Key Points for This Section

Anticipatory Grief Anticipatory grief may occur when a death is expected. Anticipatory grief may help the family but not the dying person. Anticipatory grief does not always occur. Normal Grief Normal or common grief begins soon after a loss and symptoms go away over time. Many bereaved people will have grief bursts or pangs. Grief is sometimes described as a process that has stages. Complicated Grief

Anticipatory Grief

Anticipatory grief may occur when a death is expected.

Anticipatory grief occurs when a death is expected, but before it happens. It may be felt by the families of people who are dying and by the person dying. Anticipatory grief helps family members get ready emotionally for the loss. It can be a time to take care of unfinished business with the dying person, such as saying “I love you” or “I forgive you.”

Like grief that occurs after the death of a loved one, anticipatory grief involves mental, emotional, cultural, and social responses. However, anticipatory grief is different from grief that occurs after the death. Symptoms of anticipatory grief include the following:

• Depression.
• Feeling a greater than usual concern for the dying person.
• Imagining what the loved one's death will be like.
• Getting ready emotionally for what will happen after the death.

Anticipatory grief may help the family but not the dying person.

Anticipatory grief helps family members cope with what is to come. For the patient who is dying, anticipatory grief may be too much to handle and may cause him or her to withdraw from others.

Anticipatory grief does not always occur.

Some researchers report that anticipatory grief is rare. Studies showed that periods of acceptance and recovery usually seen during grief are not common before the patient’s actual death. The bereaved may feel that trying to accept the loss of a loved one before death occurs may make it seem that the dying patient has been abandoned.

Also, grief felt before the death will not decrease the grief felt afterwards or make it last a shorter time.

Normal Grief

Normal or common grief begins soon after a loss and symptoms go away over time.

During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do. Common grief reactions include:

• Emotional numbness, shock, disbelief, or denial. These often occur right after the death, especially if the death was not expected.
• Anxiety over being separated from the loved one. The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Images of death may occur often in the person’s everyday thoughts.
• Distress that leads to crying; sighing; having dreams, illusions, and hallucinations of the deceased; and looking for places or things that were shared with the deceased.
• Anger.
• Periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life. Day-to-day living may be affected.

In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery does not happen in a set period of time. For most bereaved people having normal grief, symptoms lessen between 6 months and 2 years after the loss.

Many bereaved people will have grief bursts or pangs.

Grief bursts or pangs are short periods (20-30 minutes) of very intense distress. Sometimes these bursts are caused by reminders of the deceased person. At other times they seem to happen for no reason.

Grief is sometimes described as a process that has stages.

There are several theories about how the normal grief process works. Experts have described different types and numbers of stages that people go through as they cope with loss. At this time, there is not enough information to prove that one of these theories is more correct than the others.

Although many bereaved people have similar responses as they cope with their losses, there is no typical grief response. The grief process is personal.

Complicated Grief

There is no right or wrong way to grieve, but studies have shown that there are patterns of grief that are different from the most common. This has been called complicated grief.

Complicated grief reactions that have been seen in studies include:

• Minimal grief reaction: A grief pattern in which the person has no, or only a few, signs of distress or problems that occur with other types of grief.
• Chronic grief: A grief pattern in which the symptoms of common grief last for a much longer time than usual. These symptoms are a lot like ones that occur with major depression, anxiety, or post-traumatic stress.