Understanding The Stages Of Grief

By: Dylan Buckley

Updated September 18, 2020

Medically Reviewed By: Deborah Horton

If you have ever experienced the loss of a loved one or friend, a change in a relationship or dealt with a serious or life-changing illness, you have likely experienced some form of grief and have gone through one or more of the stages of grief. It is a very personal experience, and, at times, it can be a very overwhelming emotion.

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What Does Grief Look and Feel Like?

If you're grieving a loss, it's normal to have questions and to wonder what to expect as you move through the process and stages of grief.  You may wonder why you have certain emotions or if it is normal to have the thoughts and feelings you are experiencing.  You may ask yourself questions like "Am I supposed to be feeling this way?," "Why are others not affected as much as me?" or "How much grief am I supposed to be feeling at this point?" It can become easy to compare the way you handle feelings of grief with what you perceive as another's way of grieving.  It's important to understand that grieving is a personal journey and that everyone grieves differently.

One of the most difficult things to accept about grief is grief is difficult and the feelings associated with it vary significantly from person to person.  Emotions associated with grief, death and dying can range from anger to sadness or even numbness.  The symptoms of grief can last for weeks and months or even a year or longer.

If you are dealing with grief, it's important to understand that it is normal to have good days and bad days.  It's also normal to feel like your moods fluctuate from time to time.  As we will discuss in more detail in this article, there are stages of grief that bereaved people usually experience.  Your feelings are valid, and you have a right to grieve.

The symptoms of grief appear differently in each person who is grieving. They may appear as emotional, physical or social disruptions, depending on how well you cope with grief and other stresses in your life.  It's not uncommon for people who are grieving to experiencing physical symptoms such as headache, loss of appetite or sleep disorders.  Recognizing when grief becomes difficult or unresolved is important, as long-term complications from unresolved grief may lead to disturbances in health such as heart disease, depression or a compromised immune system.

Feeling like no one understands what you are going through or not feeling comfortable talking about the loss often leads to social isolation.  While some alone time is okay, it is also important to have a support system of people to interact with.  Having a social support system can help reduce the risk of chronic depression that often occurs as a result of grief.

Perhaps the most troubling symptoms associated with grief are the emotional symptoms that occur.  It's natural to cry because of the sadness caused by grief.  Some people who are grieving may cry but not be able to express their feelings any other way.  Anxiety, when faced with the unknown, and depression are also natural emotional responses to grief.  Feelings of anxiety and depression may appear worse on days that are significant to the grieving person, such as a wedding anniversary, the birthday of a lost loved one or the anniversary of a death or tragic accident.

Important Things to Know About Grief

There are different models of grief that have been presented by mental health professionals and those who work with the bereaved.   We will look closer at the stages of grief and some of the symptoms of each.  However, there are some important things to know about grief in general.

Many times, when people hear the word "grief" they associate it with the sadness that is related to the loss of a close friend or loved one.  However, people can experience grief for other reasons.  Any situation that causes a disruption in life or the feeling of loss can result in a person feeling grief.  The loss of a home or job, a relationship that ends, moving to a new city or being unable to complete a task such as graduating college can all cause feelings of grief.

Depending on a person's ability to cope effectively, grief may not cause major disruptions in life.  Nevertheless, there are times when seeking help to cope with grief may be necessary or beneficial.

The Grief Process

The 5 Stages of Grief model was first introduced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying.  The 5 Stages of Grief model was one of the first models introduced to help others recognize the stages of grief and how the stages of grief can affect individuals.  Although it was inspired by her work with terminally ill patients, the Elisabeth Kübler-Ross model for the stages of grief has become a valuable tool to help educate people about how any loss or significant change in life circumstances can create feelings of grief that need to be processed.  Additionally, although the original model cited five stages of grief, today many sources reference seven or more stages.

Individuals experience grief in different ways and can experience the stages of grief in a different order and at different times. Some people may follow a pattern of grief such as the patterns outlined in the stages of grief models.  Others may experience a few stages and then re-visit a previous stage before moving forward.

Grief is a personal journey.  It is a process that takes time.  As difficult as the process may seem, there is hope, and learning to understand the stages of grief can be the beginning to understanding that grief is part of the journey, not the end of your journey. Take your time to grieve. Allow yourself to do it in your unique way but remember that help is available if you feel grief is significantly impacting your life.

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Identifying and Understanding the Stages of Grief

In her original book, Elisabeth Kübler-Ross referenced five stages of grief: denial, anger, bargaining, depression, and acceptance.  Through time, different sources have added other stages.  Although most sources list an "order" of the stages of grief, not everyone will experience these stages in the same order.  Also, as previously mentioned, some people may experience the same stage more than once.  There is no right or wrong way to grieve.  There is, however, healthy grief and unhealthy (unresolved) grief, and being able to recognize if help is necessary is important.

Below is a list of the stages of grief and some examples of what happens during each stage of grief.

Shock and Denial

The initial stage of grief in all of the stages of grief is the shock and denial stage.  During this stage, feelings are often profound.  Although the facts are real and you have acknowledged them, it still may feel unbelievable.  If the loss was unexpected, especially a tragic or unexpected death of a loved one, it can cause feelings of disbelief and leave the grieving person feeling numb from the shock.  Some people try to deny the reality that the event occurred or say that there was a mistake.  It is not uncommon during this stage to experience physical symptoms such as nausea and vomiting, increased heart rate, or difficulty sleeping.  Many people report feelings as if they are paralyzed emotionally, as if they know what has happened in their head but can't seem to grasp the reality of the situation.  When you're in denial about the loss, you try to convince yourself or others the event hasn't happened or isn't permanent.

Guilt and Pain 

Once the feelings of disbelief and shock begin to subside, many people begin to experience feelings of pain, sadness, regret and emotional suffering.  They may feel like they could have done something to prevent the event that has caused grief from happening or feel regret from not being able to make peace with a loved one who has died.  Pain and remorse are difficult, but they are natural emotions related to grief and are an important part of the healing process.

Anger and Bargaining

When guilt and pain begin to ease, many people experiencing feelings of anger and frustration.  They may lash out at others for no apparent reason.  For example, if a woman loses her husband or child in a car accident, she may blame people in the other car for the loved one's death or even blame God or a higher power for allowing the tragic event or death of a loved one to happen.  If a person loses his job, he may blame his former employer for putting him in a difficult financial situation or for not giving him a chance for improvement.  In some cases, a survivor may blame the person who died for leaving them. Anger and bargaining are normal parts of the grief process and a natural part of the stages of grief. However, to prevent the risk of damaging personal and/or professional relationships, it's important to learn to release emotions in a healthy way.

Bargaining is often a bereaved person's way of trying to prevent permanent loss by "making a deal" with someone else.  For example, a person who has a terminal illness may try to make a deal with God for more time to live in exchange for living a better life.  A person who is at risk of losing a home or job may try to bargain with a bank officer or employer for more time to make improvements.  When bargaining occurs and the grieving person does not get the result he had hoped for, it could lead to experiencing shock and denial or guilt and pain again.  In some cases, the inability to bargain with a higher power to make things better leads to depression.

Depression, Loneliness and Reflection

Once the shock and denial stage begins to subside and the reality that bargaining did not get the result one hoped for, the grieving person often begins to reflect upon the loss.  This is often the stage when emotions may seem most raw.  It is not uncommon to cry often and not be sure if something else happened to trigger an emotional outburst.  Changes in eating and sleeping patterns may also occur.  Some people experience physical symptoms such as headaches, stomach aches or unexplained pain for no apparent medical reason.

During this time, the stark reality and the heaviness associated with the loss begin to surface.  For some people, isolation and loneliness lead to depression that is severe.  Thoughts of suicide or self-harm may occur if grief is overwhelming.  If you or someone you know is dealing with depression or experiencing thoughts of suicide, please reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).  The Lifeline offers free confidential support to people who are experiencing emotional difficulties or who are in suicidal crisis.  It is available 24 hours a day, 7 days a week.

In this stage of grief out of all the stages of grief, the person who is grieving may begin to withdraw from others and try to deal with the feelings of grief alone.  While personal time for reflection is important, it is just as important to have a support system of people to lean on during this critical time.  Spending time with friends or loved ones can be helpful.  Additionally, seeking the help of a bereavement (grief) counselor or joining a grief support group may be beneficial.

The Upward Turn

When an improvement in overall well-being begins to occur, this stage is referred to as the "upward turn."  Although feelings of loss are still felt, managing the symptoms associated with each of the stages of grief does not seem to be as difficult.  During this stage of grief out of all the stages of grief, bereaved individuals generally begin to feel more hopeful about life and often start to feel some measure of peace related to the loss they have experienced.

Testing

Dr. Kübler-Ross later refined her original stages of grief model. One of the stages she added was the testing stage of grief.  During this phase, a bereaved person begins to realize the effect that grief is having on their personal life and they begin to look for realistic ways to cope with grief.  They may try new things to help improve their mood and help improve their emotional outlook.

Reconstruction and Working Through

Grief is a process, but it is not all about feeling overwhelmed or distressed.  There comes a time in the journey of the stages of grief when working through changes and learning to rebuild life begins to occur.  As the emotions associated with the grieving process begin to settle and the mental strain of the initial part of grief begins to ease, it becomes easier to work through feelings and to seek solutions for managing grief and life in general.  During this stage out of the stages of grief, a bereaved person may begin to set goals for the future.

Keep in mind, although this stage is related to grief, it is more about the bereaved person beginning to have a sense of control over his/her life again.  Life begins to feel less tumultuous and focusing on physical and mental well-being seems like a less daunting task.

Acceptance and Hope

The final stage of grief out of the stages of grief is acceptance and hope. This hope and acceptance stage is an opportunity to acknowledge how the loss has affected you and to reflect upon what the person or thing you lost meant to you.  Although emotions are hardly ever 100% predictable, during this stage of grief, you are less likely to feel angry about the loss and you've come to realize that bargaining is not effective.  It's the last step toward rebuilding your life.

Accepting a loss does not mean you can't acknowledge that the loss occurred.  However, it is okay to take advantage of an opportunity to deal with the reality of the event that caused grief, to learn ways to cope with the emotions associated with it and to move forward.  The stage of acceptance and hope does not necessarily mean that every day will be happy or that moments of grief will not happen again.  It does, however, offer the promise of better days ahead.  During this stage of grief out of all the stages of grief, acknowledging the loss while thinking about and planning for the future is important.

In a perfect world, one may argue that peace comes when complete acceptance of a loss is accomplished.  Unfortunately, this may rarely happen.  However, despite occasional feelings of sadness that occur when remembering a lost loved one or when other things cause emotional strain, it is possible to achieve acceptance and hope and to regain control of your life.

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Other Variations of the Grief Model

Although grief models, and stages of grief models, and theories vary, the core of each one is the hope that people can begin to understand what causes grief and can learn to cope effectively with the emotions associated with it.  As is evident by the changes that Elisabeth Kubler Ross implemented in her own stages of grief model, the process of grief and the stags of grief is not an absolute.  A few other popular stages of grief theories were introduced by John Bowlby and Lois Tonkin.

John Bowlby, a British psychologist, studied attachments that people develop early in life.  His theory of attachment explains how a person's relationship with and attachments to others may influence the impact of the grieving process on a bereaved person.   In his study, Bowlby examined how the attachments an infant develops with caregivers often set the trajectory of their relationships with others and their response to losses later.  Bowlby's four stages of grief are: 1) shock and numbness, 2) yearning and searching, 3) despair and disorganization, 4) reorganization and recovery.

Growing Around Grief:  This model presented by Lois Tonkin challenges the popular belief that grief becomes less invasive and that it goes away with time.  Rather, according to this theory, Tonkin suggests that grief begins as an all-consuming feeling and that it does not change but suggests that the bereaved person learns to adapt and grow "around" the grief.

Are you still wondering what the stages of grief are?  That is a question only you can answer. The stages of grief you experience might be different from someone else's.  That doesn't mean that your way of grieving is wrong, and someone else's way is right.  It's a personal journey, remember?

Does Mental Illness Impact Grief?

Mental health conditions such as bipolar disorder, ADHD, and schizophrenia are a few illnesses that can may lead to complicated grief.  Because people with mental illness often experience alterations in the way they process thoughts and emotions, the effects of grief can be profound.

Postpartum depression, affective disorder, anxiety and panic attacks can also make the symptoms of grief seem much worse.  Recognizing symptoms of anxiety or depression and any other mental illness that you or a loved one has experienced is key to understanding when it's time to seek medical advice and a diagnosis.

If you or someone you know has been diagnosed with a mental illness and is also experiencing grief, it is important to see a primary care provider and/or mental health provider to make sure any necessary  measures that can promote emotional well-being are implemented and followed.

Coping Strategies to Deal with Grief

Grief can feel like an emotional rollercoaster at times.  However, there are ways to learn to cope with loss and the grief that occurs and to begin healing.  While each person deals with grief differently and goes through different stages of grief, there are some things that you can do to begin coping with grief and the stages of grief in a healthy way.

• Be intentional about self-care. During a period of grief, many bereaved people ignore self-care.   Maintaining a healthy balance of rest, nutrition and social interaction will help relieve some of the difficulty that grief brings.   Remember, you are grieving.  You don't have to do everything for everyone.  Take care of yourself first.  Read a book.  Take a walk.  Relax in a bubble bath.  Anything you can do that focuses on helping your body and mind and relax and refocus will be helpful as you go through the process of grief and the stages of grief.
• Avoid harmful behaviors. In times of stress, it is not uncommon for people who are struggling to deal with their emotions to resort to harmful behaviors.  Some examples may include abusing alcohol or illicit drugs.  If you feel the need to engage in unhealthy behaviors or habits, try to focus on things that are positive and that promote your physical and emotional well-being.
• Talk to others. Grief has a way of making people feel there is no source for help and that no one understands what they're going through.  This is not true.  You don't have to experience grief alone.  In fact, bottling up emotions and trying to pretend that things are okay when they are not could result in complicated grief.  Seek the help of a support system of friends or loved ones who can listen to you and help you through the grief as you begin to heal and process through your stages of grief. 
• Don't be afraid to seek professional help. For many, the idea of seeking professional help feels uncomfortable. However, if you feel overwhelmed by grief or one of the stages of grief and need to learn ways to cope effectively, a mental health professional or counselor could be a critical person to include on your path to healing. The right professional can help you process your emotions related to grief and help you create a plan of action of how you will handle the days, weeks and months to come as you go throughout the different stages of grief.

Getting Stuck?

Even with an active support system, the process of grieving is not always simple.  Some people may feel unable or unwilling to move from one phase of grief to another, leaving them feeling "stuck" in a particular stage of grief or stages of grief.  These people experience what is known as complicated grief.  Complicated grief is the term used to describe a bereaved person feeling "trapped" in the emotions associated with loss.  The process of grief or the stages of grief usually involves transitioning from one stage to another.  When complicated grief occurs, the bereaved person may express feeling unending feelings of anger or sadness and may remain in denial regardless of the efforts of others to help.  Complicated grief is a chronic condition that often requires the assistance of mental health professional.

Some people may transition from one phase to another without difficulty but may remain in the cycle of grief or one of the stages of grief for what seems like an endless amount of time.  They may experience one or more stages of grief repeatedly.  Although these emotions can feel overwhelming, this does not always indicate a significant problem or lack of coping mechanisms.  The type of loss and how it occurred may play a factor in how easily a person moves through all the stages of grief and how they recover entirely from a loss.

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Should I Be Reaching Out for Help?

While many people can experience the stages of grief without needing help from others, if you are experiencing complicated grief or if you feel unsure of how to process your thoughts in a healthy way, reaching out for help could be beneficial.  Because unresolved grief can begin to affect other areas of life and may be debilitating for some, it's important to seek help as soon as you realize you may need help with the symptoms.  Your healthcare provider can provide you with medical advice, diagnosis and treatment, as needed.

Grief and going through the stages of grief is a normal process that everyone experiences at some point in life.  If you do feel like you need help, you are not alone.  Many people find comfort and help to process the emotions associated with grief and the stages of grief by talking to friends, engaging in a grief support group or working with a mental health professional.

Grief counseling is an option for those who are feeling overwhelmed after a loss. Whether you're stuck in what feels like an endless cycle of grief, repeating one or two stages of grief, or are dealing with issues stemming from grief such as depression, starting your grief counseling journey can provide you with the necessary resources to help you recover.

In addition to these resources, online counseling options is becoming a popular trend for those who would like to find a therapist or talk to a mental health provider.

When Grief Doesn't End, BetterHelp Can Help

Online therapy, such as the therapy provided by BetterHelp, provides individuals an opportunity to connect with mental health professionals who are equipped with the knowledge and skills necessary to help facilitate effective coping and healing.  Online therapy is convenient, as most sessions can be scheduled at the client's discretion and can be done anywhere a client has access to a phone or internet.  Talking to a grief counselor online at BetterHelp.com allows you to work through your grief in a safe and comfortable setting when it works best for you.

BetterHelp.com offers clients access to licensed, trained, experienced, and accredited psychologists, marriage and family therapist, clinical social workers, and board licensed professional counselors who can help tailor a plan of care specific to you and your needs.If you are experiencing grief, you don't have to experience the journey alone.  Reach out today and let our dedicated team of professionals help you through the grieving process.

Counselor Reviews

"Sarah is a kind person that listens intently, focuses on issues, and then helps find successful strategies to deal with those issues. Never once did I feel that she was judging me or talking down to me. She was easy for me to open up too, she was professional, and she took me seriously. Together we discussed issues of loss and grief from the passing of my father, which had become more than I could handle alone. She not only validated my feelings of loss, but she also helped me find ways to mitigate those feelings, break them down into their roots and causes then address those. Coping with grief and loss is hard work, but Sarah helped me find the tools I needed within myself to do that hard work and ultimately find success. I am a stronger person now. I am happy and confident. I may not know what is around the next corner, but I know that whatever it is, I can handle it."

"John has been very helpful in helping me set realistic goals to understand and work through my grief. No loss is ever easy, but being able to talk to someone who understands that it's not easy has been helpful."

Conclusion

Grief is a natural part of losing something or someone you held dearly, and it takes time. If you feel your grief is a burden you can't carry alone, there are trained professionals at BetterHelp available to help when you need it.

Frequently Asked Questions (FAQs)

• What are the seven stages of grief?

It's important to remember that everyone grieves differently when it comes to the topic of death and dying. The seven stages involved in the grieving process are 1. Shock and Denial 2. Guilt and Pain 3. Anger and Bargaining 4. Depression, Reflection and Loneliness 5. The Upward Turn 6.  Reconstruction and Working Through 7.  Acceptance and Hope.

• What are the five stages of grief in order?

In the original grief model established by Elizabeth Kübler Ross model, the 5 stages of grief were: 1. Denial, 2. Anger, 3. Bargaining, 4. Depression, and 5. Acceptance. This model focuses on providing advice, diagnosis, or treatment for people dealing with negative effects of the grieving process — like exaggerated grief or complicated grief.  It is also worth noting that while some people may experience one or more stage of grief repeatedly, not everyone will experience all five stages.

• Are there 5 or 7 stages of grief?

There are at least two models that highlight the stages of grief after the death of a loved one or any other loss of loved ones. (The stages of grief as they are discussed is largely dependent on the editorial policy of the publication.) The 7-stage model of grief and the 5-stage model of grief highlighted in the book On Death and Dying (written by Elizabeth Kübler Ross) are two of the most widely recognized models used when health professionals provide medical advice, diagnosis, and mental health support for people who are coping with loss, dealing with the death of a loved one, or other losses of loved ones.

• What does bargaining mean in the five stages of grief?

The "bargaining" stage of grief as part of the five stages of grief is typically known as the third stage of the grieving process.  During this phase in the stages of grief, a bereaved person may feel as if they would do anything possible to heal a dying loved one or to bring a loved one back.  Isolation and loneliness may cause the person experiencing grief to attempt to bargain with their higher power to reverse the circumstances of the loss or death of a loved one. Bargaining is an unrealistic yet common defense mechanism that causes people to believe they can somehow reverse negative events by promising to "do better" in the future.

• How does grief affect the body?

Grief, loss, and coping with loss (even the loss of a job) can trigger physical and mental responses in the body. Unresolved grief, loss, and pain can result in the development of mental health disorders like eating disorders (including binge-eating), Attention Deficit Hyperactivity Disorder (ADHD), and other serious mental health issues. Many people suffering from grief, loss, and sorrow find themselves dealing with depression and need to learn new coping strategies on how to deal with the loss outside of denying the reality of the event (as in bargaining). When you speak with a mental health professional, they can provide diagnostic tools like a grief quiz, an ADHD quiz or ADHD overview and bipolar disorder treatment for chronic mental health symptoms.

• How long is the mourning process as a part of grief?

The amount of time it takes for someone to grieve varies from person to person and may be influenced by many factors.  For some, especially if the loss was related to an anticipated or expected death of a loved one, it may be easier to process the stages of grief and begin to feel emotionally stable and able to move on with life.  On the other hand, some people experience prolonged or complicated grief that lasts for a year or longer as part of their stages of grief.  If symptoms of grief are causing major disruption in personal or professional relationships or in one's ability to function from day to day, it's important to reach out to get help.  A mental health provider can assess your symptoms and address your concerns regarding grief.  A primary care provider can perform an assessment and help determine if there are underlying conditions that may be causing symptoms that are unrelated to grief.

• What does grief response mean?

"Grief response" refers to how you deal with the effects of overwhelming emotions of grief and loss. Many everyday situations can trigger a grief response. The diagnosis of a terminal illness (for yourself or a loved one) the death of a loved one, loss of a job, and other similar circumstances are all examples of situations that can trigger this response. Typical grief responses include denial, anger, bargaining, mentioned in the 5-stage and 7-stage grief models above.

• What are the side effects of losing a loved one? Is grief one of them?

When you're dealing with the loss of a loved one, you can expect to have good days and bad days. Dealing with grief, loss, and learning how to live your new altered life can take its toll if you don't find a therapist or other certified mental health professional to help you learn new coping strategies to heal. Side effects of losing a loved one can vary from person to person but can include mental health problems like the development of eating disorders or binge-eating behaviors, difficulty controlling anger or other emotions, and strained relationships. In many cases, symptoms of depression, anxiety, panic attacks, sleep disorders, and other mental health disorders may also develop.

• How do you deal with the loss of a loved one and the grief that comes with it?

When trying to deal with the loss of a loved one, the loss can feel devastating. Learning effective ways of coping with stress and grief is an important key in the grieving process.  A mental health professional can help develop a plan of care that is specific to your needs and help you learn effective coping mechanisms to deal with grief.  Your mental health care provider can provide you with access to strategies and diagnostic tools (like the ADHD quiz listed above) for paying homage to the person who died — while remaining mentally stable enough to regain control and carry on with your own life. For example, people with symptoms of bipolar disorder (or other chronic mental health disorders) can turn to a licensed therapist for bipolar disorder treatment. Mental health treatment occurs simultaneously with mental health treatments.

• What are the eight stages of the grieving process?

While the 5-stage and 7-stage model outline popular stages of grief, there are also other theories of grief proposed like the 8-stage model. The 8-stage model of grief includes the following:  1. Shock, 2. Emotional Release, 3. Panic, 4. Guilt, 5. Hostility, 6. Inability to Resume Activities, 7. Reconciliation of Grief, 8. Hope

• What is the bargaining stage of dying?

During the bargaining stage of dying, people can become so overwhelmed with sadness and regret that they try to make a deal with God or their higher power to "undo" the negative outcome.  In the bargaining stage of dying, the person who is dying may ask God or their higher power to give them more time to live so that they can see their children marry or meet their grandchildren.  They may make promises to live a better life if they are allowed to live longer.  It's important to understand that grief is a natural emotion for a person who is terminally ill or anticipating death for a medical reason.  They can experience the same stages as any survivor may experience after a loss.  A licensed therapist or medical provider can provide medical advice and therapeutic advice for how to deal with the grief, loss, and confusion that often accompanies a terminal illness.

• Can grief make your heart hurt?

Grief is very personal and can cause physical and mental symptoms.  It can cause you to feel anxious. When people experience anxiety and panic attacks, they often confuse these symptoms with those of a heart attack. In some cases, unhealed grief can result in more severe symptoms like a heart attack or broken heart syndrome. When you seek additional information or help — a medical or mental health provider may ask you to take a grief quiz to determine your level of grief.

• What does grief do to your brain?

Grief, loss, and anger can have lasting and traumatic effects on the brain. Unhealed grief, loss, and misplaced anger can cause symptoms of mental health disorders over time as weeks and months go by. People who already experience schizophrenia symptoms, seasonal affective disorder, bipolar disorder, or other mental health disorders can be severely affected when confronted with the news of a dying loved one. (The same is true in the case of the loss of any other close personal relationships.) Contact a mental health professional if you or someone you love is suffering from the effects of grief or bipolar disorder.

• What is the cause of grief?

The cause of grief, loss, and sorrow is related to the abrupt change that goes with losing important people or situations in your life. Grief, loss, and sorrow can trigger mental trauma that many of us are unaware of until we see the effects begin to show up in our everyday lives. For example, in the case of postpartum depression, a mother may simultaneously experience joy and grief as her life begins to change in new ways. People who are experiencing symptoms of grief can reach out to a local support group to get help, including resources and referrals.

• What are the two parts of the grief reaction?

According to the National Center for Biotechnology Information — grieving is a personal process that involves several stages to integrate. Two parts of the grief reaction are psychological and somatic symptoms that can show up in our lives. Psychological symptoms of grief, loss, and sorrow affect mental health and can aggravate or trigger mental health disorders like bipolar disorder, binge-eating, or being stuck in the grieving process. When people are unable to move on the acceptance — the final stage in the grieving process, somatic symptoms like heart-attacks and "broken heart syndrome" can be a result.

• What is exaggerated grief?

Exaggerated grief happens when a person is unable to complete the stages of the grieving process. People who become overwhelmed with grief, loss, and sorrow may become stagnant in their lives and fail to thrive without the intervention of medical professionals, mental health professionals, and grief support groups. When people aren't able to successfully navigate the grief, loss, and sorrow stages that flow from denial through acceptance, negative effects can present themselves as the person suffering fails to realize that grief is grief and that the symptoms will pass (or diminish) with time — if we allow it.

• How Does Bipolar Disorder Affect the Grieving Process?

The grieving process is not a single straight line, especially if you're someone with bipolar disorder. The symptoms associated with bipolar disorder coupled with emotions related to grief can make it difficult to cope.  The depressive episode of bipolar disorder can make the depression stage of grief feel unbearable.  On the other hand, mania episodes can make the denial stage worse.  Additionally, during manic episodes, emotional outbursts and risky behavior are more likely to occur.  Those with bipolar disorder should seek help from a therapist when they're experiencing grief.  Bipolar disorder treatment should never be stopped, but a health care provider may suggest changes to care while grieving.

• Do You Experience Denial, Anger, Bargaining, Depression, and Acceptance in Order for the Stages of Grief?

The stages of grief are a simplified way of how people experience grief, but it's not universal. Many people experience grief in many ways when they are dealing with the death of a loved one or other significant loss. Not everyone experiences the stages of grief in the same order or at the same time.

What do we mean by this? We're referring to the fact that when you experience the loss of a loved one, you may experience stages in different orders. You may feel depressed, but then have the denial stage out of the stages of grief later. You may alternate back and forth between different stages of grief. With grief, it is important that you seek help from a mental health professional if you feel like you're unable to cope, but don't worry if you are experiencing the stages of grief in a different manner or stages of grief at a different time than everyone else. Everyone grieves differently.

• What Are Some Coping Strategies for Coping with Loss and Grief?

When you are experiencing the death of a loved one, grief takes time. It's not something you want to rush through. However, there are coping strategies that can make the process much easier and allow you to live a better life. Here are a few ways.

• Create small goals for you to accomplish. Goal-setting apps can keep you productive and accountable, but also can make the goals small and bite-size so you can do it while you're dealing with the death of a loved one.
• Support groups are always a good solution. Talking with people who have experienced a loss similar to yours can allow you to have some insight and learn some coping strategies. Look for grief support groups, be it in person or online.
• Practice mindfulness and meditation. It can help you to accept what you can't control, be in the moment, and to acknowledge how you feel. Be it meditative breathing or a body scan, mindfulness is there for you.
  
  
• Should I Seek Grief Counseling if Someone Has a Terminal Illness?

Grief counseling can be very beneficial for a person with terminal illness as well as friends and loved ones of the person who is terminally ill.  It is not necessary to experience death or another loss before grief counseling is initiated.  In fact, beginning counseling before an anticipated death occurs can help individuals process their feelings about the illness, the impending death, and it offers everyone involved to cope together and develop a support system.

• Can Grief Cause Eating Disorders?

Grief can cause significant changes in both mental and physical well-being.  For some people, changes in appetite occur.  In some cases, binge-eating may occur which can result in purging to prevent weight gain (bulimia nervosa) or becoming obsessed with weight and preoccupied with the fear of gaining weight can occur.  Grief does not always lead to eating disorders, but if you experience significant changes in appetite and feel unable to control your thoughts about food and/or weight, it's important to discuss this with your doctor. They can help provide medical advice, diagnosis or treatment options, and connect you with an eating disorder support group, if needed.

• Who Was Elisabeth Kübler-Ross and her relation with grief?

Elisabeth Kübler-Ross was a psychiatrist whose 1969 book On Death and Dying, changed how we view grief. On Death and Dying first introduced the stages of grief, in five stages.  She later added additional stages to her model.  She passed away in 2004.

• Should I Seek A Higher Power if I'm Grieving?

Everyone copes in their own way, and for many, their faith is a good method. If you're religious, consulting religious figures or praying could help. However, if you aren't religious, there are some secular methods of coping with grief, too.

• What Is an Example of a Defense Mechanism in Grief?

One common defense mechanism we use while grieving is the first stage of grief: denial. In order to defend from grief, we may simply act like it never happened. Someone who is grieving may project their emotions onto someone else or try to intellectualize their feelings.

• How long does it take to go through the stages of grief?

How long grief lasts is different for everyone. It could be a few weeks, or it could be several years. Several factorscan affect how long grief and grieving take, including:

• How close you were with them
• Their age, your age, and how close in age you were
• If their death was sudden
• Your family relationship with them
• Your state of mental health before the death
• Whether you had unresolved issues with them
• How your parents or other role models dealt with loss
• Your support system
  
  
• What is the hardest stage of grief?

The hardest stage of grief in the stages of grief is whatever stage is hardest for you. For some people, the initial shock is tough to get through. For others, bargaining feels like desperation. Still others have trouble dealing with the depression that comes with grieving. No one gets to judge whether a stage should be easy for you or not. It is your grief, and everyone has a different experience of grief. Bereavement does not have a time limit. Be gentle with yourself, recognize that grief is a normal reaction,and know that you can find meaning and survive the loss.

• What is the bargaining stage of grief?

Kubler-Ross described the third of her stages of loss as the bargaining stage. This is the part of the healing process in which you try to make a deal with God or with the universe. At this point, you might promise that you will change your life if only you can have your loved one who died back.

• What's the final stage of grief?

The final stage of grief is acceptance. In this stage, you accept the reality that your loved one died. You begin finding meaning and embracing your new reality. In both the 7-stage model and the 8-stage model, the acceptance phase comes last, after the sixth stage of grief.

• How do you help people who are grieving?

The best thing you can do when someone's loved one has died is to be kind, patient, and supportive. Allow them to go through the stages of loss in whatever order and time frame they need to, without pushing them or trying to get them to slow down. Validate their grief and grieving by listening empathetically. Do not try to make them feel guilty for not grieving the way you think they should. In short, follow their lead, so you know how to help them in their process of healing.

• Is grieving harder when a loved one dies suddenly?

Grieving is not necessarily harder after a sudden death, but in some ways, it may be different. Any time you lose someone, you may feel denial and shock, even if they have been in palliative care for a long time. Sometimes, a loved one has so many close calls and survives each time that you begin to feel like they are invincible. So, even then, their death can come as a shock. You still feel the pain in an expected death as you would in an unexpected one.

However, the sense that this isn't happening may be heightened if you lose them without warning. You may experience traumatic stress if you were with them when they died or if you heard about the death first on the news. Experts recognize that when someone dies suddenly, thestages of loss tend to be more dramatic and complex. Finding meaning is especially hard after someone dies unexpectedly. And learning to accept what happened may take longer. However, each loss is different.

• Can grief kill you?

Grief can have an unhealthy effect on the body. Whether it can actually kill you is one of the topics today that researchers are studying. For example, researchersat Rice University in Texas found that widows and widowers had up to 17 times higher levels of inflammation. And inflammation can lead to a stroke, heart attack, nearly every physical ailment common in older adults, and even depression. Depression can be lethal as well if it gets so severe that you commit suicide. All these results of inflammation can lead to premature death. Therefore, it is vital to take care of your physical health when you are grieving and talk to your doctor about how to reduce inflammation.

• What's the difference between grief and depression?

Both the five- and the seven-stage models of grief include one stage that is called depression. In this stage, you have depression symptoms, like sadness, isolating yourself, and sleep and appetite disturbances. In this sense, depression is a normal reaction.

However, this type of depression is a natural response to loss. It isn't the same as mental disorders. There are many different types of depression. For example, you may experience depression, especially if you live in New England, where there are seven months of winter or another state where winter lasts longer than average. And depression can happen whether you are grieving a loved one or not. Finding meaning can help anyone with depression, but for those who have lost someone they love, finding meaning is a part of adapting to their new life situation. If you are grieving and the depression symptoms will not go away or become severe, talking to a therapist is an excellent option.

• What can you do about complicated grief?

Complicated grief is grief that lasts longer than expected and disrupts your daily functioning. According to the New England Journal of Medicine, seeking help is the best choice when you are experiencing complicated grief.

• What is the sixth stage in the 7-stage model of grief?

The sixth stage of grief isreconstruction and working through in the 7-stage model. In this sixth stage, you are adapting to changes and learning to create a new life for yourself. The sixth stage can feel very positive, but you haven't reached the seventh stage of acceptance and hope yet. Still, you are taking positive steps to move on to life without the person who is deceased. Loved ones in your support system can be beneficial to you as you move forward.

• Do the stages of grief go in order?

Not necessarily. You may experience a little of each phase, out of order, on your way to healing from your loss. You may begin to feel a little acceptance and then go back to a bit of denial or bargaining before you get back to finding meaning. The sixth stage, which involves planning and acting to create a new life, may not be the last stage you go through before you find complete acceptance, either. Finding meaning, the sixth stage, or even the first stage of shock and denial – in fact, any stage can lead you to acceptance. The critical thing to remember is that your grief is yours to deal with, in whatever way is best for you.

• Where can I learn more about grief?

One organization that provides online resources for living with grief is the Hospice Foundation of America. This hospice foundation covers many different topics related to grieving. You can also talk to a therapist, such as those at BetterHelp, to learn more about grief and understand how your experience fits in with all the grief stages.

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• RAINN (Rape, Abuse, and Incest National Network) - 1-800-656-4673
• The National Suicide Prevention Lifeline - 1-800-273-8255
• National Domestic Violence Hotline - 1-800-799-7233
• NAMI Helpline (National Alliance on Mental Illness) - 1-800-950-6264

• SAMHSA (Substance Abuse and Mental Health Services Administration) SAMHSA Facebook, SAMHSA Twitter
• Mental Health America, MHA Twitter, MHA Facebook, MHA Instagram, MHA Pinterest
• WebMD, WebMD Facebook, WebMD Twitter, WebMD Instagram, WebMD Pinterest
• NIMH (National Institute of Mental Health), NIMH Instagram, NIMH Facebook, NIMH Twitter, NIMH YouTube
• APA (American Psychiatric Association), APA Twitter, APA Facebook, APA LinkedIN, APA Instagram