5 stages of grief: Coping with the loss of a loved one

Grief is an unfortunate but inevitable part of life. Whether due to the death of a loved one (this type of grief is referred to as bereavement), losing a job, or any other significant life change, grief is the universal response to dealing with loss.

What are the five stages of grief? We describe each, and how to find support through the grieving process.

What are the 5 stages of grief?

Although everyone copes with loss in different ways, there are five commonly defined stages of grief. The stages were first described by Dr. Elisabeth Kübler-Ross in her book On Death and Dying. They help provide a framework for the complex thoughts, behaviors, and emotions that are often experienced with the loss of a loved one.

While these stages should not be thought of as resolute — not everyone experiences these stages in the same way or in the same order, if at all — understanding them can help you make sense of the emotions you may be feeling.

Denial

Denial refers to the period of grieving during which a person refuses to accept the reality of a situation. Denial is different than not understanding. It is a defense mechanism that helps us protect ourselves from the shock of the upsetting hardship. A period of denial can be normal and even helpful during the grieving process, as we work to process a difficult situation. Examples of denial include:

• refusing to accept or acknowledge the death
• refusing or avoiding the topic in conversation
• stating the loss is not true, or that the source of the news is unreliable.

Anger

Once a person comes to understand the information they received, and accepts the reality of a death, they often experience anger. Anger can be a natural response directed toward oneself, family members, doctors, God, or even the deceased. Anger is a normal part of the grieving process, though it may seem hurtful or offensive to loved ones. Often, anger is just a manifestation of grief, and can present itself in various ways. For example:

• blaming a medical doctor for not preventing an illness
• blaming family members for a lack of care or support
• feeling anger toward God or a higher spiritual power
• feeling angry with oneself or blaming oneself for the death
• experiencing a short temper or loss of patience.

Bargaining

When we experience grief, we often feel hopeless and overwhelmed. It is common to be overcome by statements of "what if" and "if only," as we experience a loss of control over what is happening. During the bargaining stage of grief, a person attempts to negotiate or make compromises. We try to make agreements with ourselves, or a deal with a higher power, in exchange for feeling less sad or having a different outcome. Bargaining is often irrational. Examples of bargaining include:

• "If only I had brought her to the doctor sooner, this would have been cured."
• "If only I had been around more, I would have noticed something was wrong."
• "God, if you bring him back, I promise I will never lie again."

Depression

Depression is a feeling of sadness and hopelessness that often results with the loss of a loved one. While the earlier stages of grief help to protect us from the emotional pain experienced with loss, often these feelings are inevitable. Symptoms of depression include:

• feelings of sadness
• loss of interest in activities you normally enjoy
• changes in sleep
• significant changes in weight
• lack of energy
• feeling agitated or restless
• feeling worthless or guilty
• decreased concentration.

Feelings of depression are a natural reaction to grief. Following the loss of a loved one, acute grief can impact your functioning for a limited time. Bereavement can lead to prolonged grief disorder if these feelings persist and continue to cause significant impairment and distress in your life for more than a year. Prolonged grief disorder is a diagnosable medical condition and can become disabling if not managed appropriately.

Acceptance

Considered the fifth and last of Kübler-Ross's stages, acceptance refers to the period of grief when we finally come to terms with accepting the reality of our loss. When we have reached this stage of acceptance, we no longer deny or struggle against our grief. During this time, we work to focus our energy on celebrating the life of our loved one, cherish the memories that were shared, and make plans for moving forward.

Finding support

It is important to remember that the grieving process is different for everyone. Grief is not "one size fits all." Learning how to deal with grief is crucial for your physical and mental health. Grief can cause changes in many aspects of your daily life, including:

• appetite
• sleep habits
• mood
• energy levels
• health problems, such as increased blood pressure.

Although grief does not generally require treatment, finding a support system can help you better manage your grief. For some people, confiding in others can help lessen the burden of emotions you are experiencing. The goal is to prevent the unhealthy consequences of grief from causing serious damage to your health and well-being. You may find support in people or groups such as:

• family and close friends
• grief counselors or therapists
• grief support groups
• religious or spiritual leaders
• your doctor.

Information on bereavement support services including support groups can often be found on your local community or state government websites.

Other examples of things you can do to help cope after the loss of a loved one include:

• Develop a daily routine. Adhering to a healthy diet, exercise routine, and sleep schedule can help you focus on the things you can control.
• Celebrate the life of your loved one. Consider taking steps to honor the memory of your loved one who has passed in a way that is meaningful to you. This could be anything from collecting photos, to sharing stories, to establishing a memorial.
• Work on finding joy. Allowing yourself to experience joy during difficult times can help improve your mental state and provide long-lasting health benefits.
• Learn about different ways to process grief. Books such as On Grief & Grieving or I Wasn't Ready to Say Goodbye can help.

If you are feeling overwhelmed by your grief or are in immediate crisis, there are grief crisis hotlines you can contact 24/7 to receive help and resources:

• National Suicide and Crisis Lifeline: Call or text 988
• Veterans Crisis Line: Call 988, then press 1 or text 838255
• Substance Abuse and Mental Health Services Administration (SAMHSA): 800-662-4357
• Crisis Text Line: Text HOME to 741-741 in the U.S.

If you ever experience thoughts of self-harm or suicide, seek immediate medical help.