All About Grief: What Causes It, How to Cope With It, and When to Get Help
More so than most other species, we form intensely close bonds with family members and friends, and to a lesser extent also with neighbors, colleagues, and acquaintances. When loss breaks one of those bonds, it’s natural and normal to experience a strong emotional response.
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 of 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.
How Do Psychologists Define Grief?
Grief, in a nutshell, is what we experience following loss.
“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 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.
He mentions the loss of a job or a romantic breakup as examples. Others include the loss of a friend, of a dream, or of a way of life.
Can Grief Affect You Physically?
The Types of Grief
Some experts divide grief into numerous subtypes or categories. Many of those are debated — or downright contested — but a few have gained broad acceptance among doctors and academics.
‘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,” says M. Katherine Shear, MD, who studies grief and bereavement and is the Marion E. Kenworthy Professor of Psychiatry at Columbia University in New York City.
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 losss; 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 a patient.
Symptoms: What Grief Feels Like and What It Does to the Body
Grief is an intensely personal experience. It can look very different from one person to the next.
What Are the Emotional Symptoms of Grief?
- Sadness
- Yearning
- Shock
- Numbness
- Denial
- Anger
- Helplessness
- Guilt
- Intense 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,” Cholbi 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 throat
- Nausea or stomach discomfort
- Dizziness
- Headache
- Numbness
- Muscle weakness
- Fatigue
- Shortness of breath
- Weight loss or gain
Complications: How Grief Can Affect Our Long-Term Mental and Physical Health
The experience of grief, especially if it persists for long periods of time, is associated with an elevated risk for a number of mental and physical health conditions.
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.
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Pain, Immune System, GI, and Sleep Problems
Grief can also cause insomnia, which itself is a risk factor or trigger for many different health problems.
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Heart Complications Related to Grief
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The Stages of Grief
One big issue is that the “stages of grief” model was developed to describe how people mourn their own impending death, not necessarily for people who are grieving, says Heidi Horsley, PsyD, executive director and cofounder of the Open to Hope Foundation, a nonprofit organization that supports people experiencing grief and loss.
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.”
- Denial Failing to acknowledge or accept that a loss has occurred. Denial can also refer to a denial of one’s feelings or of the full significance of a loss.
- Anger This emotion may be directed at spouses, friends, family members, colleagues, a spiritual being, or even at the person or thing someone has lost.
- Bargaining This can involve asking a higher power to take the pain away in exchange for some personal sacrifice — such as: “I will never sin again if my loved one will be spared.” The bargaining stage can also involve what-if thoughts about how a loss occurred or may have been avoided.
- Depression This is thought to be a deeper level stage of grief that occurs once the early stages have passed, and a person recognizes that the situation is real. This stage is often defined by sadness and a withdrawal from daily life or normal activities.
- Acceptance A person more fully accepts that the loss is real and permanent. Sadness and other feelings still crop up. But a person has reorganized their life and relationships in ways that allow them to move forward, however changed they may be.
- Shock A feeling of numbness or disbelief following a loss (one of the stages that was later added).
- Testing A person seeks out new practices or ways of living with their grief (another stage that was later added).
How to Cope With Grief
First of all, it’s important to remember that grief is not a “problem” that must be handled or dealt with — especially not in the early weeks or months following a loss.
“Grief is an emotionally rich event that allows us to appreciate what we’ve lost while also preparing us to adapt to that loss,” says Cholbi. “Even the most arduous grief episodes are healthy or fitting responses to the losses that cause them.”
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 — then 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 it also includes some standardized elements, Shear says. “It consists of weekly sessions with therapists 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’s 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.
Common Questions & Answers
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Sources
- Mughal S et al. Grief Reaction and Prolonged Grief Disorder. StatPearls. November 14, 2023.
- Boelen PA et al. Prolonged Grief Disorder in DSM-5-TR: Early Predictors and Longitudinal Measurement Invariance. The Australian & New Zealand Journal of Psychiatry. June 2022.
- Reynolds L et al. Anticipatory Grief: Its Nature, Impact, and Reasons for Contradictory Findings. Counselling, Psychotherapy, and Health. July 2006.
- Kavan MG et al. Grief and Major Depression — Controversy Over Changes in DSM-5 Diagnostic Criteria. American Family Physician. November 15, 2014.
- Clevers E et al. Relations Between Food Intake, Psychological Distress, and Gastrointestinal Symptoms: A Diary Study. United European Gastroenterology Journal. August 2019.
- Akashi YJ et al. Takotsubo Cardiomyopathy: A New Form of Acute, Reversible Heart Failure. Circulation. December 16, 2008.
- Kellehear A. Dr. Elisabeth Kübler-Ross and the Five Stages of Grief. Elisabeth Kübler-Ross Foundation. 2010.
- Stroebe M et al. Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief. OMEGA — Journal of Death and Dying
. March 2017. - Oates JR et al. Nursing Grief and Loss. StatPearls. September 18, 2022.
- Shear MK et al. Complicated Grief Treatment: An Evidence-Based Approach to Grief Therapy. Journal of Rational-Emotive & Cognitive-Behavior Therapy. March 2017.
Allison Young, MD
Medical Reviewer
Allison Young, MD, is a board-certified psychiatrist providing services via telehealth throughout New York and Florida.
In addition to her private practice, Dr. Young serves as an affiliate professor of psychiatry at Florida Atlantic University Charles E. Schmidt College of Medicine. She previously taught and mentored medical trainees at the NYU Grossman School of Medicine. She speaks at national conferences and has published scientific articles on a variety of mental health topics, most notably on the use of evidence-based lifestyle interventions in mental health care.
Young graduated magna cum laude from Georgetown University with a bachelor of science degree in neurobiology and theology. She obtained her doctor of medicine degree with honors in neuroscience and physiology from the NYU Grossman School of Medicine. She continued her training at NYU during her psychiatry residency, when she was among a small group selected to be part of the residency researcher program and studied novel ways to assess and treat mental distress, with a focus on anxiety, trauma, and grief.
During her psychiatry training, Young sought additional training in women’s mental health and cognitive behavioral therapy. She has also studied and completed further training in evidence-based lifestyle interventions in mental health care, including stress management, exercise, and nutrition. She is an active member of the American College of Lifestyle Medicine, through which she helps create resources as well as educate physicians and patients on the intersection of lifestyle medicine and mental health.