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Understanding Grief Reactions

Introduction

Loss is a universal experience repeatedly encountered throughout life. Any loss results in a deprivation of some kind, either tangible or symbolic. Grief may be described as the process of psychologic, social, and somatic reactions to loss. The intensity of grief reactions may vary across individuals and is influenced by the type of loss, the situation surrounding the loss, the personality of the bereaved, concurrent stressors or losses, the availability of social support, and the strength of the attachment to the deceased.

Anticipatory grief refers to the anticipation of a future loss and includes many of the symptoms and processes of grief after a loss. Anticipatory grief may be experienced by the dying person (e.g., loss of health, function, role) as well as his or her family and friends.

Worden (1991) identified tasks of mourning that guide survivors toward adapting to life after the death of a loved one. The mourning process is complete when the following tasks have been accomplished:

  • Accepting the reality of the loss
  • Working through the pain of grief
  • Adjusting to the world without the loved one
  • Reinvesting emotional energy into new relationships

Assessment

Somatic reactions to grief may be experienced by bereaved individuals in any combination of the following ways:

  • Appetite disturbance (loss or gain of weight)
  • Gastrointestinal disturbances (diarrhea)
  • Inability to sleep
  • Crying
  • Tendency to sigh
  • Lack of strength
  • Physical exhaustion
  • Feelings of emptiness or heaviness
  • Feelings of "something caught in the throat"
  • Heart palpitations
  • Nervousness or tension
  • Loss of sexuality or hyper sexuality
  • Lack of energy or psychomotor retardation
  • Restlessness or searching for something to do
  • Shortness of breath

Psychosocial effects of normal grief include any combination of the following:

  • Disbelief, sadness, sorrow, depression, anxiety, irritability, self-blame, guilt, anger, fear, relief
  • Inability to concentrate
  • Confusion
  • Impaired memory
  • Slow, disordered thought processes
  • Restlessness or inability to sit still
  • Inability to initiate or maintain organized patterns of
  • Withdrawal from social interaction
  • Preoccupation with thoughts of the deceased
  • Dreaming about the deceased
  • Searching for the deceased
  • Learning to live without the deceased
  • Loneliness
  • Anniversary reactions on dates throughout the year (e.g., birthday, wedding anniversary, holidays)


Assessment: Risk Profile for Complicated Grief Reactions (Parkes & Weiss, 1983)

  • Lack of resources (social isolation)
  • Low socioeconomic status
  • Poor health status
  • Sudden death or a short period of illness
  • Perceived lack of social support
  • Lack of support from one's religious belief system
  • Lack of a supportive family
  • History of psychiatric illness
  • Multiple concurrent losses
  • Dysfunctional family relationships
  • Geographic distant from extended family.
  • Guilt within family relationships
  • High level of dependency among survivors
  • Ambivalent relationships within family


Intervention

  • Explain symptoms of the grief response. Give written information about expected somatic and psychosocial grief reactions to grieving survivors.

  • Explain the process of mourning. Give written information about grieving process to survivors.

  • Patients and family members may be comforted by the presence of clergy from their religious tradition. Provide information about available pastoral care services through the agency and determine whether the family would like to contact clergy of their choice.

  • Provide time and privacy: facilitate the practice of rituals (e.g., prayer) during the terminal phase of illness.

  • Refer to community-based mutual support groups. Support groups provide membership and friendship in a setting that offers exchange of information about grief, coping, and community resources. Participation in a support group has the potential to boost self-esteem.


References

Kubler-Ross E: On Death and Dying. New York: Macmillan, 1969.

Parkes CM & Weiss RS: Recovery from Bereavement. New York: Basic Books, 1983.

Worden, JW: Grief Counseling and Grief Therapy. 2nd Ed. New York: Springer Publishing Co , 1991.





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