9 Grief and Loss Types & Stages

Grief is the multifaceted and often overwhelming response that we experience after a distressing or traumatic event. Often, we think of the death of a loved one but many other events can be the cause of experiencing grief and loss and include: 

• Miscarriage, stillbirth or an infant born with significant health conditions or disability
• Infertility (including the often-tumultuous IVF journey)
• Lifestyle or financial loss such as bankruptcy, loss of a house or the loss of a job
• End of a significant relationship – spouse, friend, pet
• Serious illness or disease or diagnosis of a loved one that changes life as we know it
• Loss of physical mobility or independence
• An incident that violates your security or safety such as an attack or robbery 
• A significant near-death experience or accident such as a motor vehicle accident or house fire
• Community events such as environmental disasters such as a cyclone or floods.

A person’s ability to process grief depends on a range of factors such as previous loss and accumulated trauma;  pre-existing mental health conditions;  ability to cope across a range of areas such as living arrangements, finances, responsibility for others etc; the nature of relationship and attachment style to the lost loved one; lack of preparation or prolonged preparation for the death and loss; the nature of the death and loss; the quality of the caregiving or dying experience; and access to support factors.

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Stages of Grief

Everyone grieves differently and although there are stages of grief, they are not always experienced sequentially.  There are many models of grief and loss and as a general guide, the following stages are experienced:

1. SHOCK – numbness; denial; silence; listlessness; a sense of unreality
2. ANGER/PROTEST – irritability, argumentative, refusal to accept/be involved and inward or outward blame (“I should have done more”; or “Why didn’t you…”) often directed at parents, siblings, friends, objects/belongings. It is common to be angry at the deceased, similar to feeling abandoned. This stage can also involve a preoccupation with thoughts of the loss.
3. DENIAL/DISORGANISATION – acting as if it is totally fine and being brave-faced; confusion; memory impairment; depression; withdrawal; restlessness; apathy and feelings of numbness/unreality with a sense of just going through the motions of living.
4. GUILT – Going over and over the ‘what ifs’, regrets (“I should have… if only I had….); ruminating on all the things that went unsaid or were said; replaying the last days and weeks and recent events and self-scrutinizing and condemning.  There is often a sense of feeling guilty for still living “It should have been me”; “Why should I get to keep living” often accompanied by a sense of guilt when experiencing joy again.
5. DEPRESSION – It is normal to feel depressed and find ways to integrate the pain into life as a function of being human. A GP visit and seeking counselling is something to consider if depressed feelings are getting worse or are constant, interfering with a normal state of mind and functioning.
6. RESOLUTION/RE-ESTABLISHMENT/REORGANISATION – this last step is reached when the person gets to a place of being able to remember and talk about the loss without becoming overly upset or denying feelings.  Some people may even be able to arrive at a place of personal growth and healing from the experience; finding existential meaning in death and life;  trying new patterns of behaviour.

At any stage a process of deterioration can occur which can feature crying; loss of appetite; sleep disturbance; irritability; self-criticism; and guilt.  Physical symptoms can be experienced such as hyperventilating or breathlessness/shallow breathing; difficulty swallowing; sweating or cold extremities; body aches and pains, numbness and nausea/vomiting.

 The good news is that grief symptoms gradually start to fade over time as we move through the grief and loss process.

Types of Grief

However, those of Unresolved/Complicated grief are ongoing and a heightened state of mourning can hinder healing and the ability to re-establish normal daily activities. Some specific categories of Complicated Grief are: 

• Absent Grief 
• Delayed Grief  
• Conflicted Grief
• Inhibited Grief
• Chronic Grief
• Abbreviated Grief
• Unexpected Grief

The DSM-5-TR includes a clinical diagnosis of ‘prolonged grief disorder’ which features prolonged distress and disability, greater negative health outcomes and suicidality. Although these are common features to other diagnosable conditions, complicated grief is distinct from anxiety and depression and other conditions such as PTSD.  The DSM5 outlines the following criteria:

• preoccupation with the deceased or circumstances of the death
• persistent yearning or longing for the deceased
• difficulty making sense of the loss
• misinterpretation of aspects of the loss (e.g. excessive self-blame)
• avoidance of reminders of the loss
• feeling that life is meaningless without the deceased
• prolonged experience of grief, e.g. for more than one year

If complicated grief or diagnosable persistent complex bereavement disorder, there is a need for psychological intervention that may also require supplements (if taking an integrative approach or anti-depressants. 

Whether you need counselling for ‘normal’ grief (acknowledging that everyone grieves individually so there is no normal) depends on how well a person is coping with the various stages of grief and loss and other factors such as support from others. Sometimes we can’t do this with our family members and friends because we are holding the space for others, or maybe they are uncomfortable with how to handle grief which may make people grieving feel very alone in a dark place that at times may seem insurmountable.  

Counselling is a good place to order thoughts and express a range of mixed emotions, a place to feel and let out pain as part of our emotional cleansing process.  It is important to find a counsellor who can sit in the silence, weeping, anger, confusion…whatever it is the person is going through, someone who will accompany the client at their pace since everyone has a different grieving process.

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