Grief, Sadness and the Different Ways We Respond to All Types of Loss

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Grief affects everyone a little differently, so allow yourself to experience a range of feelings and get help processing them if they become overwhelming.

Grief is a natural response to loss. You can grieve the death of a loved one, as well as grieve a friendship or other relationship that has faded or soured over time. Grief can also explain the pain that is sometimes felt when moving from a beloved home, retiring after a long career, or any other major change that means giving up something dear.

The way a person experiences grief is a deeply personal matter that can be emotionally overwhelming at times and puzzling and frustrating in other circumstances. You may have given thought to how you’ll feel in the event of a loved one’s passing or if some other loss, such as a divorce or financial or health calamity, occurs. But the grieving process is an unpredictable one that demands patience and understanding, whether you are going through it yourself or you’re watching someone close to you deal with loss.

“It’s important to recognize that people grieve in their own ways, and on their own individual timelines,” explains Amanda Baker, PhD, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital. “Generally, taking a more open or willing stance towards our internal experiences is a beneficial mindset to hold, while on the opposite end of the spectrum, very rigidly held beliefs that are fixated on can be particularly unhelpful.”

To that end, allow yourself to grieve in ways that feel true to you. As much as possible, don’t feel pressured by the expectations of others about how long you should grieve or actions you should take. You may understand your grieving process better by realizing that there are actually several types of grief, including a recently recognized condition called prolonged grief disorder.

Types of Grief

The type of grief that people experience is influenced by many factors. When it comes to coping with the passing of a loved one, factors can include the time since the loved one passed away, the relationship between the bereaved individual and the deceased loved one, and the circumstances of the death, Dr. Baker says.

She adds that although there are many different ways to categorize grief, there are essentially four main types:

  • Anticipatory grief occurs prior to a loss. One of the most common examples is how we cope with a loved one dealing with a terminal illness.
  • Acute grief arises within the first six months after a loss, and often includes a range of feelings such as sadness, anxiety, anger, and guilt. Acute grief can be overwhelming for months.
  • Integrated grief is a way people still deal with their feelings associated with a loss, without those emotions interfering with their daily lives.
  • Prolonged grief lasts for a year or much longer after a loss.

Prolonged Grief Disorder

Earlier this year, Prolonged Grief Disorder (PGD) was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders used by mental health professionals to make diagnoses. While the concept of prolonged grief has been around for a long time, the inclusion of PGD in the DSM-5 means that mental health clinicians, as well as individuals experiencing the disorder and their families, now share a more clearly defined understanding of what normal grief is like and alternatively what might constitute a long-term condition.

“Grieving after the death of a loved one is normal and is an expected process,” Dr. Baker says. “For most people, symptoms of grief decrease over time, but this isn’t always the case. For some individuals, grief can last many months or years after the passing of a loved one and can cause great distress and impairment in functioning in daily life. This lasting and persistent grief, which interferes in daily functioning, is called Prolonged Grief Disorder.”

She adds that adults diagnosed with PGD have experienced the loss of a loved one at least one year ago and the symptoms of grief continue to cause significant distress and impairment in daily functioning. Symptoms may include:

•Avoidance or reminders that the person has died

•Intense emotions, such as anger and sorrow, related to the death

• Difficulty moving on with life

• Emotional numbness

• Intense loneliness

Coping with Grief

For many people, grief is a condition that runs its course without the need for a formal intervention. But for others, turning to support groups or a mental health professional can make a world of difference. “If individuals are really struggling with their grief, and it is impacting their ability to function day to day, they should consider seeking support,” Dr. Baker says. “A professional can help direct grieving individuals as to how to cope with the loss, with the goal of easing suffering.”

She adds that the severity and duration of symptoms will help determine the type of grief treatment that will be the most effective.

“Grief counseling is a type of therapy that focuses on helping people cope with the loss of a loved one,” Dr. Baker explains. “Grief counseling typically occurs in the form of supportive talk therapy occurring in the first six months after the loss. The grief counselor may encourage individuals to discuss the passing of their loved one and allow them to have a safe space to express their grief. Grief counselors also help people develop skills to adjust to life without their loved ones physically present and work through other grief symptoms.”

For individuals diagnosed with PGD, a more structured form of treatment may be more appropriate.

Prolonged Grief Disorder Treatment is a short-term, evidence-based treatment that consists of 16 sessions that occur weekly, Dr. Baker says. Each week, a different theme is addressed, which includes some of the following: understanding grief, accepting painful emotions, and learning to live and integrate memories of the deceased loved one in a constructive way.

“The goal of this type of treatment is to allow those suffering from PGD to accept the loss and rebuild and strengthen relationships with others again,” she adds. “It is particularly valuable to have a network of family or friends who can provide support and social connection.”

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