Grief

Common Reactions to Grief

Physical Reactions	Affective Reactions	Cognitive Reactions	Behavioral Reactions
Headaches  Muscle aches Nausea Tiredness Loss of appetite Pains Insomnia Tenseness	Sadness Anger Guilt Jealousy Anxiety and fear Shame Powerlessness Relief Emancipation Searching for meaning Change in spiritual feelings or beliefs	Obsessive thinking Inability to concentrate Fantasizing Apathy Dreams Confusion Continued thoughts about the loss Sense of deceased's presence Attempts to understand the loss	Crying/ inability to cry Illness-related behaviors Outward expression of emotion Avoiding or seeking reminders of loss Social withdrawal Physical activities Increase in alcohol, smoking or other drug use Being careful about assuming the meaning of any specific behavior

First, some definitions:

• Loss refers to being deprived of someone or something to which one was attached or previously possessed.
• Secondary loss follows as a consequence of the primary loss (e.g., loss of income, hopes, and sometimes even faith).
• Bereavement refers to the basic fact or objective reality of loss.
• Grief refers to the response and reactions to the loss. It involves the tension created by the conflict between the world that was, what it cannot be, and how it may become, and includes physical, affective, cognitive, and spiritual domains.

Factors that contribute to coping:

• Type and timing of loss.
• Quality of relationship with the deceased.
• Social support.
• Pre-existing factors.

Fear and anxiety about death:

• The view of death as loss is linked to fear and anxiety about death.
• Middle-aged adults show greatest fear of death. Older adults the least fear of death. Young adults' level of fear is somewhere in between.
• Concern about death and dying increases across aging. Therefore, although death is highly salient in late adulthood; it is not as frightening as it was in middle-age.
• Numerous personal qualities are predictive of fear of death (e.g., religiosity, neuroticism, personal competence, etc).

The process of dying:

• Kübler-Ross has developed a model of coming to term with death: Denial, Anger, Bargaining, Depression, and Acceptance.
• Kübler-Ross's conception has been enormously influential; however, it is weakened by methodological flaws.
• Some controversy as to whether there truly are universal stages of dying.
• One aspect of dying which is missing from Kübler-Ross's stages is the process of saying farewell to loved ones. This process is important for the dying and the grieving.
• Significant individual differences in emotional and physical process of death.
• Positive avoidance, fighting spirit, stoic acceptance, helplessness/hopelessness, anxious preoccupation.
• Studies link these psychological differences to immune system functioning.
• Social support is another important factor in a person's response to imminent death.

After death: rituals and grieving.

• Every culture has rituals associated with death that help people apply meaning to death and the life of the person who has died.
• The process of grief can be viewed through Kübler-Ross's stage theory.
• Recent research suggests personality and coping influences how one deals with grief.
• Bowlby describes four stages of grief: shock, yearning, despair, reorganization.
• Wortman and Silver identify patterns of grief: normal grieving, chronic grieving, delayed grieving, and absent grieving.
• Loss can also lead to growth.
• Awareness of death can help define and give meaning to daily life.

National Institute of Health Grief Information