Grieving: Complete guide to what is it, phases, symptoms, and tips

When we lose a loved one we start to have all kinds of negative feelings and emotions. Grieving is a normal process when we lose someone or something important to us. But there are times when it can get complicated, making it difficult for us to continue with our lives. Discover here a useful guide: What is grieving, its characteristics, what are the stages and phases of mourning, symptoms, types, diagnosis pathological grief, tips to overcome grieving.

What is Grieving?- Definition

Grieving is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. It is a normal and necessary reaction, in which the person has to adapt to life without what they have lost. It can be the death of a loved one, breaking off a relationship, losing your job, etc. Grieving can appear during major life changes such as a chronic illness, loss of biological or physical function, etc.

Each person faces the loss of a loved one in a different way. Grieving is a necessary process in the face of any loss. If you understand your emotions, you seek support from your loved ones and take care of yourself, you can overcome it. 

Grieving: Characteristics

• The first emotional reaction in grieving implies the denial of the loss.
• Expressions of anger, deep sadness, and depressive symptoms might begin to show.
• The need to reestablish some kind of relationship with the deceased appears.
• Routines are interrupted.
• The person feels the need to restructure beliefs and attitudes towards life.

Phases of grieving- Bowlby

The next stages of grieving were first mentioned by John Bowlby, a British psychologist, and psychiatrist, long before Kubler-Ross’s well-known 5-stage model. Bowlby was known for his attachment theory. He applied what he knew about attachment to the grieving process.

Grieving Phase 1: Bewilderment, Stunned, Confused

This stage of grieving is usually brief (hours, days), and its main purpose is as a defense mechanism. It involves feeling shocked as if it weren’t real with a sense of numbness. Physical stress also appears during this phase, which can result in somatic symptoms. The most frequent verbalizations are “It is impossible”, “This can’t be happening”, “This must be a mistake”. Our brain tries to deny what happened to give us more time to process the loss slowly and not all at once. 

If we do not progress to the next phase it will be very difficult for us to accept and understand our emotions as well as express them. This might make us shut down emotionally altogether.

Grieving Phase 2. Deep sadness and Yearning

At this stage we are already aware of the void left by the loss. The future that we imagine is no longer possible. In this phase of grieving, we seek the comfort we used to have with the person who has left us, and we try to fill the void of their absence. We constantly try to find reminders or do activities that might make us feel closer to our loved one.

Once we have faced reality there are intense emotions, such as pain, fear, anger, guilt and resentment. It is normal to feel frustrated and irritable. We seem angry at ourselves, others and even the person that has just left. Rationally we know that we can’t blame them but emotionally we are angry this all leads to feeling guilty for being angry.

During this phase, people start questioning  “What would have happened if …?” “I should have done…”, “I didn’t pay enough attention…”

If we stall in this phase, according to Bowlby, we will spend our lives trying to fill that void of loss and having our mind constantly on that loved one.

Grieving Phase 3. Disorganization-Despair

In this phase of grieving, we become aware of the loss and accept that everything has changed and will not be as it was or as we imagined. Depression symptoms appear such as apathy and disinterest, sustained sadness, loneliness, and lack of goals. It feels as though life will never improve or make sense again without the deceased or the person that left. We may even drive others away from us.

If we don’t overcome this stage we will continue to be consumed in sadness, depression, and our attitude towards life will be negative and hopeless.

Grieving Phase 4. Reorganization-Recovery

This is the last phase of grieving. It is when faith in life begins to recover. In it, the loss is accepted, but hope reappears, new goals, new relationships. Gradually you begin to rebuild and you realize that life can be positive even after the loss. Confidence is slowly restored. In this phase, grief is not completely gone, but the loss has no primary influence in what we do.

Stages of grieving- Kubler-Ross

Grieving Stage 1: Denial

In this grieving stage, the world becomes meaningless and overwhelming. Similiar to Bowlby’s first phase, life makes no sense and we go numb. Denial and shock help us to cope and helps us to pace our feelings of grief.

Grieving Stage 2: Anger

Anger is a necessary stage of the healing process. It’s important to feel it since the more you truly feel it, the more it will begin to dissipate and the more you will heal. Anger is really pain, pain from feeling abandoned. It gives a temporary structure to the numbness and uncertainty that can be death.

Grieving Stage 3: Bargaining

In this stage of grieving the person is so desperate to get back the person gone that “deals” and bargaining strategies begin. Common phrases are  “Please God”, “I will never be angry at my wife again if you’ll just let her live”.  Guilt is the common emotion in this stage. The person engages in questions or statements such as “if only…”

Grieving Stage 4: Depression

After the anger and guilt, then the loss starts to settle and depression takes over. We start to withdrawal from life and let the feelings of sadness and loneliness settle in. Common phrases are “is there is any point in going on alone? Why go on at all?”. Keep in mind that depression in this process is entirely normal and necessary.

Grieving Stage 5: Acceptance

This grieving stage is not about saying “well ok this happened now I’m moving on”. This is a misconception that is in nowhere near what acceptance means. This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality. We will never like this reality or make it OK, but eventually, we accept it. We learn to live with it.

Grieving: Problems during the stages

The stages and phases mentioned are not linear or universal. Each person carries their own grieving process, which may be different from that of others. Also, it is not linear either, we may not go through all the phases or even repeat some. It is true that the phases are usually common, but are not mandatory.

There is no evidence that we all go through these phases. It is possible that we can, but it is also possible that we skip all but one, or that we pass quickly through and stay in acceptance. We may also repeat or create stages. In fact, the actual grieving is more like a roller coaster of emotions than a list of ordered stages.

In addition, many people feel bad for not following the stages but there is no right way or healthy way to do it.

Grieving Symptoms

Physical symptoms

• Feeling empty stomach
• Lack of energy, exhaustion
• Crying
• Sleep disturbances (insomnia or excessive sleepiness)
• Weight loss
• Chest tightness
• Loss of sexual desire

Psychological symptoms

• Strangeness
• Disbelief
• Irritability
• Confusion
• Hallucinations related to loss
• Concern about what has been lost
• Loss of illusion, disinterest
• Blame and guilt
• Anxiety
• Rage and anger towards doctors, God, family, friends, etc.
• Relief
• Feeling of abandonment
• Loneliness

Grieving Manifestations

Spiritual manifestations

• Awareness of one’s limitation
• Awareness of death
• Search for God, in the form of resentment, indifference or trust.
• Search for the meaning of life

Social manifestations

• Resentment towards society
• Feeling of isolation
• A new identity is created and new social roles are assumed.

What can influence the grieving process?

Not all grieving processes are the same. There are several factors that can determine the severity of the grieving process and its complication.

• Closeness to the deceased. Obviously, sadness will be greater the closer we are to the person we have lost.
• The type of relationship with the deceased. There is a greater risk of a complicated grieving process if the relationship is ambivalent or dependent. That is, the relationship is close but conflicting. This can trigger feelings of guilt over not having done certain things or not being able to change the relationship in some way.
• Little social support. Low family cohesion or the inability to express emotions will make the grieving process difficult.
• Whether there has been preparation or not. In chronic disease processes, people can prepare for the loss, so that grieving is usually somewhat more bearable. While when death is sudden, it can be more difficult.
• Religious beliefs. Religiousness, belief in God, and in heaven or a place “beyond” can help us face death. Culture can also influence how we see death.
• Previous psychological problems. Having already problems or psychological disorders at the time of loss can be a risk factor for a complicated grief.

Types of Grieving

• Delayed grieving: It has the characteristics of a normal grief but appears several months after the death. This may be due to the fact that during those months the emotional reactions of the grieving process have been suppressed, due to circumstances such as family, job stress, etc.
• Absent grieving: There is no emotional reaction as if nothing had happened. This happens because the person is in denial due to the traumatic loss.
• Chronic grieving: Grief extended in time with anxious, depressive symptoms, continuous and obsessive concern for the deceased. If left untreated, it can lead to depression, substance abuse, self-harm or even suicide.
• Inhibited grieving: Inability to clearly express sadness and grief, due to personal or social limitations. These emotions are likely to be channeled through physical manifestations, such as headaches, digestive problems, diseases, etc.
• Unauthorized grieving: Happens when your surroundings don’t let the person express their emotions. Others may minimize the importance of the loss. This can happen with the death of pets, friends, etc.
• Cumulative grieving: This happens when several losses occur in a short period of time. The person doesn’t have time to process one death, and another occurs.

What is Pathological Grieving?

Although it will depend a lot on the person, a normal grieving process usually lasts between 3 and 6 months. However, there may be people who need more time. The time you need to “heal” will depend a lot on your personality, your support system, your age, your beliefs.

The grieving begins to be problematic when the person who suffers it has stalled in some phase or stage of the grieving process and fails to move to the next phase. The pain doesn’t cease and if this is happening we may be facing a case of pathological grief.

Pathological Grieving Diagnosis

There is no consensus to diagnose pathological grieving but a series of criteria have been established:

Criteria A

Stress due to the separation that death implies. To do this, 3 of the following 4 symptoms must be presented each day or very intensely:

• Appearance of intrusive and repetitive thoughts about the deceased
• Yearning
• Searching constantly for the deceased even though you know he died
• Feelings of loneliness

Criteria B

Stress from the psychological trauma of death(4 of the 8 symptoms)

• Absence of goals and/or having the feeling that everything is useless
• Subjective feeling of coldness, numbness, indifference or lack of emotional response (emotional block)
• Difficulty accepting reality
• Feelings of emptiness and that life is meaningless
• Feeling that a part of yourself has died too
• Assume symptoms and inappropriate behaviors of the deceased or related to him
• Excessive irritability, bitterness, and/or anger in relation to death
• Alterations in the way we see and interpret the world

Criteria C

Symptoms last for at least six months.

Criteria D

Deterioration in all areas of the person’s life (work, social, family).

All this means that in order to be considered a pathological or complicated grieving process all criteria have to be met.

If the person can continue with his life reasonably well even if he continues to feel sad, he would not consider himself complicated.

In any case, it will depend on the person and the situation, so it is necessary to make a good evaluation first.

Grieving: When do we seek help?

It is always good to have people close to us who help us cope with the grieving. If you search for professional help, this will be more of a cane or aid to help you walk through the grieving process. It is advisable to seek professional help when we feel that our feelings don’t imporve and sadness doesn’t abandon us.

Seek professional help when:

• You have problems maintaining your daily routine, going to work, doing household chores.
• Feelings of depression
• Self-harm or thoughts that life is not worth living
• Inability to stop blaming yourself.

How to Overcome Grieving?

Sometimes we do not know how to deal with the death of a loved one. So, here we give you a series of tips and techniques to work through grieving that can help you.

• Avoid handling your emotions through drugs, alcohol, food, or work. These are ways to avoid facing reality and in the long run, won’t help you feel better.
• Give yourself time. Don’t push yourself. Don’t think “I should have gotten over this already.” Everyone has their time and their process. Accept your feelings.
• Talk to other people. Spend time with your loved ones, family and friends. Sometimes what we need is a hug. Do not be afraid to ask. Isolation is very harmful at these vulnerable times, and can accentuate depressive symptoms.
• Exercise, sleep, and eat well. Sometimes getting into a routine can help us get back into our lives. It is important not to neglect ourselves because this can make our grieving process worse.
• Take up your hobbies. If after the loss you have left aside those activities or hobbies that provided happiness, repeat them. This will help you improve your mood, keep you active and motivated.
• Join a support group. Talk to others who are going through grief. Sharing experiences and connecting with others can help you a lot too.
• Avoid leaving the room or belongings of the deceased as he left them. Leaving the room as a mausoleum can slow down the process of accepting the loss. You can leave photos or a small personal object, and donate the rest of the things. Don’t let the loss anchor you the past.
• Don’t make radical changes in your lifestyle. Sometimes people believe restarting everything and avoiding everything related to the deceased person will be better to overcome it. However these radical changes in life are an emotional avoidance. Change should be gradual and death is already a big change to digest.
• Cultivate your self-esteem and confidence in yourself. Sometimes, if we have depended heavily on the loved one we have lost, we feel useless and helpless. Our self-esteem may be harmed.

We hope this provided the information you needed and remember you are not alone, loads of people have been through grieving.

This article is originally in Spanish written by Andrea García Cerdán, translated by Alejandra Salazar. 

Andrea García Cerdán

Psicóloga General Sanitaria, experta en terapia sexual y de pareja. Ayudo a mejorar la calidad de vida de las personas mediante terapia psicológica y la comunicación a través de la red.