Grief Reaction: What Is Normal After a Loss

What a grief reaction is

Grief is how the mind and body adjust to a loss. Doctors call the period after a death bereavement, the inner experience grief, and the outward ways people express it, shaped by culture and religion, mourning.

Grief is not only about death. Similar reactions follow divorce, miscarriage, a serious diagnosis, losing a job or home, the death of a pet, or a loved one's dementia (sometimes called anticipatory or ambiguous grief). When distress after a loss such as divorce or redundancy is out of proportion and disrupts daily life for months, doctors may diagnose adjustment disorder.

Symptoms of grief

Emotional

• deep sadness and yearning or longing for the person
• crying, often in sudden waves ("grief bursts") set off by a song, a smell or a date
• numbness or disbelief, especially early on
• anger at the person, doctors, God or yourself
• guilt about things said or not said, or relief after a long illness, followed by guilt for feeling relief
• anxiety, including fear about your own health or other losses

Physical

• tiredness and low energy
• trouble sleeping or sleeping too much
• poor appetite and weight change
• a tight chest or throat, sighing, aches and headaches
• getting colds more easily, as stress affects immunity

Thinking and behavior

• poor concentration and forgetfulness
• preoccupation with the person or the circumstances of the death
• briefly sensing the person's presence, hearing their voice or seeing them in a crowd; this is common and not a sign of mental illness
• avoiding reminders, or keeping their belongings exactly as they were
• withdrawing from friends

The "stages of grief" and how grief really works

The five stages described by Elisabeth Kübler-Ross (denial, anger, bargaining, depression, acceptance) were based on people facing their own death. They are a helpful vocabulary, but research shows grief does not move through fixed stages in order. Most people swing back and forth between feeling the loss and getting on with daily life. This dual process is healthy. Over time the moments of intense pain become shorter and less frequent, and the person can remember the loss with warmth as well as sadness.

How long grief lasts

There is no set timetable. Typically:

• First days to weeks: shock, numbness and intense distress
• First months: strong yearning, sadness and disrupted sleep and eating
• 6 to 12 months: for most people, the acute pain eases and life starts to feel livable again
• Long term: grief remains but is integrated. Anniversaries, birthdays and holidays can bring back strong feelings for years.

Sudden, violent or traumatic deaths, the death of a child, and losses with complicated relationships often lead to longer and more difficult grief.

Grief vs depression

Grief and depression share sadness, poor sleep and low appetite, but they differ in important ways.

Hopelessness and thoughts that life is not worth living are not part of normal grief and need prompt help (see suicidal ideation). Major depression can develop during bereavement, and current guidelines say it should be diagnosed and treated even when a loss is the trigger.

Prolonged grief disorder

A minority of bereaved people, around 7 to 10%, develop prolonged grief disorder (previously called complicated grief). The American Psychiatric Association's DSM-5-TR diagnoses it when, at least 12 months after a death (6 months for children), a person has intense yearning or preoccupation nearly every day, along with symptoms such as:

• feeling part of themselves has died
• marked disbelief about the death
• avoiding reminders
• intense emotional pain, anger or bitterness
• difficulty re-engaging with life, numbness, meaninglessness or intense loneliness

and this causes major problems at home, work or socially. The World Health Organization's ICD-11 uses a 6-month threshold.

Risk is higher after sudden or violent deaths, the death of a child or partner, with a history of depression or anxiety, and with little social support.

Coping with grief

• Let it come: crying and talking about the person help. Suppressing grief tends to prolong it.
• Keep basic routines: regular meals, a set bedtime and daily time outdoors.
• Stay connected: accept practical help, and tell friends what you need. Many people want to help but do not know how.
• Limit alcohol and sleeping pills, which worsen sleep and mood over time.
• Delay big decisions, such as selling a home, for about a year if you can.
• Plan for hard days: anniversaries and holidays are easier with a plan, such as a ritual, a visit or company.
• Join a support group, through hospices, faith groups or organizations for specific losses such as suicide or the loss of a child.

Treatment when grief needs help

• Grief counseling from a counselor, hospice bereavement service or therapist
• Prolonged grief disorder therapy: a specific, structured talking therapy, usually around 16 sessions, that has been shown to work better than general therapy
• Cognitive behavioral therapy for linked depression, anxiety or insomnia
• Trauma-focused therapy when the death was traumatic and there are flashbacks; see post-traumatic stress disorder
• Antidepressants for major depression during bereavement. They are not used for normal grief.

Frequently asked questions

What is a normal grief reaction?

A normal grief reaction includes sadness, yearning, crying, sleep and appetite changes, tiredness, guilt, anger and poor concentration after a loss. It comes in waves, is triggered by reminders, and gradually becomes less intense over months while the person can still feel moments of comfort or pleasure.

What are the physical symptoms of grief?

Grief commonly causes fatigue, insomnia, appetite loss, aches, headaches, a tight chest or throat, sighing and getting ill more easily. These usually ease with time. New chest pain, palpitations or breathlessness should still be checked by a doctor, because they can have other causes.

How long does grief last?

The most intense phase usually lasts several months, and most people find the pain more bearable within 6 to 12 months. Grief never completely disappears, and anniversaries can bring it back for years. If grief is still overwhelming and disabling after a year, talk to a doctor about prolonged grief disorder.

How is grief different from depression?

Grief centers on longing for the person and comes in waves, with self-esteem usually intact. Depression is a constant low mood with loss of pleasure in almost everything, worthlessness and hopelessness. Both can occur together, and depression after a loss is treatable.

Is it normal to see or hear a loved one after they die?

Yes. Briefly sensing the presence of the person, hearing their voice or glimpsing them is common in the first months of bereavement and is usually comforting. It is not a sign of mental illness. Frightening or persistent experiences, or other unusual beliefs, should be discussed with a doctor.

What is prolonged grief disorder?

It is a recognized mental health condition in which intense yearning or preoccupation with the person who died continues nearly every day for at least a year (6 months in children) and seriously disrupts life. It affects a minority of bereaved people and responds well to a specific form of grief-focused therapy.