeth Kubler-Ross introduced the idea that people go through five stages of grief denial, anger, bargaining, depression and acceptance. Although she helped legitimize the wide variety of emotions that people experience after loss, the stage model she proposed soon became a prescription for proper grief rather than a loose structure to identify broader patterns of grieving. As a result, many people mistakenly assumed they must move through all the stages and emotions, in succession, to cope with grief correctly or completely.
Although the stage models of Kubler-Ross and others have become a very popular way of explaining the grieving process, researchers exploring different types of loss found little evidence that people move through a consistent set of stages toward recovery. If you are familiar with the stages of grieving and are worried that you are missing a step or are cycling through one step more than once, rest assured this is not necessarily a sign that you are stuck in the grief process.
The grieving process, which may take anywhere from a couple of months to a couple of years, should help you come to terms with your loss and eventually lead you to some feeling of resolution. Without this sense of closure, you may have difficulty functioning in your daily life and may have an increased risk of physical and mental illnesses.
Complicated grief and depression are conditions that can keep you from achieving this sense of closure. When the grieving process is prolonged or totally stalled, there is cause for concern.
Research still emerging
Complicated grief is known as “persistent complex bereavement disorder” in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, a need remains for greater clarity in defining it and determining areas of distinction and overlap with this condition and normal grief and posttraumatic stress disorder.
Making the journey
When working through a loss, you may feel you're traveling a long, winding path with no specific destination or end in sight—but, eventually, you can regain a feeling of control and predictability in your life. Many factors will shape your journey and some may complicate it. Having ups and downs along the way is normal and healthy, as is backtracking, as long as you feel you are making progress overall.
But if the path continues getting rockier rather than smoother, or if you feel stalled or stranded at any point, seek the advice of a mental health professional who is familiar with helping people learn how to cope with grief issues. You may choose to seek professional counseling even if you are not experiencing any complicating circumstances. Regardless of how you move through the grieving process, counseling can help you better understand your grief and help you move forward in your healing process.
