Features of grief
Grief is a normal, yet highly individualised, response to loss; each patient, family member and carer will experience different feelings or reactions to perceived or impending loss. Grief is influenced by social, cultural and spiritual beliefs and attitudes. It is often characterised by:
- separation distress—preoccupation with thoughts or images of the deceased, especially yearning for the deceased
- intense sadness, tearfulness
- loss of usual levels of activity and ability to undertake normal tasks
- withdrawal from others
- physical symptoms, including fatigue and loss of appetite
- sleep disturbance
- fleeting images and transient hallucinations involving the deceased
- anxiety about the future.
For characteristics of grief in children, see Children’s responses to death.
Symptoms of grief usually fluctuate, then progressively decline over time, and gradually become integrated as a person resumes involvement in their usual interests and responsibilities. Symptoms may be exacerbated or recur at significant times, such as anniversaries. The time frame of ‘normal grief’ following death is debated and can reflect cultural and social factors; in general, symptoms start decreasing within 6 months. Parents of a child who has died often experience grief for much longer.
Individuals with a developmental disability or cognitive impairment, may express their grief as behavioural changes. Patients with chronic psychiatric disorders may experience relapses or other behavioural changes.