What Is Bereavement?

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What Is Bereavement?

Bereavement refers to the state of having experienced the loss of a loved one. It most often refers to the time after a loss when emotions are at their most profound. This time is marked by intense grief and tremendous sorrow.

The term is sometimes used synonymously with grief and mourning. How people experience this time of grief can vary from one person to the next.

While bereavement is usually associated with death, it can also occur after other deep significant losses. The end of an important relationship or a major change in a person's health, for example, can also lead to feelings of bereavement.

Symptoms

People may experience a wide range of symptoms during bereavement including:

  • Shock
  • Numbness
  • Guilt
  • Sadness
  • Crying
  • Depression
  • Anger
  • Changes in appetite
  • Difficulty sleeping
  • Trouble concentrating

Diagnosis

Bereavement is a normal response to loss and is in and of itself not a diagnosable condition recognized by the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5). However, it may sometimes play a part in the onset of other conditions such as depression or anxiety.

The most recent edition of the DSM-5 removed what was known as the "bereavement exclusion" from the diagnosis of major depression. This change made it clear that while bereavement and depression are distinct, depression can occur within the context of bereavement.

"[The] DSM-5 recognizes that bereavement does not immunize the patient against major depression, and often precipitates it. Indeed, grief and depression—despite some overlapping symptoms, like sadness, sleep disturbance, and decreased appetite—are distinct constructs, and one does not preclude the other,” explained psychiatrist Ronald Pies in an article published in the journal Innovations in Clinical Neuroscience.

Causes

Bereavement is a response to loss. The circumstances that surround the loss, as well as the closeness of the relationship, can play a role in how the grief and bereavement that people experience. Some types of losses that can cause this include:

  • The death of a loved one: The loss of a family member or close friend can be one of the most difficult losses a person will face. In many cases, people must also cope with many different types of decisions related to the loss including making funeral arrangements and dealing with finances as they grappling with intense feelings of grief and sadness. 
  • Anticipatory grief: This type of bereavement may occur when a loved one is dying. While the person is not gone yet, loved ones may still experience feelings of grief including sadness and anger as they prepare for the loss of their loved one.
  • The loss of a beloved pet: Losing an animal companion can also trigger a period of bereavement. It can be a difficult transition and many people may struggle with feelings of deep sadness.
  • Miscarriage: The loss of a pregnancy can also lead to feelings of grief and a period of bereavement. 
  • A loss due to suicide: When sometimes dies by suicide, loved ones may be left struggling with feelings of shock and guilt. Because suicide is sometimes accompanied by stigma, those who are grieving may feel particularly isolated and unsupported.
  • A change in health status: The onset of a chronic illness or a sudden change in a person’s health status can also lead to feelings of bereavement. People may experience feelings of fear, anger, anxiety, regret, and mourning as they face the new challenges presented by their condition.

It is important to note that sometimes people are not able to experience bereavement and grief openly, often due to social stigma. This is known as disenfranchised grief.

It can occur when the loss is ambiguous, when there is a social stigma attached to the loss, or when a person's relationship with the person who has died is not recognized or valued by others.

Types

Everyone experiences bereavement and grief differently. However, it often follows a predictable pattern that is often characterized as a normal response to loss. In other cases, people may experience more persistent symptoms that continue to interfere with their ability to function normally for a longer period of time.

Normal Bereavement

Feelings of grief and bereavement typically occur in a series of five stages:

  • Denial: This stage is characterized by feelings of numbness, shock, and disbelief. People may refuse to accept the reality of the loss.
  • Anger: During this stage, people may feel anger about the loss. These feelings may be directed at other people, at themselves, or even toward the individual who has died.
  • Bargaining: This phase is often marked by appealing to a higher power for relief or a way to change the outcome. 
  • Depression: During this stage, people tend to experience great sadness and feelings of depression. They often turn inward and withdraw socially.
  • Acceptance: In the final stage of the bereavement process, people reach a point where they can accept the reality of the loss.

Psychiatrist Elisabeth Kubler-Ross introduced this stage model in 1969 to describe the process of bereavement following the loss of a loved one. However, she later adapted these stages to apply to other types of grief as well.

While it is often presented as a series of discrete stages, it is important to note that people may cycle through these stages at various points and may sometimes return to earlier states, even years after the loss.

Complicated Grief

Bereavement is painful and can be exhausting. While it isn't something that people "get over," the intensity of these feelings of grief usually lessen gradually over time. Some people, however, experience a more persistent form of bereavement that is known as complicated grief

This form of bereavement is characterized by intense feelings of sadness and pain that persist for a longer period of time. People who are experiencing complicated grief may experience symptoms such as:

  • Hopelessness
  • Preoccupation with death 
  • Feelings of detachment
  • Social withdrawal and isolation
  • Loss of interest
  • A loss of their sense of self

Research suggests that around 7% of bereaved people experience complicated grief.

While it is not recognized as an official diagnosis by the American Psychiatric Association's diagnostic manual, medical experts have suggested that complicated grief is characterized by symptoms of persistent, acute grief that last six months or longer. A proposed condition called "persistent complex bereavement disorder" is listed as requiring further study.

Treatment

The experience of bereavement is a natural and inevitable part of life, albeit incredibly painful. It often temporarily affects a person's ability to function normally and can affect nearly every aspect of an individual's life. During bereavement, carrying on with normal daily tasks, work, school, and relationships can seem difficult or even impossible.

For people who are struggling to cope, professional help may be beneficial. Grief counseling can support people as they work through the normal grief process with the guidance of a therapist. Support groups can also be a helpful place to explore difficult emotions and find social support from people who have had similar experiences.

For more prolonged bereavement, treatments such as cognitive-behavioral therapy (CBT), complicated grief treatment (CGT), or bereavement therapy can be beneficial.

  • CBT works by helping people identify and change the negative thoughts that affect their mental well-being.
  • CBT helps people learn how to make plans for the future, set goals for their recovery, and cope with their feelings about the death of their loved one.
  • Bereavement therapy, also known as grief counseling, is a type of treatment designed to help people who are coping with a loss.

The American Psychological Association reports that the majority of people can recover from bereavement on their own if they have time, support, and healthy habits.

Coping

Some things that you can do when you are bereaved include:

  • Showing yourself acceptance when you are dealing with strong or difficult emotions
  • Talking about the loss with others
  • Finding support from friends, family, and others
  • Caring for yourself by getting enough rest, eating healthy meals, and staying physically active
  • Celebrating and remembering your loved one

There are a number of different factors that can influence how people cope with bereavement. Access to support, maturity levels, experience with past losses, and the nature of the relationship can all affect how a person manages the loss.

Your own beliefs about death, religious upbringing, and cultural factors may also influence the bereavement and grieving process. A loss that was sudden, unexpected, or traumatic can also affect how people cope in the aftermath.

In such cases, reaching out for professional help can be a way to get the extra support that you need to come to terms the loss and the emotions you are experiencing.

Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares tips to stay mentally strong when you’re working through grief.  

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