Grief and Grieving

Cause

Grief and grieving are the natural response to a major loss, such as the death of a loved one. Loss can cause feelings of grief, sometimes when you least expect it.

You may find that old feelings of grief from past loss can be triggered by current experiences or anniversaries of that loss. This is normal.

Anticipatory grief happens in advance of an impending loss. You may feel anticipatory grief for a loved one who is sick and dying.

Symptoms

Your experience of grief is likely to be different from another person's. Similarly, you will probably grieve somewhat differently each time you experience a significant loss. Your reaction to loss is influenced by the relationship you had with the lost person and by your general coping style, personality, and life experiences. How you express grief is influenced in part by the cultural, religious, and social rules of your community.

Grief is expressed physically, emotionally, socially, and spiritually.

• Physical expressions of grief may include crying or sighing, headaches, loss of appetite, difficulty sleeping, weakness, fatigue, feelings of heaviness, aches, pains, or other stress-related ailments.
• Emotional expressions of grief may include feelings of sadness or yearning. But feelings of worry, anxiety, frustration, anger, or guilt are also normal.
• Social expressions of grief may include feeling detached from others, isolating yourself from social contact, and behaving in ways that are not normal for you.
• Spiritual expressions of grief may include questioning the reason for your loss, the purpose of pain and suffering, the purpose of life, and the meaning of death. After a death, your grieving process is influenced by how you view death.

Intense grief can bring on unusual experiences. After a death, you may have vivid dreams about your loved one, develop their behaviors or mannerisms, or see or hear your loved one.

Symptoms of grief in children and teens

Age and emotional development influence the way a person grieves a death.

Children younger than age 7

Children younger than 7 usually perceive death as a temporary separation. They may feel abandoned and scared. And they may fear being alone or leaving people they love. Grieving young children may not want to sleep alone at night, or they may refuse to go to day care or school.

• Children under age 7 usually aren't able to verbally express their feelings. Instead, they tend to act out their feelings through behaviors, such as having trouble following directions, having temper tantrums, or role-playing their lives in pretend play.
• Children younger than age 2 may refuse to talk. And they may be generally irritable.
• Children between the ages of 2 and 5 may develop eating, sleeping, or toileting and bed-wetting problems.

Children ages 7 to 12

Children from ages 7 to 12 often perceive death as a threat to their personal safety. They tend to fear that they will die also and may try to protect themselves from death. While some grieving children want to stay close to someone they think can protect them, others withdraw.

• Some children try to keep things normal or may seem unusually calm. Others act out their emotions in negative ways.
• A grieving child may have problems concentrating on schoolwork, following directions, and doing daily tasks.
• Children in this age group need to be reassured that they aren't responsible for the death they are grieving.

Teens

Teens perceive death much like adults do. But they may express their feelings in dramatic or unexpected ways. For example:

• They may join a spiritual group that defines death in a way that calms their feelings.
• They may do things that are dangerous, such as reckless driving, smoking cigarettes, drinking alcohol, taking drugs, or having unprotected sex.

Like adults, preteens and teens can have suicidal thoughts when grieving. Warning signs of suicide in children and teens may include preoccupation with death or suicide or giving away belongings.

What Happens

Feeling and expressing grief

Your way of feeling and expressing grief is unique to you and the nature of your loss. You may find that you feel irritable and restless, are quieter than usual, or need to be distant from or close to others. Or you may find that you aren't the same person you were before the loss. Don't be surprised if you experience conflicting feelings while grieving. For example, it's normal to feel despair about a death or a job loss yet also feel relief.

The grieving process does not happen in a step-by-step or orderly fashion. Grieving can't be predicted. Thoughts and feelings can come and go.

While grieving may make you want to isolate yourself from others and hold it all in, it's important that you find some way of expressing your grief. Use whatever mode of expression works for you. Talking, writing, creating art or music, or being physically active are all ways of expressing grief.

Spirituality often is part of the grieving process. You may find yourself looking for or questioning the higher purpose of a loss. While you may gain comfort from your religious or spiritual beliefs, you might also be moved to doubt your beliefs.

Adjusting to a loss

You may become more aware of your feelings of grief during holidays, birthdays, and other special events.

With loss, your sense of self and security is disrupted. It may help to develop or strengthen connections with other people, places, or activities. These new parts of your life are not meant to replace what you have lost. Instead, they serve to support you.

When to Call a Doctor

Call 911 or other emergency services if:

• You think you cannot stop yourself from harming or killing yourself.
• You hear voices that frighten you, especially if the voices tell you to hurt yourself or other people.
• Someone who is grieving tries to harm themself or someone else.
• Someone who is grieving threatens to hurt someone else or makes threats of suicide.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call or text the Suicide and Crisis Lifeline at 988.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call a doctor if:

• You feel out of control, unsafe, or empty (without any feeling) for more than a couple of weeks.
• You can't stop yourself from thinking about death or suicide.
• You are concerned that you're using substances to avoid emotions and thoughts, such as drinking more alcohol than you normally do.
• You have been grieving longer than you expected.
• You or someone you know has symptoms of depression. These symptoms include feeling sad and losing interest in most daily activities.

Treatment Overview

Grief itself is a natural response that doesn't require medical treatment. Social support and good self-care may help. But if you find that your grief is making it difficult to function, contact a grief counselor, bereavement support group, or your doctor.

If you have symptoms of depression, prolonged anxiety, or post-traumatic stress disorder (PTSD), contactl your doctor.

Getting help for suicidal thoughts

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call or text the Suicide and Crisis Lifeline at 988.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Self-Care

Talking about the loss, sharing cares and concerns, and getting support from others can help you grieve in a healthy way. If you have just had a major loss in your life, you might try these steps.

• Get enough rest and sleep. Not getting enough rest and sleep can lead to physical illness and exhaustion. Try activities to help you relax, such as meditation or guided imagery.
• Eat healthy foods. If you have trouble eating alone, ask another person to join you for a snack or meal. If you don't have an appetite, eat frequent small meals and snacks.
• Exercise. Walking and other forms of exercise, such as yoga can help.
• Comfort yourself. Allow yourself to be comforted by familiar surroundings and personal items that you value. Special items, such as photos or a loved one's favorite shirt, may also give you comfort.
• Try to stay active with your support network. Staying involved in work, church, or community activities may help.
• Surround yourself with loved ones. Surrounding yourself with loved ones and talking about your feelings and concerns may help you feel more connected with other people and less lonely.
• Get involved. Take part in the activities that occur as a result of the loss, such as making funeral arrangements.
• Avoid quick fixes. Resist the urge to drink alcohol, smoke cigarettes, or take nonprescription medicines (such as sleeping aids). When you are under emotional stress, these may only add to your unpleasant feelings and experiences. They may mask your emotions and prevent you from normal, necessary grieving.
• Ask for help. During times of emotional distress, allow other people to take over some of your responsibilities. Allowing other people to help you also helps them, because it gives them an opportunity to show their care and concern for you.

Giving Support

There are many ways that family members and other people close to a person who is grieving can give help and support. The best way to help a grieving person often depends on how well the person was prepared for the loss, the person's perception of death, and the person's personality and coping style. The person's age and stage of emotional development are also important to think about when you are helping someone who is grieving.

Here are some ways to help.

• Encourage the person to grieve at their own pace.
  • The grieving process doesn't happen in a step-by-step or orderly fashion. There will be good days and bad days.
  • Provide support and be willing to listen.
• Be sensitive to the effect of your words.
  • When you aren't sure what to say, offer to listen.
  • Some people may appreciate a check-in regularly during the first year and beyond, especially on important days, such as the anniversary of the death, holidays, and birthdays.
• Recognize that this person's life has changed forever. Encourage the person to take part in activities that involve and build the person's support network.
• Respect the person's personal beliefs. Listen to the person's beliefs or feelings without making judgments.