Grief and Bereavement

When we lose someone or something that we care about, grief may be waiting afterward. The grieving process is a natural part of life—a reaction to death, divorce, breakups, terminal disease, and more. The things that we turn our heads from eventually find a way back into our lives; but despite the intense emotional pain and psychological dissonance, the odds of successfully processing your grief 

aren’t insurmountable. 

Grief is an immensely personal experience. While no one can speak to another’s loss, we’ve collected our knowledge of the grieving process into one encompassing and empathetic guide. Whether you’re coming to grips with the death of a loved one or mourning the end of a close friendship, we’ve detailed honest, straightforward answers to some of the toughest questions about grief. It’s your process—we’re here to lend a helping hand. 

What Is Grief Counseling?

Grief counseling, or bereavement counseling, is designed to help people cope with difficult losses. A therapist or counselor can help you develop methods and strategies for coping with your loss and grief. Grief counseling provides an outlet through which to discuss one’s feelings and emotions surrounding the grieving process and the effect it has had on their life. 

Grief counseling is especially helpful for those whose grief: 

• Interrupts the flow of their daily activities and goals
• Creates residual feelings of guilt, anxiety, or depression
• Doesn’t seem to be progressing
• Is preventing the sufferer from successfully forming new relationships

What Is Uncomplicated Bereavement?

Uncomplicated bereavement, also known as normal grief, is the process of feeling the natural, difficult emotions that follow a loss, like the death of a loved one. The way people experience uncomplicated bereavement varies from person to person, as the intensity and duration can depend on a number of factors, such as a person’s personality and culture, the circumstances surrounding the loss, and the grieving person’s relationship with the lost individual. 

Symptoms of Uncomplicated Bereavement

The symptoms of uncomplicated bereavement, or normal grief, may resemble those of a major depressive episode or even a physical disease. Common physical and emotional symptoms of uncomplicated bereavement can include:  

• Crying or emotional outbursts
• Insomnia
• Lack of appetite
• Fatigue 
• Difficulty focusing
• Withdrawal from routines and social activities
• Feelings of loneliness or anger
• Questioning beliefs

Acute grief is the intense, immediate reaction to a loss, something that can involve feelings of profound despair, guilt, and hopelessness, as well as uncontrollable crying or anger. A person experiencing acute grief might find it hard to do anything but mourn their loss. 

As acute grief evolves into integrated grief, individuals start to regain their usual functioning. Memories of the loss remain, but life becomes more balanced, with the capacity to enjoy other aspects returning. Sadness may still arise during anniversaries or significant moments, but it no longer dominates everyday life.

What Is Prolonged Grief Disorder?

Prolonged grief disorder (PGD) describes an ongoing, intense sorrow that significantly interferes with a person’s ability to function in daily life. A person can be diagnosed with PGD if their grief symptoms persist for a sustained period of time—typically 12 months for adults or six months for children. 

Symptoms of Prolonged Grief Disorder

To be diagnosed with prolonged grief disorder as an adult, the affecting loss must have occurred at least a year ago—and for children and adolescents, at least six months ago. Additionally, the individual must have experienced at least three of the following symptoms nearly every day for the last month or longer:

• Disrupted identity
• Feelings of disbelief about the death
• Avoiding reminders that the individual has passed
• Intense emotional pain directly related to the loss
• Trouble getting back to normal life
• Numbness
• Feeling that life is meaningless
• Loneliness and detachment from others

One group at a greater risk of developing prolonged grief disorder includes those who have a history of mental health issues. For those who have suffered from a substance use disorder, grief and loss may be a trigger and could potentially increase the risk of relapse.

What Causes Grief? 

Grief arises from loss. Though the grieving process is often misidentified as depression by non-professionals, grief only occurs when experiencing a loss of some sort, while depression can occur even when everything around us seems fine. Some events that may cause grief include: 

• The death of a loved one or family member
• The end of an intimate relationship or marriage
• The loss of a close friendship or mentorship
• The death of a pet 
• A natural disaster or major tragedy that affects some aspect of the griever’s life
• A personal terminal illness diagnosis

Are Grief and Bereavement the Same Thing?

Grief and bereavement aren’t the same thing, but the two terms are closely related. 

Bereavement refers to the state of having experienced a loss, while grief describes the emotional reactions to that loss, such as sadness or preoccupation with the deceased. Mourning, in contrast, involves the cultural and social rituals surrounding that loss, like funerals or memorials.

What Are the Stages of Grief?

When left with no other choice but to accept the loss at hand, grief often takes place in stages as we struggle to wrap our minds around what has happened. Not everyone may follow these stages in order, and some may skip stages. In full, the five stages of grief are: 

• Denial- When first faced with the task of processing what has happened, our instinct is often to deny that what’s taken place is real. That’s why denial is the first initial stage of the grieving process. This is a painful, but normal part of experiencing grief. Denial needs to wear off before we feel ready to start moving further into what we’re experiencing. Denial may cause antisocial, erratic behavior that’s based on a desire to avoid the reality that something or someone that we care about is now gone. 
• Anger- After we understand that our loss has occurred, we may feel that the circumstances behind the events unfolding are unfair—and we get angry. As the second stage of the grieving process, anger is often demonized as a negative emotion, but that’s not always the case. Anger, if we’re paying attention, can help point out that something is bothering us, and we need to address it. What we do with our anger during the grieving process is also important: Self-destructive behavior or old habits (like drinking, smoking, and other risky behavior) may manifest for some people.
• Bargaining- At the third stage in the grieving process, we start thinking about the “what-ifs”. Perhaps if we go through a divorce or a breakup, we stress over thoughts such as, “Maybe if I’d spent more time with them, they wouldn’t have lost interest.” If we lose a loved one due to a death, maybe we dwell on, “If only I wasn’t so selfish, I could have been there to help.” These statements can run back and forth in our minds, postponing the next stages of the grieving process, and creating a feeling of guilt felt by many. 
• Depression- The fourth stage is depression, which is often considered the most difficult. This is a time when the individual’s grief is at its peak. The temptation to turn away from the reality of life without the person, relationship, or thing that we’ve lost may seem overwhelming. Because of its difficulty, those caught in the fourth stage of the grieving process are often best assisted by a mental health professional, who can help prevent their depression from becoming a chronic condition. 
• Acceptance- The end of the grieving process occurs at the fifth stage. Acceptance involves coming fully to terms with our denial, our anger, our bargaining, and “what-ifs”. We also transition through depression, seeing that although losing something close to us indeed causes sadness, hope remains. The potential value is seen in what is left remaining (friends, family, career, future plans) after our loss. 

Why Is Grief So Hard?

Grief may be so hard to handle because the events that trigger this emotional process are so painful to endure and comprehend. The subjective experience of enduring grief, and the loss that causes this emotional time period can be incredibly burdensome for many people. But aside from the emotional pain, grief triggers chemical changes in the body and brain that can alter the way we receive and respond to stimuli. Grief may be so difficult to endure because it affects not only our emotions but our mind and body’s balance, too. 

Can Grief Cause Physical Pain?

Yes—grief can manifest as physical discomfort. Some of the physical side effects of the grieving process include: 

• Digestive health issues like IBD or constipation
• Intramuscular neck and back pain
• Chest pain 
• Arthritis 
• Generalized fatigue

The reasons why grief can manifest physically aren’t entirely understood, but the ability of our bodies to respond physically to negative emotions highlights the importance of maintaining self-care and physical health during the grieving process. Those who are grieving may also be less likely to want to take care of themselves, complicating (and possibly worsening) the physical effects of grief.

How Does Grief Affect Mental Health?

Loss of any kind will re-shape our perspective and personal views because something that we once had and valued is now gone. Whether this new vacancy becomes something that we contend with successfully long-term depends on the individual—those with pre-existing mental health conditions like depression, forms of anxiety, or ADHD may struggle more than others to process feelings of grief. But despite the pain, many people successfully manage and move through their grief, arriving at the final stage of the grieving process: acceptance.

Can Grief Cause Anxiety?

Yes, grief can contribute to anxious thoughts and feelings. When someone or something we care about is suddenly gone, this can make us feel anxious. Having to comprehend and cope with the stages of the grieving process also takes time—usually several months. And when we’re forced to confront anxiety-inducing topics brought on by our grief (death, breakups, divorce, regrets) we may feel trapped, helpless, or frustrated by the hand we’ve been dealt. 

During tough times, we may be driven by an impulse to close ourselves off from the world. Though grief can highlight what has been lost by one person or many, tragedy may also shed light on the close relationships that still exist in our lives. And if the people closest to us are unable to assist in the ways we need, grief counseling or therapy can help address any unresolved emotions. 

When Should Someone Attend Grief Counseling?

Any time one experiences a loss or if one is expecting a loss, like with a loved one on hospice, grief counseling can be helpful. 

If a loss has occurred a long time ago and the sadness is still present, or if you feel unable to move on from a loss, those are good signs that grief counseling would be useful then, too.