Grief is the name we’ve given to that emotional response. It encompasses the sadness, disorientation, and other intense and often sorrowful experiences we go through as we live with a loss. Grief can also cause a range physical symptoms and behavioral responses. While just about everyone has an idea of what it means to grieve, psychologists and therapists who study grief say that there is a lot more to the experience than most of us fully appreciate. “Researchers, including myself, usually use the term grief to refer to our emotional reactions to the deaths of those we care about,” says Michael Cholbi, PhD, a professor of philosophy at the University of Edinburgh in Scotland. Dr. Cholbi’s research has focused on grief, much of which he details in his new book Grief: A Philosophical Guide. “In the wider culture, [grief] is increasingly used to refer to our emotional reactions to any significant loss, not just losses due to others’ deaths,” he says.
‘Normal’ Versus Complicated or Prolonged Grief
At a high level, most experts recognize two types of grief. The first is sometimes termed “normal” or “healthy” grief, while the second goes by the name “complicated” or “prolonged” grief. “The difference between normal or healthy grief and prolonged grief is related to whether certain defensive responses — that are a normal part of early grief — become persistent and overly influential in mental functioning,” explains M. Katherine Shear, MD, the Marion E. Kenworthy Professor of Psychiatry at Columbia University in New York City, who studies grief and bereavement and is the founding director of Columbia’s Center for Complicated Grief. Dr. Shear says that some examples of such defensive responses include: disbelief that a loved one is really gone and never coming back; self-blame or anger related to the death; avoidance of things that trigger grief; or imagining alternative scenarios in which the source of one’s grief doesn’t happen or happens differently. ”It’s characterized by persistent pervasive yearning, longing, or preoccupation with the person who died, along with a range of other manifestations of intense grief that is interfering with the person’s life and is persisting at least six months and longer than the person’s social, cultural or religious group expects,” says Shear, whose work and input as an advisor helped shape the DSM-5’s inclusion of prolonged grief disorder. It’s important to highlight that, when a person is first grieving, almost all emotions or experiences are considered normal and not disordered. It’s only after a fair amount of time has passed — and again, the amount of time is going to depend on some cultural or subjective criteria — that some grief responses could potentially be considered a disorder. Learn More About Complicated Grief
Other Types of Grief
Apart from normal and prolonged grief, other subtypes that some experts recognize include:
Anticipatory grief is a type of grief a person may begin to experience even before a loss. For example, anticipatory grief can happen when someone’s loved one is diagnosed with a terminal medical condition.Disenfranchised grief is a type of grief that people experience when they experience a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported. An example is a doctor who cannot openly grieve for the loss of his or her patients, notes StatPearls.In an opinion article published in 2021 in the journal Frontiers in Psychology, psychologists posited that the COVID-19 pandemic has likely led to many people experiencing disenfranchised grief due to social distancing restrictions that made it impossible for people to be with loved ones leading up to and at the time of their deaths, or participate in typical bereavement rituals.
RELATED: How Two Caregivers Are Coping With Losing a Loved One During the COVID-19 Pandemic
What Are the Emotional Symptoms of Grief?
SadnessYearningShockNumbnessDenialAngerHelplessnessGuiltIntense emotional pain
Some people may cycle through many of these symptoms. Others may experience several at once.
Other Cognitive Symptoms of Grief
“One that people are often surprised by is a sense of disorientation or alienation — finding ordinary places, situations, or objects unfamiliar,” says Cholbi. Our lives can become so firmly anchored to our friends and loved ones that, when one of them is gone, everything feels changed and even foreign. “Some even feel like strangers in their own bodies,” he adds. “This aspect of grief seems to reflect how others’ deaths can upend our expectations for what is typical or normal in the world.”
Physical Symptoms of Grief
Tightness or heaviness in the chest or throatNausea or stomach discomfortDizzinessHeadachesNumbnessMuscle weaknessFatigueShortness of breathWeight loss or gain
Anxiety, Panic Disorders, and Depression
In the past, the DSM has included a “bereavement exclusion,” which suggested depression linked to the death or loss of a loved one should not be considered disordered unless it lasted for more than two months and met other criteria. However, the latest version of the DSM dropped this bereavement exclusion. Instead, it draws many fine-grained distinctions between “normal bereavement” and a major depressive episode. To sum up, grief and depression often seem to go hand-in-hand. There’s no doubt that grief can be a risk factor for depression. But experts tend to treat clinical depression as separate from grief. RELATED: Detecting and Diagnosing Depression
Immune, GI, Pain, and Sleep Problems
Grief can also cause insomnia, which itself is a risk factor or trigger for many different health problems. RELATED: How Does Stress Affect Digestion?
Heart Complications Related to Grief
RELATED: How Stress Affects Your Body, From Your Brain to Your Digestive System
The model can apply to people who are grieving, but it still shouldn’t be used to suggest that people process grief in a linear and rigid way, says Dr. Horsley, who also serves on the advisory council of the Elisabeth Kübler-Ross Foundation and is an adjunct assistant professor at Columbia University in New York City. “Everyone will go through some of the stages, but not necessarily all of the stages, and it won’t necessarily be in a linear manner,” she says. “It is normal to move back and forth between the stages as you are going through the grief journey.” Other experts express similar sentiments. “Grief is all about time,” says George Bonanno, PhD, a professor of clinical psychology at Columbia University’s Teachers College and author of the book The Other Side of Sadness “When a couple of months go by and a person is still grieving, they may start to worry, but that’s still early.” Dr. Bonanno says that, speaking very generally, if after six months a person isn’t getting back into something that resembles their normal life — working, seeing friends, and other usual activities — than that may indicate the need to speak with a therapist or some other grief expert. “But some people take longer than others,” he adds. “If as time passes you’re able to do some elements of normal functioning, you’re probably going to get better.” This targeted psychotherapy is personalized to the individual and what they are going through, but that it also includes some standardized elements, Shear explains. “It consists of weekly sessions with and a set of activities to do at home,” she says. “It includes work on accepting grief, managing emotions, envisioning a positive future, strengthening relationships, narrating the story of the death, living with reminders, and connecting with memories.” Bonanno mentions Shears work, and says a key component of her therapy — and many other forms of treatment for people seeking help with grief — involves talking through the experience of grief and the events or loss that caused it. When you’re struggling to understand and accept a loss, you often only think about it in fragments, he says. This fragmented thinking can lead to “some really dysfunctional ideas,” he says. Talking through things with a professional can help to reveal the flaws in these ideas. “When people talk through things and put together the whole story, that can be really helpful,” he adds. Learn More About How to Cope With Grief
