Grief and Loss: Understanding Bereavement

Grief is the natural response to loss: the mix of emotional, physical, cognitive, social and spiritual reactions that follow the death of someone we love or the loss of something important. It is not an illness but an expression of attachment, and most people gradually adapt to loss over time. This guide explains what grief is, the main types of grief, what research says about the famous "five stages," the models psychologists use today, and how people cope and support each other.

Understanding Grief

Grief is most often associated with death, but it can follow any significant loss: a divorce or breakup, a serious diagnosis, infertility, a job, a home, a country, or a hoped-for future. Psychologists see it as a normal response rooted in attachment: when a bond is broken, the attachment system keeps searching for the lost person or thing, producing yearning, sadness and disorientation.

Grief, mourning and bereavement

What shapes the experience of grief

No two people grieve the same way. Research points to several influences: the closeness and nature of the relationship (including dependence or ambivalence), whether the death was expected or sudden and violent, earlier losses and mental health, the quality of social support, cultural and religious beliefs, and other stressors happening at the same time. Because so much varies, there is no single "right" way or timetable to grieve.

Types of Grief

Researchers and clinicians use several terms to describe particular forms of grief. These are descriptive labels rather than diagnoses, apart from prolonged grief disorder.

Anticipatory grief

Grief that begins before a death, often during a terminal illness or dementia. It can allow time for goodbyes, but it does not necessarily make grief after the death easier, and it is common among caregivers.

Disenfranchised grief

Kenneth Doka (1989) coined this term for grief that is not openly acknowledged or socially supported, such as after a miscarriage, the death of an ex-partner, a death from a stigmatized cause, or the death of a pet (see grief after pet loss). Without recognition, people may grieve alone.

Ambiguous loss

Family therapist Pauline Boss described ambiguous loss as loss without clarity or closure. It takes two forms: physical absence with psychological presence (for example, a missing person) and physical presence with psychological absence (for example, a loved one with advanced dementia or addiction).

Traumatic grief

When a death is sudden, violent or horrifying, such as an accident, homicide or suicide, grief can be intertwined with trauma reactions such as intrusive images and avoidance. Trauma-focused support may then be needed (see trauma and PTSD).

Delayed and collective grief

Some people seem little affected at first and feel grief later, often when practical demands ease. Communities can also grieve together after disasters, pandemics or the deaths of public figures, a shared experience sometimes called collective grief.

Secondary losses

A death often brings further losses: income, a home, a social role such as "spouse," friendships, future plans and a sense of safety. Recognizing these secondary losses helps explain why grief can feel so wide-ranging.

Prolonged (complicated) grief

For a minority of people, often estimated at around 7–10% of bereaved adults, intense grief persists and disrupts life long after the death. The DSM-5-TR and ICD-11 now recognize this as prolonged grief disorder, discussed below and in detail on the complicated grief page.

Models and Theories

Kübler-Ross's five stages: a popular myth

The best-known grief model is Elisabeth Kübler-Ross's five stages: denial, anger, bargaining, depression and acceptance. It is also the most misunderstood. Kübler-Ross developed the stages in her 1969 book On Death and Dying from interviews with terminally ill patients, describing how people faced their own deaths, not how families grieve. She later wrote that the stages were never meant to be linear or universal.

Research has not supported the idea that bereaved people move through fixed stages. In a study of bereaved adults, Maciejewski and colleagues (2007) found that acceptance was the most frequently endorsed reaction from early on, yearning was the strongest negative feeling, and disbelief, anger and depression were comparatively low. Grief researchers Margaret Stroebe, Henk Schut and Kathrin Boerner have warned that teaching the stages as fact can make people feel they are grieving "wrongly." The stages are best seen as a list of feelings that may come and go in any order, or not at all.

Bonanno's grief trajectories

George Bonanno and colleagues followed older adults from before the death of a spouse to 18 months after. They found several distinct patterns, or trajectories. The most common was resilience: relatively stable functioning with brief disruption. Others showed gradual recovery, chronic grief, or depression that had begun before the loss and sometimes improved afterwards. This work challenged the assumption that absence of visible distress must mean "denial" or delayed grief. See the psychology of resilience.

Worden's tasks of mourning

Psychologist J. William Worden reframed grief as active work rather than passive stages. His four tasks are to accept the reality of the loss, to process the pain of grief, to adjust to a world without the deceased (practically, in one's identity and in one's beliefs), and to find an enduring connection with the deceased while embarking on a new life. People may work on the tasks in any order and revisit them.

The dual process model

Margaret Stroebe and Henk Schut's dual process model (1999) proposes that healthy grieving involves oscillation between two kinds of coping:

Moving between the two is considered adaptive; getting stuck in either one, constant rumination or total avoidance, is linked to poorer outcomes.

Continuing bonds

Older ideas, partly drawn from Freud's 1917 essay "Mourning and Melancholia," held that grief work meant detaching from the deceased. The continuing bonds perspective, set out by Dennis Klass, Phyllis Silverman and Steven Nickman in 1996, argues that many people healthily maintain an inner relationship with those who have died, through memories, rituals, conversation or carrying on their values. Research suggests the effect depends on the form the bond takes: comforting bonds tend to help, while bonds that prevent acceptance of the death can be associated with more distress.

Meaning reconstruction

Robert Neimeyer and colleagues propose that loss can shatter assumptions about the world and one's life story, and that a central task of grief is rebuilding meaning: making sense of the death, finding any benefit or growth, and reworking identity. Difficulty making sense of a loss is one of the stronger predictors of complicated grief.

How Grief Manifests

Grief affects the whole person. Common reactions include:

• Emotional: waves of sadness, yearning, anger, guilt and "if only" thoughts, anxiety, numbness, loneliness, and sometimes relief, especially after long illness.
• Physical: fatigue, disturbed sleep, appetite changes, tightness in the chest or throat, aches and restlessness. Bereavement is associated with increased short-term health risks, including the rare stress-related heart condition takotsubo cardiomyopathy ("broken heart syndrome").
• Cognitive: poor concentration, forgetfulness, preoccupation with the person who died, a sense of unreality, and difficulty making decisions.
• Behavioral: crying, searching for or "seeing" the person, avoiding or seeking out reminders, keeping belongings, and social withdrawal.
• Spiritual and existential: questioning or deepening faith, searching for meaning, and sensing the presence of the deceased, which surveys suggest is common and usually comforting.

Grief often comes in waves rather than a steady decline, triggered by anniversaries, holidays, places and everyday reminders. Grief overlaps with depression in some symptoms, but in grief, painful feelings usually focus on the loss and alternate with positive memories, while self-esteem is often preserved.

Complicated Grief

Prolonged grief disorder

The DSM-5-TR (2022) added prolonged grief disorder. In broad terms, clinicians look for grief lasting at least 12 months after a death in adults (6 months in children and adolescents), marked by intense yearning for or preoccupation with the deceased nearly every day, plus several other symptoms, such as identity disruption, marked disbelief, avoidance of reminders, intense emotional pain, numbness, a sense that life is meaningless, or intense loneliness. The grief must clearly exceed cultural and religious norms and cause significant distress or impairment. ICD-11 uses a six-month threshold. Only a qualified clinician can make this diagnosis.

Risk factors

Risk is higher after sudden or violent deaths, including suicide, after the death of a child or partner, and for people with a highly dependent or conflicted relationship with the deceased, previous mental health difficulties or trauma, insecure attachment, or little social support.

Treatment approaches

Complicated grief therapy (CGT), developed by M. Katherine Shear, is a structured, typically 16-session treatment that combines elements of interpersonal therapy, cognitive behavioral therapy and exposure-based work, including retelling the story of the death, working with memories and reminders, and setting goals for the future. Randomized trials have found it more effective than standard interpersonal therapy for prolonged grief. Grief-focused CBT has also shown benefits. Medication is not a treatment for grief itself but may be one option a doctor discusses for co-occurring depression or anxiety.

Cultural Perspectives

Culture shapes how grief is expressed, how long mourning lasts and what rituals mark a death. Some traditions encourage open, communal expressions of sorrow; others value restraint. Many religions provide structured mourning practices. Examples include the Jewish practices of sitting shiva for seven days and marking the yahrzeit anniversary, Islamic customs of prompt burial and a defined mourning period, Hindu cremation and memorial rites, Buddhist teachings on impermanence, Christian funerals and memorials, and the ancestor-centered rituals of many Indigenous and East Asian cultures.

In many Western societies, critics note a pressure to "move on" quickly, short bereavement leave, and discomfort talking about death. Culturally sensitive support means asking people what their traditions and beliefs require rather than assuming, and recognizing that a response that looks unusual in one culture may be entirely expected in another. See cross-cultural psychology and the psychology of religion.

Coping with Grief

There is no formula for grieving, but research and clinical experience point to approaches that many people find helpful. They support wellbeing and do not need to be done "correctly."

• Allowing feelings: letting sadness, anger or relief come and go without judging them. Writing can help; see journaling for mental health.
• Oscillating: giving time to grief and also to rest, routine and enjoyable activities, in line with the dual process model.
• Looking after the body: keeping basic routines for sleep, meals and gentle movement, and going easy on alcohol, which can worsen sleep and mood.
• Staying connected: accepting practical help, talking with people who knew the person, and considering a bereavement support group.
• Using rituals: funerals, memorials, anniversaries and personal rituals can provide structure and a sense of connection.
• Practicing self-compassion: treating oneself with the kindness one would offer a grieving friend; see self-compassion practice.

When to seek professional help

Most bereaved people do not need therapy, and a 2008 meta-analysis by Currier, Neimeyer and Berman found that interventions offered to everyone who is bereaved show little benefit on average. Support is more clearly helpful for people who are struggling significantly. It is worth reaching out to a doctor, grief counselor or therapist when grief remains overwhelming for many months, when daily functioning is badly affected, when guilt or self-blame is intense, when alcohol or drugs are being used to cope, or when there are thoughts of suicide. Anyone in immediate danger should use the options on the crisis resources page.

Supporting Others Through Grief

Many people want to help a grieving friend but fear saying the wrong thing. Research and the experience of bereaved people suggest that presence matters more than perfect words.

Practical support

Specific offers ("I'll bring dinner on Thursday" or "I can pick up the children this week") are easier to accept than "Let me know if you need anything." Help with meals, errands, childcare, paperwork and transport is often most valued in the early weeks.

What tends to help and what tends to hurt

Support often fades after the funeral, while grief continues. Staying in touch over the following months, and acknowledging losses others may overlook, such as miscarriage or pet loss, can make a lasting difference. See how to support someone.

Children and Grief

How children understand death

Research reviewed by Mark Speece and Sandor Brent (1984) found that most children come to understand three key ideas about death, that it is irreversible, that the body stops functioning, and that it happens to all living things, by around 5 to 7 years of age, although timing varies with development and experience.

• Infants and toddlers do not understand death but notice absence, changes in routine and caregivers' distress.
• Preschool children may see death as temporary or reversible, ask the same questions repeatedly, and sometimes believe their thoughts or behavior caused it.
• School-age children usually understand that death is permanent and may be curious about physical details or worry about others dying.
• Adolescents understand death abstractly and may grapple with meaning and identity, sometimes grieving privately or with peers.

Supporting grieving children

Children often grieve in short bursts, moving between sadness and play, which is sometimes described as grieving in "puddles" rather than waves. Child development specialists generally recommend clear, honest, age-appropriate language ("died" rather than euphemisms like "lost" or "went to sleep"), answering questions truthfully, keeping routines, offering choices about taking part in rituals, and showing that adults grieve too. Persistent regression, school refusal, ongoing nightmares, intense guilt or talk of self-harm are reasons to seek help from a pediatrician or child mental health professional.

Healing and Growth

Many grief researchers now speak of integration rather than "recovery" or "closure." Acute grief gradually gives way to integrated grief, in which the loss is woven into a person's life story, love and sadness remain, and the person can again engage with work, relationships and enjoyment.

Some people also report posttraumatic growth, a term coined by Richard Tedeschi and Lawrence Calhoun for positive changes after struggling with adversity, such as deeper relationships, greater appreciation of life, a sense of personal strength, new possibilities and spiritual change. Growth is not universal, is not a requirement, and does not cancel out pain. For many, meaning comes through legacy projects, helping others facing similar losses, or carrying forward the values of the person who died.

The Ongoing Journey

Grief is not a problem to be solved but a natural response that reflects the depth of our attachments. The research of the past few decades has replaced the idea of fixed stages with a more flexible picture: people move between pain and restoration, often maintain bonds with those they have lost, and in most cases adapt over time with the help of others.

For those whose grief stays intense and disabling, effective help exists. For everyone else, patience, connection and permission to grieve in one's own way remain the most important supports, whether you are grieving yourself or standing beside someone who is.