7 Types of Grief People Can Experience During the End of Life

Anyone facing the end of life or the death of someone they love wishes that there was an instruction manual detailing how to manage grief. Unfortunately, there are no road maps for bereavement outlining what to do and what to expect. Everyone responds to grief differently depending on their perspective, experience with loss, and the circumstances surrounding the death.

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Many people embrace the idea that there are five distinct and predictable stages of grief: denial, anger, bargaining, depression, and acceptance. This concept was made popular by Elisabeth Kubler-Ross in her book On Death and Dying first published in 1969. People liked the idea that there could be a predictability to grief. It was comforting for many to think that there was an end point and you could eventually be “done” with grief. But the five stages of grief were never meant to explain bereavement after the death of a person. These stages were originally intended to describe the experience of a person dying.

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Even though grief does not operate on a specific timeline or in prescribed stages, there are several different types of grief. Understanding the different types of grief can help you recognize that you are not alone in your experience and enable you to identify what type of support might be beneficial following a significant loss.

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Normal Grief

Grief feels anything but normal. Your life feels turned upside down and you can experience a wide range of emotions. However, grief is a normal reaction to the loss of a person or thing. We grieve the loss of things we love and cherish.

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So-called “normal grief” describes the common physical, emotional, and psychological reactions to loss. A person experiencing normal grief can generally integrate the death or loss into their experience and continue to engage in daily activities. In normal grief, grief symptoms (such as exhaustion, confusion, sleep changes, changes in appetite, sadness, lack of pleasure and interest, etc.) tend to alleviate over time. With normal grief, a person gradually learns that they can make space for both joy and pain in their life.

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Anticipatory Grief

Anticipatory grief is experienced when someone knows that a loss is imminent. The complicated emotions that surface when imagining a future loss describe anticipatory grief. One might experience anticipatory grief when given a terminal diagnosis or being told by their medical team that there are no other treatments available. A patient may start to anticipate and grieve the loss of their health and independence. Friends and family members begin to imagine what life will be like without their loved one. They start letting go of plans and dreams they may have hoped for with this person. Individuals might feel guilty or conflicted that they are grieving someone who is still living, but this is a common and normal reaction.

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Anticipatory grief may motivate a person to prepare for their own death. This might look like creating a will or death care plan, engaging in meaningful experiences, and spending time with their loved ones. Anticipatory grief can also inspire people to repair relationships, create memories, and say goodbye.

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Delayed Grief

Delayed grief occurs when grief symptoms surface long after a person has died, or a loss occurred. A bereaved individual may suppress the emotions they are feeling only to find themselves impacted by the loss when they least expect it. A teen who experienced the death of a parent in elementary school may find themselves overcome with grief when they realize that their parent will not be there to teach them how to drive or attend their high school graduation. Other people may have so much to manage after a significant loss, such as settling an estate or taking care of young children, that are unable to process their grief until life slows down. The feeling of being numb or in shock after a loss can be the brain’s way of helping a person survive until they have the physical and emotional bandwidth to grieve.

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Cumulative Grief

Cumulative grief, also known as “grief overload”, occurs when someone experiences more than one significant loss at a time. The bereaved individual does not have time to process an initial loss before contending with a second loss. Many individuals during the COVID-19 pandemic dealt with the death of several friends and family members within a relatively short period of time. Communities impacted by gun violence grieve multiple losses at the same time along with their sense of safety and security. This can lead to feeling emotionally overwhelmed and overloaded. Cumulative grief can also challenge an individual’s faith, their value system, and how they see the world.

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Disenfranchised Grief

Disenfranchised grief describes the experience of dealing with a loss that is not recognized or acknowledged by friends, family members, or the community. Kenneth Doka, a grief researcher, said that disenfranchised grief “is not openly acknowledged, socially validated, or publicly observed.” An individual whose grief is disenfranchised often feels isolated and lacks support from others. There are no sympathy cards and neighbors bringing over flowers or meals. Disenfranchised grief includes situations like:

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• Grieving an ex-spouse
• A death by suicide or overdose
• Miscarriage or stillbirth
• A co-worker’s death
• The death of a celebrity
• Loss of a job or home
• The death of a partner in an extramarital affair
• The loss of a foster child when they are transferred or reunited with biological family
• A death due to HIV/AIDS
• Pet loss
• The death of a person involved in criminal activity
• The death of someone with whom you used to be close

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If you are grieving a loss that is not recognized by others, it is important to find places where you feel heard. A support group, therapist, or grief coach can offer you the support you are not getting else ware.

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Traumatic Grief

Traumatic grief occurs when the circumstances involving the death are distressing, violent, frightening, or unexpected. Individuals with traumatic grief may become preoccupied with how a loved one died. They may experience bad dreams, flashbacks, intrusive thoughts and feelings, anxiety, numbness, avoidance, anger, changes in sleep or appetite, or post-traumatic stress disorder. A person grieving a traumatic loss may have difficulty engaging in their daily activities. If traumatic grief symptoms impact your daily life and don’t seem to be subsiding, reach out for support from a mental health professional.

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Complicated Grief

Feeling devastated after the loss of a loved one is common and normal. Grieving individuals often experience a period of acute grief after a significant loss. Complicated grief, also called persistent complex bereavement disorder, occurs when a person’s acute grief symptoms don’t improve over time. Complicated grief can look like depression, but it’s not the same. An individual experiencing complicated grief feels hopeless that they can have a meaningful life without their loved one. Dysfunctional thoughts, feelings, and behaviors begin to interfere with a person’s daily activities and ability to have healthy relationships. Complicated grief makes it difficult for an individual to adapt or have any hope for their future.

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If you think you might be experiencing complicated grief, seek the support of a mental health professional or grief coach to talk about what you are feeling.

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Tasks of Mourning

Even though everyone grieves differently and experiences different types of grief, there are several tasks of mourning that we all work through after a loss. William Worden, a grief theorist, outlined 4 tasks of mourning in his book Grief Counseling and Grief Therapy. These tasks include:

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1. Accepting the reality of the loss

2. Working through the pain of grief

3. Adjusting to an environment in which the deceased is missing

4. Finding an enduring connection to the deceased while embarking on a new life

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The first task acknowledges that someone is gone through participating in funeral arrangements or memorial services, reflecting on the relationship with the person who died, and accepting how the person died. The second task speaks to experiencing the wide range of emotions that occur in grief. The third task involves adjusting to the impact that the death of a person had on your daily life and routines. Finally, the fourth task speaks to integrating your loved one’s memory into your present and future. These tasks of mourning do not have to be completed in any certain order or within a certain time frame. Individuals may even find themselves coming back to certain tasks in their grief.

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Your emotions are important and real no matter what type of grief you are currently experiencing. David Kessler, a well-known expert and author on grief, explains in his book Finding Meaning: The Sixth Stage of Grief that:

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“Each person's grief is as unique as their fingerprint. But what everyone has in common is that no matter how they grieve, they share a need for their grief to be witnessed. That doesn't mean needing someone to try to lessen it or reframe it for them. The need is for someone to be fully present to the magnitude of their loss without trying to point out the silver lining.”

Everyone needs their grief to be acknowledged and validated. Seek out supportive friends, a support group, grief resources, or the help of a grief coach so that you have a safe place to talk about what you are feeling. Getting support can help you with the emotional tasks of mourning. You are not alone in your grief.  

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References:

1. ‍64 Examples of Disenfranchised Grief. (2018, April 3). Whats Your Grief. https://whatsyourgrief.com/64-examples-of-disenfranchised-grief/
2. ‍Complicated grief - Symptoms and causes. (n.d.). Mayo Clinic. Retrieved July 6, 2022, from https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374
3. ‍Complicated Grief Overview | Center for Complicated Grief. (n.d.). The Center for Prolonged Grief. Retrieved July 6, 2022, from https://prolongedgrief.columbia.edu/for-the-public/complicated-grief-public/overview/
4. Five Stages Of Grief - Understanding the Kubler-Ross Model. (n.d.). Psycom.Net - Mental Health Treatment Resource Since 1996. Retrieved July 5, 2022, from https://www.psycom.net/stages-of-grief
5. ‍Traumatic Grief: What it Is, Symptoms, and How to Cope. (2022, January 25). Psych Central. https://psychcentral.com/health/traumatic-grief
6. ‍Types of Grief: Yes, there’s more than one. (2013, July 26). Whats Your Grief. https://whatsyourgrief.com/types-of-grief/
7. ‍What Is Anticipatory Grief? (n.d.). Verywell Mind. Retrieved July 5, 2022, from https://www.verywellmind.com/what-is-anticipatory-grief-5207928
8. ‍Worden’s Four Tasks of Mourning. (2013, June 24). Whats Your Grief. https://whatsyourgrief.com/wordens-four-tasks-of-mourning/