GRIEF – Symptoms, Types and Stages

GRIEF – Symptoms, Types and Stages 

nurseinfo nursing notes for bsc, msc, p.c. or p.b. bsc and gnm nursing

GRIEF – Symptoms, Types and Stages

Grief is the painful psychologic and physiologic responses to loss. It affects physical, cognitive, behavioral, emotional, social and spiritual aspects of the individual.

Grief is the natural response to loss. It is essential for good mental and physical health. It is a natural part of human experiences

It is the total response to the emotional experience related to loss which is manifested in thoughts, feelings and behaviors associated with overwhelming distress and sorrow.

Bereavement: it is the subjective process through which grief is eventually resolved or altered. It is often influenced by cultural, religious experiences and customs.



  1. Physical symptoms – weakness, anorexia, feeling of choking, shortness of breath, tightness of chest, dry mouth and gastro-intestinal disturbances, insomnia etc.
  2. Cognitive symptoms – difficulty in concentration, people may experience hallucinations
  3. Behavioral and relating symptoms – disruption in pattern of conduct, ranging from an inability to perform even basic activities of daily living, restlessness, disorganized behavior.
  4. Affective symptoms – sadness, guilt, anger, major depression



  1. Anticipating grief (Pre mourning) – it is defined as grief associated with anticipation of predicted death or loss. It is generally viewed as an adaptive process that can help resolve relationships and prepare solutions to some extent for the loss.
  2. Acute grief – usually referred to simply as grief, is the typical painful experience after a loss. People might initially respond to death of loved one without shock and disbelief.

Many factors other than culture and religion influence the length and intensity of grief. These are the nature of the relationship, manner of death, survivor’s involvement in care, length of illness and the presence or absence of hope. Acute grief does not have clear ending


3. Dysfunctional grief – it has been described in multiple ways. It’s types are

Absent or inhibited grief – It is characterized by no expression of grief following significant loss. Suppressed grief may manifest as chronic physical illness such as ulcerative colitis, peptic ulcer or major depression

Distorted grief – it is characterized by distortion, usually exaggeration, of one or more components of grief especially guilt or anger. It may lead to depression or legal difficulties following angry or violent outbursts.

Coverted grief – It is similar to conversion disorder in which pre-occupation with decreased may be exaggerated to the extent that the survivor exhibits symptoms or characteristics of the deceased.

Chronic grief – it is unending grief. Its symptoms may intensify over time. It occurs in response to a loss (e.g. death)


4. Chronic sorrow: it is a form of grief that may include characteristics of other forms of grief but differs in several key aspects. Chronic sorrow is a response to ongoing loss such as chronic illness. E.g. sorrow of parents having a child with drug addiction.



By Kubler Ross

Stage I – Denial

Stage II – Anger

Stage III – bargaining

Stage IV – depression

Stage V – acceptance


By John Boulby

Stage I – Numbness or protest

Stage II – disequilibrium

Stage III – disorganization and despair

Stage IV – reorganization


Stages of Grief by George Engel:

Stage I – shock and disbelief

Stage II – developing awareness

Stage III – restitution

Stage IV – resolution of the loss

Stage V – recovery


Kubler’s Ross Stages of dying:

Kubler Ross (1969) considers 5 stages of dying:

1. Denial and isolation: in this stage, the client denies that he or she will die, may repress that is discussed and may isolate self from reality. The person may think, “they made mistake in the diagnosis”. They may not come to the hospital
2. Anger: the client expresses range and hostility in the anger stage and adopts a “why me?” attitude. Hostility may be directed towards care givers or local ones.
3. Bargaining: the client tries to barter for more time “if I can live up to my grandson’s marriage, I will be satisfied. Just let me live until then”. May clients put their personal affairs in order, make wills and fulfil last wishes.
4. Depression: in this stage, the client goes through a period of grief before death. The grief is characterized by crying and not speaking much. “I waited all these years to see my grandson married, I will die before he gets married” etc.
5. Acceptance: when this stage is reached, the client feels tranquil. She or he has accepted the death and prepared to die. He may think, “I have tried up all the loose ends, made all arrangements to my son to lead a happy life”.