Understanding Bereavement After a Loss

The loss of a loved one is one of the most painful experiences we'll have in life. Bereavement refers to the state of having experienced the loss of a loved one. It most often refers to the time after a loss when emotions are at their most profound. This time is marked by intense grief and tremendous sorrow.

The term is sometimes used synonymously with grief and mourning. How people experience this time of grief can vary from one person to the next.

While bereavement is usually associated with death, it can also occur after other significant losses. The end of an important relationship or a major change in a person's health, for example, can also lead to feelings of bereavement.

Symptoms of Bereavement

People may experience a wide range of symptoms during bereavement, including:

• Shock: The unexpected loss of a loved one can trigger physical and emotional symptoms that are triggered by the body's stress response.
• Numbness: You may feel detached, isolated, and disinterested in anything around you.
• Guilt: You may feel guilty that you survived when someone else did not, or you may feel guilty about unresolved issues in your relationship with your loved one.
• Sadness: Intense sadness about the loss of your loved one is normal and expected.
• Crying: It's normal to shed more tears than you normally do during this period of bereavement.
• Depression: The sadness brought on by a loss can also result in feelings of depression.
• Anger: You may also experience feelings of anger about the loss or even feel angry at your loved one for dying.
• Changes in appetite: You might eat less or more than usual.
• Difficulty sleeping: You may struggle to sleep or sleep much more than usual.
• Trouble concentrating: Bereavement can affect your ability to focus.

How Is Bereavement Diagnosed?

Bereavement is a normal response to loss and is in and of itself not a diagnosable condition recognized by the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). However, it may sometimes play a part in the onset of other conditions, such as depression or anxiety.

"[The] DSM-5 recognizes that bereavement does not immunize the patient against major depression, and often precipitates it. Indeed, grief and depression—despite some overlapping symptoms, like sadness, sleep disturbance, and decreased appetite—are distinct constructs, and one does not preclude the other,” explained psychiatrist Ronald Pies in an article published in the journal Innovations in Clinical Neuroscience.

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What Causes Bereavement?

Bereavement is a response to loss. The circumstances that surround the loss, as well as the closeness of the relationship, can play a role in how intense the grief is that people experience. Some types of losses that can cause bereavement include:

• The death of a loved one: The loss of a family member or close friend can be one of the most difficult losses a person will face. In many cases, people must also cope with many different types of decisions related to the loss including making funeral arrangements and dealing with finances as they grapple with intense feelings of grief and sadness. 
• Anticipatory grief: This type of bereavement may occur when a loved one is dying. While the person is not gone yet, loved ones may still experience feelings of grief including sadness and anger as they prepare for the loss of their loved one.
• The loss of a beloved pet: Losing an animal companion can also trigger a period of bereavement. It can be a difficult transition and many people may struggle with feelings of deep sadness.
• Miscarriage: The loss of a pregnancy can also lead to feelings of grief and a period of bereavement. 
• A loss due to suicide: When someone dies by suicide, loved ones may be left struggling with feelings of shock and guilt. Because suicide is sometimes accompanied by stigma, those who are grieving may feel particularly isolated and unsupported.
• A change in health status: The onset of a chronic illness or a sudden change in a person’s health status can also lead to feelings of bereavement. People may experience feelings of fear, anger, anxiety, regret, and mourning as they face the new challenges presented by their condition.

It can occur when the loss is ambiguous, when there is a social stigma attached to the loss, or when a person's relationship with the person who has died is not recognized or valued by others.

Types of Bereavement

Everyone experiences bereavement and grief differently. However, it often follows a predictable pattern that is often characterized as a normal response to loss. In other cases, people may experience more persistent symptoms that continue to interfere with their ability to function normally for a longer period of time.

Normal Bereavement

Feelings of grief and bereavement typically occur in a series of five stages:

• Denial: This stage is characterized by feelings of numbness, shock, and disbelief. People may refuse to accept the reality of the loss.
• Anger: During this stage, people may feel angry about the loss. These feelings may be directed at other people, at themselves, or even toward the individual who has died.
• Bargaining: This phase is often marked by appealing to a higher power for relief or a way to change the outcome. 
• Depression: During this stage, people tend to experience great sadness and feelings of depression. They often turn inward and withdraw socially.
• Acceptance: In the final stage of the bereavement process, people reach a point where they can accept the reality of the loss.

Psychiatrist Elisabeth Kubler-Ross introduced this stage model in 1969 to describe the process of bereavement following the loss of a loved one. However, she later adapted these stages to apply to other types of grief as well.

Complicated Grief

Bereavement is painful and can be exhausting. While it isn't something that people "get over," the intensity of these feelings of grief usually lessen gradually over time. Some people, however, experience a more persistent form of bereavement that is known as complicated grief. 

This form of bereavement is characterized by intense feelings of sadness and pain that persist for a longer period of time. People who are experiencing complicated grief may experience symptoms such as:

• Hopelessness
• Preoccupation with death 
• Feelings of detachment
• Social withdrawal and isolation
• Loss of interest
• Loss of sense of self

While it is not recognized as an official diagnosis by the American Psychiatric Association's diagnostic manual, medical experts have suggested that complicated grief is characterized by symptoms of persistent, acute grief that last six months or longer.

Prolonged Grief Disorder

To recognize that long-lasting forms of grief deserve a clinical diagnosis, the American Psychiatric Association added a new condition to the trauma- and stressor-related disorders chapter in the DSM-5-TR (fifth edition, text revision), published in 2022. This condition is called prolonged grief disorder (PGD).

There is some controversy surrounding the pathologizing of grief into some form of mental illness. Some in the mental health community don't support labeling grief as a medical condition, but rather, would rather address the fact that there is no "normal" when it comes to grieving, and its severity exists on a continuum.

Others claim that making grief an official medical condition allows those who experience extreme forms of it to better access treatment—such as therapy and medication if needed—through their insurance carriers.

Treatment for Bereavement

The experience of bereavement is a natural and inevitable part of life, albeit an incredibly painful part. It often temporarily affects a person's ability to function normally and can affect nearly every aspect of an individual's life.

For people who are struggling to cope, professional help may be beneficial. Types of treatment include:

• Bereavement therapy: Also known as grief counseling, this is a type of treatment designed to help people who are coping with a loss. You may speak about the circumstances surrounding your loved one's death as well as your emotions related to the loss.
• Cognitive behavioral therapy (CBT): CBT works by helping people identify and change the negative thoughts that affect their mental well-being. CBT helps people learn how to make plans for the future, set goals for their recovery, and cope with their feelings about the death of their loved ones.
• Grief-specific cognitive behavioral therapy: This type of therapy uses techniques similar to CBT, such as changing negative thought patterns. However, grief-specific cognitive behavioral therapy also teaches ways to develop a healthy attachment to your lost loved one in a way that doesn't negatively affect your life. It may be especially helpful for those with prolonged grief disorder.
• Interpersonal psychotherapy (IPT): IPT is often used to treat depression; however, it has shown promising results to help address symptoms of bereavement, particularly those associated with complicated grief. IPT focuses on building up your relationships and encourages involvement in activities you enjoy as part of your healing.
• Complicated grief treatment (CGT): CGT combines elements of CBT and IPT. You will share the story of how you lost your loved one, work on building up healthy relationships, and set personal goals for yourself and your recovery.

Support groups can also be a helpful place to explore difficult emotions and find social support from people who have had similar experiences.

Coping During Bereavement

Some things that you can do when you are bereaved include:

• Showing yourself acceptance when you are dealing with strong or difficult emotions
• Talking about the loss with others
• Finding support from friends, family, and others
• Caring for yourself by getting enough rest, eating healthy meals, and staying physically active
• Celebrating and remembering your loved one

There are a number of different factors that can influence how people cope with bereavement. Access to support, maturity levels, experience with past losses, and the nature of the relationship can all affect how a person manages the loss.

Your own beliefs about death, religious upbringing, and cultural factors may also influence the bereavement and grieving process. A sudden, unexpected, or traumatic loss can also affect how people cope in the aftermath.

In such cases, consider seeking professional help. It can be a great way to get the extra support you need to cope with the loss and the emotions you are experiencing.

Takeaways

Bereavement is normal after you've experienced a loss. What you experience and how long it lasts can vary, but sadness, numbness, crying, guilt, and anger are all common. While we often associate bereavement with the death of a loved one, it can also happen as a result of miscarriage, anticipatory grief, and other painful losses.

You may cycle between various stages of grief that gradually lessen with time. In cases where grief is intense or long-lasting, therapy and medication may help. If you struggle to cope, caring for yourself and reaching out to others for support are vital.