Grief

Alternative names 
Mourning; Grieving; Bereavement

Definition

Grief is a reaction to a significant loss. It is most frequently an unhappy and painful emotion triggered by the death of a loved one. These same emotions can also be experienced by someone with a terminal illness who expects to die, or by someone with a chronic condition who must deal with a loss of autonomy. The end of a significant relationship often results in a grieving process as well.

Causes, incidence, and risk factors

Everyone experiences grief in their own way, but generally there are recognized stages to the process of mourning. It starts at the recognition of a loss and extends to the eventual acceptance of it. Responses will vary depending upon the circumstances associated with the death.

For example, if the deceased suffered from a chronic illness, the death may have been anticipated, and may even come as a relief of suffering. If the death was accidental or violent, coming to a stage of acceptance may take longer.

Symptoms

There are typically 5 stages of grief. These reactions do not occur in a specific order, and may (at times) show simultaneously. Not all of these emotions are necessarily experienced:

     
  • Denial, disbelief, numbness  
  • Anger, blaming others  
  • Bargaining (e.g., “If I am cured of this cancer, I will never smoke again.”)  
  • Depressed mood, sadness, and crying  
  • Acceptance, coming to terms

Individuals who are grieving will frequently report crying spells, some trouble sleeping, and difficulty being productive at work.

Signs and tests

     
  • Prolonged symptoms may lead to clinical depression.  
  • Physiological signs of depression may be present, such as sleep and appetite disturbance.

Treatment

Emotional support for the grieving process is usually provided by family and friends. Sometimes outside factors can influence the normal grieving process, and outside help from clergy, social workers, mental health specialists, or self-help groups may be indicated.

The acute phase of grief can usually last up to 2 months, but some residual milder symptoms may extend a year or longer. Psychological counseling may benefit a person suffering from absent grief reaction, or from depression associated with grieving.

Support Groups
The stress of grieving can often be helped by joining a support group where members share common experiences and problems. See loss of a child - support group or loss of a spouse - support group.

Expectations (prognosis)


Grieving may take a year or longer to overcome strong feelings associated with loss, and to reach acceptance.

Complications

Grief and loss can have an adverse effect on overall health. It can contribute to depression or excessive use of alcohol or drugs. Major depression is also a complication. Debilitating grief that interferes with daily life lasting for more than two months may be indicative of more severe illness.

Calling your health care provider

Call your health care provider if you are unable to deal with grief, are using excessive amounts of drugs or alcohol, become severely depressed, or have prolonged depression that interferes with your daily functioning.

Prevention
Grief is a healthy response to loss that should not be prevented. Rather, it should be respected, and support should be provided to the grieving.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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