Grief & Bereavement

What Is Grief?

Grief is the natural emotional response to loss — most commonly the death of someone you love, but also the loss of a relationship, a job, health, a home, or any significant part of your life. Grief is not a disorder. It is a deeply human experience that involves pain, adjustment, and ultimately, finding a way to carry the loss forward.

However, for some people, grief becomes so intense, prolonged, or debilitating that it interferes with daily functioning long after the loss has occurred. When this happens, it may meet the criteria for Prolonged Grief Disorder (PGD), a condition newly recognized in the DSM-5-TR and the ICD-11, affecting an estimated 7 to 10 percent of bereaved adults according to research published in World Psychiatry.

7–10%

Source: Lundorff et al., World Psychiatry, 2017

Signs and Symptoms

Grief affects people emotionally, physically, cognitively, and behaviorally. There is no single "right" way to grieve, and the intensity and duration of symptoms vary widely from person to person.

These responses are normal and expected after a significant loss. They do not indicate a mental health disorder. Most people experience a gradual reduction in the intensity of grief over the first 6 to 12 months, even though waves of grief may continue to arise around anniversaries, holidays, and other reminders for years to come.

Types of Grief

While every experience of grief is unique, clinicians and researchers have identified several patterns:

Normal (Uncomplicated) Grief

The most common grief trajectory. While intensely painful, normal grief follows a general pattern of acute distress that gradually lessens over time. The bereaved person is eventually able to re-engage with life, form new relationships, and find meaning — even while carrying the loss. This does not mean forgetting; it means integrating the loss into one's ongoing life.

Prolonged Grief Disorder (PGD)

Recognized in the DSM-5-TR (2022), PGD is diagnosed when intense grief persists for at least 12 months after a death (6 months in the ICD-11) and is characterized by persistent yearning for the deceased, preoccupation with the death, identity disruption (feeling that part of yourself died), and marked difficulty returning to daily activities. PGD is distinct from depression and PTSD, though they can co-occur.

Anticipatory Grief

Grief that begins before the actual loss — such as when a loved one has a terminal illness. Anticipatory grief allows some people to begin processing the loss gradually, but it can also be exhausting and isolating, especially when others expect you to "stay strong" for the person who is ill.

Disenfranchised Grief

Grief that is not openly acknowledged or socially supported — for example, the loss of an ex-partner, a pet, a pregnancy, a person who died by suicide or overdose, or a relationship that others did not know about. The lack of social validation can intensify grief and delay healing.

Traumatic Grief

When a death occurs through sudden, violent, or traumatic circumstances — homicide, suicide, accident, disaster — the bereaved person may experience grief intertwined with traumatic stress symptoms such as intrusive images, hypervigilance, and avoidance. This presentation often requires treatment that addresses both grief and trauma.

Causes and Risk Factors

Grief itself is not caused by a disorder — it is caused by loss. However, certain factors increase the risk that grief will become prolonged or complicated:

• Nature of the relationship: The loss of a child, a spouse or life partner, or a person with whom you had a deeply enmeshed or dependent relationship carries a higher risk for prolonged grief.
• Circumstances of the death: Sudden, unexpected, violent, or traumatic deaths are more likely to lead to complicated grief than deaths that were anticipated.
• History of mental health conditions: Pre-existing depression, anxiety, or PTSD increases vulnerability to complicated grief.
• Insecure attachment style: People with anxious or avoidant attachment patterns may have more difficulty processing loss.
• Lack of social support: Grieving in isolation, or in an environment where grief is minimized or discouraged, increases risk.
• Multiple losses: Experiencing several significant losses in a short period can overwhelm a person's coping capacity.
• Unresolved conflict: If the relationship with the deceased involved significant unresolved conflict, ambivalence, or abuse, grief can be more complicated.

How Grief Affects Daily Life

Grief reaches into every area of a person's functioning:

• Work and cognitive function: "Grief brain" is real. Many bereaved people experience difficulty concentrating, forgetfulness, reduced productivity, and impaired decision-making that can last for months.
• Relationships: Grief can create distance in relationships, especially when people grieve differently or when others become uncomfortable with the duration or intensity of your grief. Some relationships are lost; others are deepened through shared mourning.
• Physical health: Research published in JAMA Internal Medicine found that the risk of heart attack increases 21-fold in the 24 hours following the death of a loved one. Bereaved individuals also have elevated rates of immune dysfunction, sleep disorders, and mortality — particularly older adults who lose a spouse.
• Identity and meaning: The loss of a significant person can shatter your sense of identity, purpose, and worldview. Parents who lose a child, for example, often describe losing not just a person but an entire envisioned future.
• Spiritual and existential distress: Many bereaved people struggle with questions of meaning, fairness, and faith that can be profoundly disorienting.

21x

Source: Mostofsky et al., Circulation, 2012

Evidence-Based Treatments

Most people do not need professional treatment for grief — social support, time, and personal resilience are sufficient for the majority. However, when grief is prolonged, complicated, or accompanied by significant functional impairment, evidence-based treatments can help.

Complicated Grief Treatment (CGT)

Developed by Dr. M. Katherine Shear at Columbia University, CGT is the most rigorously studied treatment specifically designed for prolonged grief disorder. It integrates elements of CBT, interpersonal therapy, and motivational interviewing with grief-specific techniques including revisiting the story of the death, situational exposure to avoided reminders, and structured work on personal goals. A randomized controlled trial published in JAMA Psychiatry found CGT to be significantly more effective than standard interpersonal therapy for prolonged grief.

Cognitive Behavioral Therapy (CBT)

CBT adapted for grief helps individuals identify and challenge unhelpful thought patterns that maintain intense grief — such as "I should have prevented it," "I can never be happy again," or "If I let go of the pain, I'm letting go of the person." CBT for grief also includes behavioral activation to help the bereaved gradually re-engage with meaningful activities.

Acceptance and Commitment Therapy (ACT)

ACT helps bereaved individuals learn to hold their grief with openness rather than fighting against it or being consumed by it. ACT focuses on identifying personal values and taking committed action toward a meaningful life even in the presence of pain. This approach can be particularly helpful for people who feel stuck between wanting to move forward and fearing that doing so means betraying the deceased.

Interpersonal Therapy (IPT)

IPT addresses grief through the lens of relationships — helping the bereaved person process the loss, navigate changed social roles, and strengthen their support network. IPT is well-suited for grief that involves significant relationship disruption or social isolation.

Group Therapy and Support Groups

Grief support groups — both professionally led and peer-based — provide a space where bereaved individuals can share their experiences with others who understand. Groups normalize the grief experience, reduce isolation, and offer practical coping strategies. Research supports group-based interventions for both normal and complicated grief.

Co-Occurring Conditions

Grief — particularly prolonged or traumatic grief — frequently co-occurs with other mental health conditions:

• Depression: Prolonged grief and major depression co-occur in approximately 50 percent of cases. While they share symptoms like sadness and withdrawal, grief-specific yearning and preoccupation with the deceased distinguish PGD from depression.
• PTSD: When loss occurs through traumatic circumstances, grief and PTSD symptoms can become intertwined. Trauma-focused treatment may be needed before grief processing can proceed.
• Anxiety disorders: Heightened anxiety — including health anxiety, separation anxiety, and generalized worry — is common in the aftermath of loss, particularly if the death was sudden or unexpected.
• Substance use disorders: Some bereaved individuals use alcohol or drugs to numb their pain. This pattern provides temporary relief but delays grief processing and creates additional problems.

When to Seek Help

Consider reaching out to a mental health professional if you:

• Feel unable to carry out daily responsibilities months after the loss
• Experience intense grief that is not gradually improving after 6 to 12 months
• Are preoccupied with the circumstances of the death to the point of significant distress
• Feel that life has no meaning or purpose without the person who died
• Are avoiding people, places, or activities that remind you of the deceased to an extent that shrinks your life
• Are using alcohol, drugs, or other substances to cope with grief
• Have thoughts of wanting to die or of joining the deceased person

Seeking help for grief is not a sign of weakness, and it does not mean something is wrong with you for grieving. It means the weight of what you are carrying is too heavy to bear alone, and a skilled therapist can help you find your footing.

Frequently Asked Questions

You Don't Have to Carry Grief Alone

If grief is overwhelming your life, a therapist trained in bereavement can help you find a path through the pain — without asking you to forget.

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