There are over 16 different classifications of grief – some with such subtle distinctions as to render a separate category non-sensical. This blog aims to better equip you to make sense of the terms you may have heard to describe different types of grief and to arm you with some information as to what is considered a ‘normal’ or ‘common’ response to a significant loss and when it may be appropriate to seek specialist help.

We all experience losses in life – not just when someone dies but when we lose anything that is important to us: our relationships, our dreams of having a family, our health, our home, our job, our independence, our pets, and our hopes or expectations. Grief comprises a collection of emotions that we may experience following a loss such as sadness, loneliness, fear, anger, guilt, shame, regret, disbelief, shock, and/or relief. Grieving is the active process of exploring those feelings and adjusting to life without the person or thing that you’ve lost. There is no right or wrong way to grieve; as Lois Tonkin states in her Brief Guide to Grief, ‘grief is like a fingerprint; everyone feels it and expresses it differently’.

Hang on a minute! If grief is unique to the individual how can it ever be defined as a normal grief? Perhaps a better term to use, therefore, might be uncomplicated grief – namely, the process whereby someone experiences physical, behavioural, emotional, and/or social reactions following a loss for a period of time but is able to move towards acceptance, to experience an alleviation of their symptoms, and to be able to function and engage in their daily activities.  With uncomplicated grief, a person may still feel intense bursts of numbness or pain. However, over time the intensity and frequency of those feelings tend to lessen until the individual adapts to a ‘new normal’ and their life starts to grow around their grief.

It is important to note that when we experience a significant loss we can often experience numerous additional or secondary losses following the primary loss. For example, the loss of a job may lead to the loss of a stable living situation, disruption to the relationship with your partner, a changed financial situation impacting your ability to participate in social activities and planned trips, more limited career prospects and the loss of your previously held dreams for the future. Each of these losses need to be reflected upon and processed in order to achieve a healthy outcome.

Sometimes we grieve for a loss that we know is coming. This is known as anticipatory grief and may arise when you or a loved one is diagnosed with a terminal illness, you anticipate a redundancy or job loss, you are relocating away from family and friends, or anticipating an impending divorce. When experiencing anticipatory grief, you may start envisioning your life after the loss and start to prepare and make plans for how you will respond. You may experience heightened anxiety and intense feelings associated with the loss of your life hopes and expectations.

Anticipatory grief can be challenging: on the one hand, you may feel helpless which can lead to feelings of anger, frustration and resentment; you may feel guilty for pre-empting the loss as if this makes you disloyal or uncaring; and/or you may find it challenging to stay in the moment and fully experience the time you have left. On the other hand, anticipatory grief may feel protective against events that are out of your control and/or may put you in a position to be better able to process a good ending and achieve peace and resolution so that you feel in a healthier place emotionally for when the loss occurs. That said, while for some people anticipatory grief lessens the impact of the loss when it does occur, this is not necessarily the case.

Sometimes grief can be relatively short-lived and is described as abbreviated grief. This could be because there was a period of anticipatory grief during which the individual has done work to process the loss beforehand, or it may be because there wasn’t a strong attachment to what was lost and the individual is able to move on with their life. Grieving for a short time does not mean that the individual did not care for that which was lost. As grief is unique, a short-lived grief can be entirely healthy and ‘normal’.

So what if your feelings of grief do not become less intense or less frequent following a loss? This is often described as prolonged, complicated or chronic grief. Prolonged grief is experienced by 10-20% of bereaved people who experience an extended period of grieving, lasting 6 to 12 months or longer, with symptoms so severe it becomes difficult to return to daily life. Symptoms of prolonged grief vary from person to person, but may include deep and constant feelings of guilt, feelings of emptiness, hopelessness and despair, low self-esteem, loss of identity, suicidal ideation, radical lifestyle change, and self-destructive behaviour (including self-medication through alcohol and/or drug use).

There are a number of factors that can lead to grief being more prolonged, complicated or chronic and can indicate the need for professional help from a practitioner specialising in loss and grief:

• • Traumatic grief is a common result of trying to process grief and trauma at the same time – often where there is a sudden, unexpected loss or where the loss occurs in horrific or violent circumstances. It can result in an impairment of your daily functioning in life and can be accompanied by survivor’s guilt. Some people who have experienced a traumatic loss may develop PTSD-like symptoms such as anxiety, panic or overwhelm, flashbacks, intrusive thoughts and images, or feel numb or ‘spaced out’. In these cases an intervention like EMDR can be beneficial.

• • Distorted or exaggerated grief is a very intense or extreme reaction to a loss, often accompanied by behavioural changes, anger/hostility, suicidal ideation and ‘acting out’ or self-destructive behaviours such as alcohol or drug use.

• • Disenfranchised grief (sometimes described as hidden or ambiguous grief) is the term used when an individual feels that their loss and the grief that ensues is unrecognised or invalidated by those around them and/or by society as a whole. Examples include the death of an ex-partner, sibling, estranged family member, work colleague, pet or someone you did not know for a long time; the loss of your health or that of a loved one; an abortion; an early miscarriage; a failed IVF cycle; retirement; loss of independence arising from social care needs; loss of faith; or following the end of an extra-marital affair. It can also arise when there is a perceived stigma associated with the manner of death such as death by suicide or drug overdose. In such circumstances, the individual may receive little support or compassion which can leave them feeling exceptionally isolated and unseen and/or may lead to them suppressing their feelings which, in turn, may lead to delayed or inhibited grief described below.

• • Delayed grief refers to when grief reactions to a significant loss are delayed for a period of time. This can occur when an individual has either consciously or unconsciously suppressed their feelings following a significant loss. When this suppression is done consciously (possibly to maintain privacy or keep their emptions hidden from family and friends) it is described as inhibited or absent grief. The suppression of emotions, irrespective of whether this takes place consciously or unconsciously, consumes an inordinate amount of emotional energy which can lead to the emergence of other seemingly unrelated physical symptoms or maladaptive coping strategies such as excessive use of alcohol. This is sometimes referred to as masked grief.

• • Cumulative grief occurs when someone experiences multiple losses within a short space of time which can lead to the individual being unable to process each loss. It is also used to describe a situation when a current loss triggers previous unresolved losses so one experiences a ‘tsunami of grief’ all at once. This can be exceptionally confusing to an individual who may be unaware that their current distress is connected to their previous unprocessed loss(es).

Unresolved losses have a tendency to make their presence known – sometimes when you least expect it. It’s like leaving a stone in your shoe instead of removing it. Not only do you subsequently need to remove the stone but you now also have a blister to contend with!

Get in touch to see how we can work together to make sense of your loss, to relieve intrusive thoughts and images, and to better manage your thoughts and feelings; helping you to stop feeling stuck, to adjust to events and changes in your life, and to begin to embrace life more fully.