Written by: Darabeth Freiberg
As the days grow shorter, the weather colder, and the holidays around the corner, grief can be exacerbated. It is essential to shine a light on the various types of grief people experience. We aim to provide an overview of grief and loss, discuss the different types and symptoms to watch out for, and reassure individuals that grief and loss are standard parts of life with available resources. If you are reading this blog, you may be seeking information about a loss you have experienced, wondering if your symptoms are typical, and trying to understand the type of grief you are going through. Understanding the grief you are experiencing is crucial, as it can help you identify your feelings and seek appropriate support. Remember, you have the power to seek support and manage your grief. This blog emphasizes prolonged grief disorder, a new addition to the Diagnostic and Statistical Manual of Mental Health Disorders 5th edition (DSM-5) in 2022. However, it is helpful to recognize there are many types of grief. If you or someone you know is experiencing any of these or the associated symptoms, please explore the resources and references provided at the bottom of the page or contact our practice to see if we can offer assistance or guide you in the right direction. Of note, given the recent natural disaster, Hurricane Helene’s toll on Western North Carolina, some individuals may be grappling with collective grief, and we want to raise awareness about this, too, and offer our support.
What is Grief?
Coping with loss or grief can be prompted by various events, and each individual's experience with grief is unique. It is essential to be patient when dealing with grief, whether it is your own or when supporting a loved one. Grief is a natural and universal response to loss, a process rather than a state. While symptoms of grief may diminish over time, some individuals may find that these feelings persist and interfere with their daily lives. The different types of grief highlight the diverse and complex nature of the grieving process. It is important to remember that the symptoms you are experiencing are a normal part of the grieving process and you are not alone in this experience. Grief can also manifest at other times, not necessarily immediately following the loss. It can accompany any event that disrupts our sense of normalcy and connections. People grieve not only the loss of loved ones but also relationships, homes, jobs, health, and more. Additionally, grief can arise when facing a terminal illness.
Types of Grief
Abbreviated Grief
Abbreviated grief is where you move through the grief process quickly, and instead of experiencing the emotions that accompany grief immediately, you feel them days, weeks, or months later.
Acute Grief
In acute grief, signs include persistent longing and sadness, recurring thoughts of disbelief, rumination, avoidance of reminders, and feeling shocked or numb. People may become distant, have a diminished sense of self, and experience symptoms like sadness, tearfulness, shock, numbness, denial, anger, guilt, helplessness, depression, insomnia, and a yearning for the lost person.
Anticipatory Grief
Anticipatory grief is a response to an expected loss that affects both the person diagnosed with the terminal illness and their families.
Cumulative Grief
Cumulative grief is the experience of multiple losses that occur in a short period. It can be known as bereavement overload or grief overload. Cumulative grief can make the grieving process more challenging and complex, as each loss compounds the emotional burden.
Collective Grief*
Collective grief is a shared emotional response to a loss that affects a group of people, a community, or a nation. It can occur when a group of people experiences the fallout from a death or multiple deaths, such as in a war, natural disaster, or a school shooting. Collective grief can make people feel a lack of control and bring people together through shared sorrow.
Complicated Grief
Complicated grief is usually identified at least six months after a loss but can continue for a more extended period (Mayo Clinic, 2022). It is different from depression or post-traumatic stress disorder, although they can occur together. Complicated grief affects about two to three percent of the population, which equals millions of individuals in the US alone (Mayo Clinic, 2022). It is a condition characterized by deep and prolonged grief that impairs daily functioning. In cases of complicated grief, anxiety arises from the loss of the deceased, and individuals may struggle with intrusive or distorted thoughts related to the event. Feelings of guilt, anger, restlessness, and difficulty concentrating may also be experienced.
Disenfranchised Grief
Disenfranchised grief is a type of grief that a person experiences when they incur a loss that cannot be openly acknowledged, publicly mourned, or socially supported. This can be a particularly challenging form of grief, as the lack of validation and support can make the grieving process more difficult. Examples of disenfranchised grief can include the loss of a pet, prenatal or perinatal losses, and the loss of a body part. This condition can also be persistent in healthcare workers who experience losses in the form of patient deaths.
Inhibited Grief
Inhibited grief occurs when someone suppresses their feelings rather than confronting them immediately after a loss. This can lead to the development of physical symptoms and can prolong the grieving process. It is important to remember that the grieving process must happen, as repressed emotions will resurface. The reasons for inhibiting grief can vary, and it can result in a slower resolution of the grieving process. Loss, especially from sudden or traumatic events, can lead to this type of grief.
Primary Grief Disorder
Most individuals recover adequately within a year of the loss. However, some individuals experience an extension of the grieving process. This is a condition identified as primary grief disorder, which results from failure to transition from acute to integrated grief.
Prolonged Grief Disorder*
Prolonged grief disorder is characterized by intense and persistent grief that causes problems and interferes with daily life. It involves intense painful emotions associated with a failure to adapt to the loss of a loved one, persisting for at least 12 months for adults or six months for children and adolescents (Mughal et al., 2023.) Research suggests that seven to ten percent of adults and five to ten percent of children and adolescents may experience prolonged grief disorder after a loss (APA, 2024.) Those at higher risk include older adults, individuals with a history of depression or bipolar disorder, and caregivers. Factors such as sudden or traumatic loss, pre-existing mental health disorders, and difficulty adapting to the loss may increase the likelihood of prolonged grief disorder. The criteria include an intense yearning for the deceased, preoccupation with thoughts or memories of the deceased, identity disruption, disbelief about the death, avoidance of reminders of the death, intense emotional pain, difficulty reintegrating into relationships, inability to experience positive moods, and emotional numbness.
Symptoms
Behavioral
Behavioral issues associated with grief may include difficulty sleeping, decreased interest in daily activities, increased irritability or aggression, difficulty concentrating, confusion, impaired decision-making, a sense of hopelessness, preoccupation with the loss, and challenges in remembering or managing responsibilities.
Feelings
Grief produces feelings of a sense of loss, shock, numbness, sadness, denial, anger, guilt, helplessness, depression, yearning, and unexplained crying.
Physical
Grief can cause physical sensations such as tightness and heaviness in the chest, nausea, dizziness, headaches, numbness, muscle weakness, gastrointestinal distress, tension, and fatigue.
Physiological
Physiological symptoms include guilt, anger, hostility, restlessness, inability to concentrate, lack of capacity to initiate and maintain an organized pattern of activities, and Takotsubo cardiomyopathy. This condition includes chest pain and shortness of breath and can mimic a heart attack.
Psychological
It is essential to understand that there are no right or wrong emotions regarding grief. Allowing yourself to feel these emotions is crucial for healing. Symptoms like preoccupation with the loss, persistent thoughts, and social withdrawal are linked to reminders of the deceased in depression and other psychological symptoms.
Somatic
Somatic symptoms often manifest as chest tightness and choking, making it difficult to breathe. They can also cause abdominal distress, decreased muscle power, and lethargy.
Thoughts
Thoughts that accompany grief include a sensation of disbelief, confusion, difficulty concentrating, preoccupation, and hallucinations.
What is DABDA?
Many people have heard of Elizabeth Kubler-Ross describing the five stages of grief in her book "On Death and Dying," published in 1969. The acronym is DABDA, representing the stages of denial, anger, bargaining, depression, and acceptance.
Treatments
Dealing with grief takes time and patience. Seeking targeted treatment for grief and complex grief responses helps to reduce the risk factors for anxiety and depression. While cognitive behavioral therapy (CBT) is the preferred treatment method due to its high effectiveness, in its absence, another reasonable approach is to obtain information about adapting to grief and reduce avoidance of reminders of the loss, as well as coping skills for depression.
Acknowledge your emotions and seek support from family, friends, support groups, and your faith community. Joining a support group that focuses on your specific loss can also provide valuable help. Do not hesitate to ask your doctor for local resources and recommendations for bereavement counseling.
How TCFCH Can Help
At the Center for Creativity and Healing, we recognize the intricacies of grief and loss. Our team includes specialized clinicians, and we also provide Expressive Arts Therapy (EAT) as a beneficial approach for navigating various forms of grief and loss. For example, our Broken Bowl workshop focuses on the ancient Japanese art of Kintsugi. It is suitable for adults and older children coping with divorce, chronic pain, and all types of loss and grief. We can help match you with the right clinician for your unique situation or make a referral to a trusted colleague if needed. Additionally, we are happy to collaborate with you, your family, or your group to create a personalized EAT workshop tailored to your needs.
Resources
References
American Psychiatric Association. (2024). Prolonged grief disorder. Psychiatry.org - Prolonged Grief Disorder
Association for Behavioral and Cognitive Therapies. (2023). What is complicated grief? Complicated Grief | Fact Sheet - ABCT - Association for Behavioral and Cognitive Therapies
Clevland Clinic. (2024). Grief. What Is Grief? Types, Symptoms & How To Cope (clevelandclinic.org)
Friends in Transition. (2022, August 9). Inhibited grief: What it is & how to start healing. Inhibited Grief: What It Is & How to Start Healing - Friends In Transition (fit-counseling.com)
Hoey, D., Johnson, V., & Ojeda, L. (n.d.) Confronting collective and cumulative grief: Self-care as an institutional responsibility. Confronting-Collective-and-Cumulative-Grief_-Self-care-as-an-Institutional-Responsibility-1.pdf (nhchc.org)
Mayo Clinic. (2022, December 13). Complicated grief. Complicated grief - Symptoms and causes - Mayo Clinic
Mughal S., Azhar Y., Mahon M.M. & Siddiqui, W. J. (2023). Grief reaction and prolonged grief disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK507832/
コメント