A strong and sometimes overwhelming emotion, grief can impact daily functionality. For example, it can cause a person experiencing it to feel numb or detached from everyday reality. Keeping up with regular responsibilities while dealing with a sense of loss can be challenging. Even though it’s difficult to deal with, grief is considered a natural reaction, and it’s a universal experience, making it different from mental health conditions.

What Is Grief?

Grief can be a process or a spectrum of experiences occurring with a loss. It most often occurs after the loss of a loved one. It can also happen for different reasons, such as the loss of a significant relationship or a serious health diagnosis. When something or someone you love is taken from you, you naturally can experience grief as a result.

The experience can include a variety of feelings, such as shock and anger, disbelief, guilt, and sadness. It can affect your health physically, and the more significant the loss, the more intense you’re likely to experience grief.

The earliest days of a loss can be known as acute grief. However, as we survive those feelings, the pain is intense, but our brains can start to fathom the world where we’re missing something or someone we love.

At some point during the grief process, integration occurs. You may realize the experience changes you, and you can’t return to your old sense of normal. Instead, to cope with your feelings and stay connected with the memory of a loved one while still living with a sense of purpose, we integrate grief. Integrated grief exists as a part of your life in an ongoing way but doesn’t dominate it.

That’s not the same as prolonged grief disorder. Prolonged grief disorder is defined by intense, persistent symptoms similar to acute grief that interfere with daily life, are distressing, and cause problems.

What Are the Symptoms of Grief?

The symptoms of grief can affect you mentally, physically, and spiritually. Some symptoms are considered normal and healthy, but some symptoms can become unhealthy and may benefit from interventions.

Physical Symptoms

Physical grief symptoms can include:

• Weakened immune system
• Fatigue
• Nause
• Headaches
• Restless
• Stomach and digestive problems
• Weak muscles
• Heart palpitations
• Joint pain
• Tightness in the throat or chest
• Reduced or increased appetite
• Changes in sleep, like insomnia or sleeping too much

Emotional Symptoms

Emotional symptoms of grief, may include:

• Sadness
• Guilt
• Anxiety
• Loneliness
• Detachment
• Confusion
• Trouble with decision-making
• Feeling hopeless or lost
• Problems focusing
• Memory problems
• Having a hard time keeping up with responsibilities

Grief’s emotional symptoms tend to be confusing and often conflict with one another, for example:

• Sadness but, at the same time, relief that a loved one is at peace.
• Feelings that compete with one another include anger, sadness, apathy, and regret.
• Feelings of gratefulness that you don’t have to continue to provide care for a loved one who’s dying.
• Missing a spouse after a divorce but feeling excited about the chance of new love.

Unfortunately, some people may experience what is known as unhealthy symptoms of grief, which can include:

• Being unable to believe the death or situation happened.
• Identity disruption, like feeling that a part of yourself died.
• Avoiding reminders.
• Intense emotions such as bitterness or extreme anger.
• Problems reintegrating socially, pursuing interests, or making plans for the future.
• Emotional numbness
• Feeling a sense of meaninglessness about life.
• Intense detachment and loneliness.

An estimated 7-10% of adults will experience prolonged grief disorder or unhealthy grief symptoms. It can also lead to further mental health complications, including depression or post-traumatic stress disorder.

If grief symptoms become severe and prolonged, mental health treatment may be needed. Treatment with cognitive-behavioral therapy (CBT) approaches are often effective to reduce symptoms. Bereavement support groups may also help when paired with CBT or other therapeutic approaches.

Types of Grief

There are different types of grief, which can vary depending on the symptoms you might experience and the situations surrounding the trigger of the grief.

Anticipatory Mourning

This type of grief occurs before the loss of a loved one. You can also feel this if you’re facing your own death. Anticipatory grief is considered a state of painful, deep sorrow before an impending loss. Along with anticipatory grief related to a death, it can occur in other situations as well. For example, it can occur following a diagnosis of Alzheimer’s disease, an impending divorce, or the loss of a breast during a mastectomy.

Normal Grief

Normal grief is also known as uncomplicated grief. Normal grief means that someone is working through their feelings in a way that’s in line with cultural expectations. This doesn’t mean that normal grief is better than complicated grief; it is just a way to describe the different impacts and symptoms. Grief is necessary when going through a loss, and while there are variations between people, there are also often shared experiences and emotions following a major loss. Those shared concepts are normal grief.

Secondary Loss

The term secondary loss is different from primary loss. Primary loss would, for example, be the actual death of a loved one. The experiences that come from that death are secondary losses, such as a loss of health, relationships, self-worth, financial stability, or hopes and dreams.

Complicated Grief

Complicated grief is when grief lingers or gets worse. It’s an ongoing state of mourning that prevents healing. Signs and symptoms of complicated grief can include intense rumination, focusing on very little else aside from the loss, or extreme focus on reminders. Excessive avoidance of reminders can also be a symptom of complicated grief. It can lead to problems with everyday routines, depression, isolation, or belief that you could have prevented the death. You may feel as if life doesn’t have meaning, or you could feel an inability to enjoy your life.

Chronic Grief

Chronic grief is sometimes a term used interchangeably with complicated grief or prolonged grief. Symptoms of chronic grief can include a fixation on a person you lost, making it hard to function in a variety of settings. For many people, the painful feelings and thoughts following a loss begin to improve after six months. For someone with chronic grief, they not only linger but worsen.

Absent Grief

Absent grief is characterized by showing little, if any, signs of normal grief. It’s thought to be related to avoidance or denial of the loss. Symptoms can include no signs or symptoms of grief at all, forgetting about the loss, denial, a lack of connection to the loss, and irritability.

Cumulative Grief

Cumulative grief is also known as compounded grief, which stems from a series of losses over a relatively short period of time. For example, someone experiencing compounded grief could lose a loved one, a financial loss, and be diagnosed with a medical condition all in a short time. People with routine trauma exposure, individuals with substance use disorders or depression, and people with a lack of social support are more likely to go through cumulative grief. Older people and people in an environment such as a war zone are also more susceptible.

Disenfranchised Grief

Disenfranchised grief occurs when your grieving doesn’t fit with societal views about dealing with loss. Society has certain expectations for how we should deal with the grieving process. If your symptoms or experiences don’t fit in with that, then you may have a hard time finding social support or sympathy from others.

Causes of Grief

There are many causes of grief, aside from losing someone you love, including:

• Separation or divorce
• Losing a pet
• Giving up something important to you
• Changes at work, like losing your job or retiring
• The loss of good health because of a disability or health condition
• Infertility or miscarriage
• Being diagnosed with a terminal illness
• Having a loved one who has a terminal illness, mental illness, or disability
• A move away from people you love
• Being an empty nester when children leave home

Certain risk factors can worsen the symptoms of grief and make complicated grief more likely. For example, people with a history of depression or bipolar disorder, older adults, and caregivers are also more at risk for severe grief symptoms and the development of complicated grief. If the death of a loved one is sudden or occurs under highly traumatic situations, there’s also more likelihood of complicated grief occurring.

Process Model of Grief

Elizabeth Kubler-Ross coined the Process Model of Grief. The psychiatrist introduced a five-stage model of grief in her book, On Death and Dying. She based her model on her experience working with terminally ill patients. Now, Kubler-Ross admits the stages aren’t linear, and some people may not experience any of them, but still, these five stages of grief are frequently seen. Other models of grief include the Dual Process Model and the Four Tasks of Mourning.

Five Stages of Grief

Kubler-Ross’s model introduced the five stages of grief. These are:

• Denial: You may go numb and wonder how your life will go on in its new state. You’re in a state of shock at this time, and you may not feel like you’re living in reality. You could cling to false hopes or develop a preferable reality.
• Anger: In the five-stage model, after you start to live in actual reality, you might start to feel anger. You could blame others, feel life isn’t fair, or wonder why this happened to you. Most mental health professionals believe anger is a necessary part of grieving.
• Bargaining: There’s a sense of false hope in this stage where you might believe you can negotiate with God or a higher power or do something differently to bring back your life to the way it was before a loss.
• Depression: This is frequently associated with grief, occurring as a reaction to feelings of emptiness when we live in reality and realize the situation or person is gone.
• Acceptance: The final stage of grief in this model is acceptance. It’s not that it’s okay that you lost someone or something you love, but you’re realizing you’ll be okay as you move forward. You re-enter reality, and your emotions start to stabilize as you readjust.

Dual Process Model

Margaret Stroebe and Henk Schut created the Dual Process Model of Coping with Bereavement in 1995. In this model, there’s an oscillation between what are called loss-oriented and restoration-oriented phases through the processing of grief. At times, you could look backward and miss what you’ve lost. At other times, you may focus more on the present and the future and on repairing your life after a disruption.

Four Tasks of Mourning

The four tasks of mourning were outlined by psychologist William Worden, who was critical of the Kubler-Ross model. Worden believes that during mourning, it’s important to engage actively in four tasks rather than handle them passively. The four tasks of grieving or mourning, as outlined by Worden, are:

• Accept the reality of the loss as it is.
• Experience the pain of grief.
• Adjust to an environment in which the deceased is missing.
• Find an enduring connection with the deceased while embarking on your new life.

The concept empowers you to adjust to your new normal and continue with daily life, but do hard work to get through it in the process.

Grief’s Impact on Mental Health

If someone has a pre-existing mental health disorder, such as depression or anxiety, they are at a higher risk of developing complicated grief. Even in someone without a pre-existing condition, grief can trigger emotional crises. Depression can have similar symptoms to grief and may develop, as can post-traumatic stress disorder.

Grief and Substance Use

Grief is commonly something shared by people who are in treatment for a substance use disorder. It’s common by the time someone enters recovery to have dealt with grief and several losses. Some people begin using drugs or alcohol for the first time to deal with a loss. Other people may already be in the midst of addiction and suffer a loss. The effects of substances can include emotional numbing, which is why they can become a coping mechanism for grief.

Unfortunately, substance use can block the process of grieving, meaning the loss remains unresolved. Unresolved grief can then turn into complicated grief disorder and other complications. It’s often said that dealing with grief through substance use can mean you trade temporary relief or peace for long-term suffering. You could become locked into an ongoing, long-term cycle of grief and addiction.

Grief Treatment Options

Therapy is one of the most effective, evidence-based treatments for grief. Medication may also be part of a grief treatment plan, depending on the needs of the individual. If you’re dealing with grief and substance use issues, an integrated treatment plan known as dual diagnosis can help you recover from this debilitating cycle.

At The Recovery Village, in addition to dual diagnosis addiction and mental health treatment programs, we also offer primary mental health services.

Please reach out to our Recovery Advocates today to learn more or take the next step.