About Grief

Grief is complex, unpredictable and has no time limit.  It is the reaction from us that is exhibited emotionally and behaviorally (1). It can be chronic, brief, or hidden.  We struggle to understand its impact because so much time can be spent trying to remove ourselves from the intolerable experience of grief.  I have chosen to specialize in this area because most of humanity is confronted by grief, and it does not always have to be because of a death, or a “loss.”  

Grief has layers, it is rich with processes that may not have even originated with you.  It can be transmitted and projected through generations and through collateral experiences.  While grief can have aspects of depression, the main differentiation is the response of the individual related to grief.  Like the birth of your child, grief presses upon you in a way that becomes imprinted, and unlike other mental health areas we address, grief becomes intertwined as a fabric of ourselves versus trying to get “rid” of it.

It is not our desire to “forget” but to reduce the level of intolerance that gets created when it takes us over.  It is about creating an emotional landing pad not to forget those parts that we want to remember and hold so close, but to hold them without falling apart.

Grief Versus Mourning

While grief broadly defined is our internal and intrapsychic experience, mourning is the outward display of grief. This can vary from individual to individual based on a number of personal factors such as culture, religious beliefs, environment, and personal values related.

Bereavement: Defined as the reality in which one continues to face after death. It is in its most general explanation of one’s objective experience and how they continue to interact after death.

Types of Grief

Normal Grief: A common and expected pattern or reaction to a loss. Typically exhibited in the days, weeks, and months after loss. Generally, the emotional experience is tolerated and does not disrupt activities of daily living.

Some “normal” grief responses include:

  • Crying or sobbing

  • Sleep problems (such as difficulty falling asleep or getting too much/too little sleep)

  • A persistent lack of energy

  • Feeling lethargic or apathetic about life in general

  • Changes in appetite (such as not eating at all or eating excessively)

  • Withdrawing from usual social interactions and relationships

  • Difficulty concentrating on important tasks

  • Questioning spiritual or religious beliefs, career choices, or life goals

  • Feelings of anger, guilt, loneliness, depression, emptiness, sadness

Anticipatory Grief: When a loss is expected, the emotional and physiological response to the individual and family members experiencing the upcoming loss.

Complicated Grief (Prolonged Grief): Intense and heightened state of mourning that can result in significant impairments in functioning. There is very little focus on anything else. There are three different types.

  • Persistent complex bereavement disorder, when elevated grief continues for 12 months for adults and 6 months for children (DSM-5).

  • Prolonged grief disorder, when elevated grief continues 6 months after the death (ICD-11).

Symptoms of prolonged grief disorder (APA, 2022) include:

  • Identity disruption (such as feeling as though part of oneself has died).

  • Marked sense of disbelief about the death.

  • Avoidance of reminders that the person is dead.

  • Intense emotional pain (such as anger, bitterness, sorrow) related to the death.

  • Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).

  • Emotional numbness (absence or marked reduction of emotional experience).

  • Feeling that life is meaningless.

  • Intense loneliness (feeling alone or detached from others).

Delayed or Absent Grief: Emotional pain experienced long after the loss that was experienced.  It can be felt for years after, which suggests a detachment from the grief at the origin timeline of the loss.

Chronic Grief: When the intensity of your emotions due to grief do not subside, resulting in excessive limitations in functioning daily.

Grief and loss of:

  • Partner or spouse

  • Parents and grandparents

  • Child (including in utero)

  • Chronic Illness

  • Pet 

  • Suicide

  • Substance Use

  • Career or personal dreams

  • Medically assisted death

Please see my list of resources regarding the most recent literature and progress in the treatment of grief.

CITATIONS

  1. Stroebe MS, Hansson RO, Schut H, et al., eds.: Handbook of Bereavement Research and Practice: Advances in Theory and Intervention. American Psychological Association, 2008.