Good Grief! Is That All?

Types of Grief Defined By Rachel Rutledge, MSW Candidate, Kovir LLC Intern 

Anticipatory grief, complicated grief, chronic grief, delayed grief, distorted grief, cumulative grief, prolonged grief, exaggerated grief, secondary loss, masked grief, disenfranchised grief, traumatic grief, ambiguous loss, inhibited grief, abbreviated grief, absent grief, vicarious grief, integrated grief… (Haley, 2013). Woah, who knew there were so many types of grief? This blog will serve as an index of sorts to describe each type of grief. We have categorized these types of grief on a continuum of sorts by similar kinds. By defining each type of grief and identifying the circumstances in which each type may arise, we may be able to better equip older adults and end-of-life caregivers to deal with grief.

The Kinds with Unexpected Timing

Anticipatory grief: Anticipatory loss or anticipatory grief occurs when you begin to grieve someone before they have actually passed away. You could see this happen with a person experiencing Alzheimer’s or dementia. The person you used to know may seem different to you as the disease process takes over. In this way, you may begin to grieve them prior to their passing. It is not uncommon for individuals to experience some form of guilt in these situations because the person they are grieving is still living. However, it is important to remember that this type of grieving is very normal. You have already experienced a type of loss due to the changes taking place. Additionally, your mind and body are simply preparing you for the loss and grief that is still to come. (Haley, 2013).

Abbreviated grief: This is when the grief is short-lived. It may be due to anticipatory grief, in which the person was able to begin the grieving process early or it may be due to life changes that fill the absence of the loss. (Haley, 2013).

Delayed grief: Delayed grief is basically as it sounds. A delayed reaction to loss. This delay may be weeks, months, or even years after the loss. Delayed grief is typically due to the shock or denial that may accompany the loss. Sometimes this is your body’s way of protecting your mind to accept the real shift in small increments. This may also be a coping mechanism to allow yourself to handle the immediate practical problems like planning the funeral or raising one’s children alone. When the grief does finally “hit” it may be a very overwhelming experience after the time delay. This emotional response should be allowed to come, seeing as accepting and acknowledging these feelings is what will help the person to heal from the loss. (Beyond, n.d.).

The Long or Extreme Kinds

Complicated grief / Prolonged grief: Complicated grief is an overarching term that encompasses prolonged grief, chronic grief, delayed grief, distorted grief, and exaggerated grief (Roldan, 2021). Complicated and prolonged grief are often used interchangeably. This type of grief occurs when intense feelings of grief continue past the first year since the loss. This would be grief in which healthy grieving and mourning have not yet occurred. A person experiencing this type of grief may not have been able to accept the reality of their loss. They may still have feelings that their loved one may reappear at any moment (Mayo Clinic Staff, 2021; The Center for Complicated Grief, 2017). In 2020, the American Psychiatric Association added Prolonged Grief Disorder to the DSM 5. A diagnosis of Prolonged Grief Disorder would include at least 3 of 8 of the following symptoms: disbelief, intense emotional pain, the feeling of identity confusion, avoidance of reminders of the loss, feelings of numbness, intense loneliness, meaninglessness, or difficulty engaging in ongoing life (Center for Complicated Grief, 2017). It is still important to remember here even though prolonged grief was added as a disorder in the DSM 5, there is nothing out of order with the experience of grief. It is a natural and normal experience. And although we can define complicated grief/prolonged grief as something that continues past the first year of loss, there is no timeline for grief. Healthy grievers will continue to grieve in their own ways throughout their lives, not just the first year. The main distinction to make here is that the healthy griever would be able to find some kind of new normal or adaptation in their lives. 

Chronic grief: Depending on who you are talking to, chronic grief is interchangeable with complicated or prolonged grief. It is most certainly the same concept. It is when the symptoms of grief last significantly longer than what a grief expert would consider “normal”, a challenging task if you ask me. Grief expert, Stephen Moeller, also refers to the term “chronic sorrow” to describe grief that is extended and ongoing due to the environment (2017). He uses the example of parents to developmentally disabled children who can experience this chronic grief or sorrow due to the ongoing loss they feel about not having a “normal” or “perfect” child. Not to say that these children are not perfect in their own beautiful ways, however, the parents may have to adjust their previous expectations of the child. Prior to this adjustment, they may experience something like this chronic grief or sorrow throughout their life (Moeller, 2017). 

Distorted grief: Distorted grief is another form of complicated grief. Specifically, it refers to an individual developing extreme behavioral changes consisting of guilt, anger, hostility toward others, and/or self-destructive behaviors (Haley, 2013; Roldan, 2021). 

Exaggerated grief: Under the same umbrella term of complicated grief, exaggerated grief refers to a significant escalation of normal grief responses. In this type of grief, as time passes, the symptoms of grief get worse rather than better. 

Traumatic grief: Traumatic grief is a combination of a loss and a traumatic experience. This may occur if the loved one is lost in a frightening, horrifying, or unexpected way (Haley, 2013). An individual experiencing this may have symptoms of both grief as well as PTSD (Post Traumatic Stress Disorder). (Phillips, 2021).


The Kind that Keeps Coming

Cumulative grief: This can also be understood as “bereavement overload” or “grief overload”. Cumulative grief is when an individual experiences multiple compiling losses before they are able to fully grieve and heal from the initial loss (Haley, 2013). The Georgetown Psychology Team (2021) recently released an article about this very thing. In the article, they discussed how COVID-19 created ample cumulative grief for individuals. First, loss of normalcy, then loss of jobs, loss of friends and family… The list could go on (Georgetown Psychology Team, 2021). 

Secondary loss: Secondary loss refers to other losses that occur due to the initial loss. For example, if a child loses their parents due to a car accident and they had to go into foster care, the initial loss would be the death of their parents, and the secondary losses would be loss of their home, loss of normalcy, loss of a relationship, loss of support system, and the list could go on. (Williams, 2013).

The Hidden Kinds 

Masked grief: Related to complicated grief, this type of grief is due to maladaptive coping mechanisms that interfere with the individual’s ability to process their grief head-on. Masked grief may also occur out of an effort to be more socially appropriate. Because grief cannot be avoided, the symptoms may reveal themselves in other masked ways. Examples may include a variety of physical symptoms like a rash developing, headaches, intestinal issues or ulcers, increased heart rate, or high blood pressure. (Moeller, 2017). 

Inhibited grief: Inhibited grief is defined by an individual showing no outward signs of their grief. Much like masked grief, when the grief is not processed or expressed, the grieving person may begin to experience physical or somatic symptoms. (Haley, 2013)

Absent grief: This is an absolute lack of any and all grief symptoms. (Haley, 2013). It is defined by the APA Dictionary as another form of complicated grief, and it is understood to be due to denial or avoidance of the emotional response. (Haley, 2020).

The Unvalidated Kinds 

Disenfranchised grief: Bereavement expert Kenneth Doka coined this term in 1989. He describes disenfranchised grief by saying, “it is a loss that’s not openly acknowledged, socially mourned or publicly supported,” (Cardoza & Schneider, 2021). I think it helps to look at the word “disenfranchise” itself. It can be defined as “to deprive of a legal right or of some privilege” (Merriam-Webster, 2021). In this definition, we can see that our natural response to grieving is our right.  COVID-19 presents ample examples of potential disenfranchised grief. People may feel grieved by the sheer number of people who passed away from the virus but perhaps did not lose anyone who was closely related. Doka remarks on this same thing in an interview with NPR, “The pandemic of COVID-19 will be followed by a pandemic of complicated grief because so many losses are disenfranchised,” (Cardoza & Schneider, 2021). Our takeaway here should be, to stop and feel the loss, no matter how small it may seem. 

Ambiguous loss/grief: A term developed by Dr. Pauline Boss, it is a loss that lacks clarity or can be difficult to explain. It is, in fact, ambiguous! Dr. Boss emphasizes the importance of understanding this type of loss as it impacts all of us. It is similar to disenfranchised grief. A few examples Dr. Boss refers to include having aging parents, immigration, or divorce. (Boss, 2021).

The Empathetic Kind

Vicarious grief: Vicarious grief is grief that is stimulated by someone else’s loss (Gupta, 2021). Examples are seen by the significant impact of COVID-19. There has been so much loss all around us, even if you don’t know anyone personally that has passed away from COVID, the impact of hearing about it so much can lead to feelings of grief and loss. Vicarious grief could also be seen as commonly indirect care providers working with individuals near the end of life. 

The Healthier Looking Kind

Integrated grief: Integrated grief occurs when the person grieving is able to integrate the loss into their life in a healthy way. This would be like finding a new normal after the loss. That does not mean the grief is over or no longer felt. Instead, thoughts, feelings, and behaviors related to their loss are integrated in ways that allow them to remember and honor the person. This would be a result of healthy grieving (The Center for Complicated Grief, 2017).

How are you feeling? How is your colleague feeling?


References:

Beyond. (n.d.) What is Delayed Grief? In Grief, Loss, and Bereavement. https://beyond.life/help-centre/grief-loss-bereavement/what-is-delayed-grief/

Boss, P. (2021). About Ambiguous Loss. Ambiguous Loss. https://www.ambiguousloss.com/about/

Cardoza, K. and Schneider, C. (2021). The Importance of Mourning Losses (Even When They Seem Small) https://www.npr.org/2021/06/02/1002446604/the-importance-of-mourning-losses-even-when-they-seem-small

Georgetown Psychology Team. (2021). The Distress of Cumulative Grief.  https://georgetownpsychology.com/2021/07/the-distress-of-cumulative-grief/

Gupta, S. (2021). Why you should address vicarious grief. Mint Lounge. https://lifestyle.livemint.com/relationships/it-s-complicated/how-to-address-vicarious-grief-111621050053061.html

Haley, E. (2020). Absent Grief: Why Am I Not Grieving Like I Expected To? What’s Your Grief? https://whatsyourgrief.com/absent-grief-why-am-i-not-grieving-like-i-expected-to/

Haley, E. (2013). Types of Grief. What’s Your Grief? https://whatsyourgrief.com/types-of-grief/

Mayo Clinic Staff. (2021). Complicated Grief. https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374

Merriam-Webster. (2021). Disenfranchise. In Merriam-Webster.com dictionary. Retrieved November 22, 2021, from https://www.merriam-webster.com/dictionary/disenfranchise

Moeller, S. (2017). Chronic and Prolonged Grief. The Grief Recovery Method. https://www.griefrecoverymethod.com/blog/2017/09/chronic-and-prolonged-grief

Moeller, S. (2017). Masked Grief. https://www.griefrecoverymethod.com/blog/2017/09/masked-grief

Phillips, L. (2021). Untangling trauma and grief after loss. Counseling Today. https://ct.counseling.org/2021/05/untangling-trauma-and-grief-after-loss/

Roldan, K. (2021). Distorted Grief: 10 Things to Know When Grief Turns Hostile. USURNS Online. https://www.usurnsonline.com/grief-loss/distorted-grief/ 

The Center for Prolonged Grief. (2017). CG is a form of grief that takes hold of a person’s mind and won’t let go. Columbia School of Social Work.  https://complicatedgrief.columbia.edu/for-the-public/complicated-grief-public/overview/

The Center for Prolonged Grief. (2017). Official Diagnostic Criteria. Columbia School of Social Work. https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/diagnosis/

Vasquez, A. (2020). How Does Chronic Grief Work? Definition & Examples. Cake. https://www.joincake.com/blog/chronic-grief/

Williams, L. (2013). Secondary Loss — one loss isn’t enough??!! https://whatsyourgrief.com/secondary-loss-one-loss-isnt-enough/