Test Your Knowledge

Grieving is a personal process. Different people may grieve in different ways, and these may vary by families and culture. Some people may express their sorrow openly by crying, whereas others believe certain aspects of grieving should remain private.

The emotional and psychological symptoms of grief include:

• Sadness and low mood. Sorrow, regret and a sense of mental discomfort are common in grief. The grieving person may sigh, sob, cry out or yearn for what was lost. There may be a feeling of having a lump in the throat.
  
  
• Shock, disbelief and confusion. The first response to a major loss is often the denial that the loss has occurred. Individuals may not be able, or may refuse, to grasp the truth of the loss. When the actuality of the loss sets in, the grieving person may be confused and unable to comprehend how or why it has happened.
  
  
• Anger and irritability. After denial, anger may set in. Grieving people may be angry at themselves or others for allowing the loss to occur. They may lash out and seem enraged at the world.
  
  
• Guilt. Guilt generally follows anger in the grieving process. People who are grieving may feel as though they failed to prevent the loss. They may also experience a mild reduction in their feelings of self-worth, but any severe decline in self-esteem may be a warning sign that major depression is developing.
  
  
• Anhedonia. Loss of interest or pleasure in activities. Many people who are grieving lose interest in daily activities.
  
  
• Passive wish to “join the loved one.”  This should not be confused with actual suicidal ideation (thoughts of suicide) and does result in suicidal behavior or attempts. Actual suicidal behavior is a serious warning sign that grief has progressed into major depression and requires immediate treatment.
  
  
• Anxiety.
  
  
• Obsession with what was lost.

Grief can negatively impact on physical health, as well. Existing medical conditions may worsen and new conditions may develop. Other physical symptoms of grief include:

• Numbness and emptiness. People who are grieving may experience emotional and physical numbness and hollow or empty feelings in the chest and abdomen.
  
  
• Fatigue. Grieving people may tire easily or feel as though they are always tired.
  
  
• Appetite and sleep disturbances. People who have experienced a major loss may eat too much or lose their appetite. They may sleep too little (insomnia) or too much (hypersomnia) and may have nightmares.
  
  
• Substance abuse. Grieving people may use alcohol or drugs in an attempt to deal with their grief.
  
  
• Aches and pains. Vague physical complaints such as stomachaches and headaches are common among grieving individuals.
  
  
• Trouble concentrating. Grief can often impair a person’s concentration.

Children and adolescents may exhibit different signs and symptoms while grieving. Signs that a child may be grieving include:

• Withdrawal from friends
• Unrestrained, aggressive play
• Decline in school performance or refusal to attend school
• Asking questions about or imitating what was lost
• Playing games about dying
• Acting much younger or reverting to earlier behaviors (e.g., bedwetting, baby talk, thumb sucking)

Grieving adolescents may show signs of shock or anger for an extended period of time. Some teenagers may respond to grief by turning to alcohol, drugs or sexual activity. Some adolescents may have thoughts of suicide while grieving. In such cases, professional help should be sought immediately for the person.