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ULY CLINIC
ULY CLINIC
24 Septemba 2025, 14:06:55
Grief
Grief is defined as deep anguish or sorrow, typically experienced in response to separation, bereavement, or significant loss.
In patients with terminal illness, grief may precede the stage of acceptance of dying.
Unlike clinical depression, grief proceeds through identifiable stages and often resolves naturally over time.
Pathophysiology / Psychosocial Mechanisms
Grief involves complex emotional, cognitive, physiological, and behavioral responses to loss.
Psychological models, such as Kubler-Ross’s Five Stages of Grief, describe the process as:
Denial – Initial refusal to accept the reality of loss.
Anger – Frustration or resentment related to the loss.
Bargaining – Attempt to negotiate or reverse the loss.
Depression – Sadness, withdrawal, and preoccupation with the loss.
Acceptance – Coming to terms with the loss and integrating it into life.
Neurobiological studies suggest grief activates limbic and prefrontal circuits, influencing mood, reward, and stress responses.
Chronic or unresolved grief may predispose individuals to depression, anxiety disorders, or physical health complications.
Assessment and Clinical Features
Feature | Manifestation |
Emotional response | Sadness, longing, anger, guilt, or helplessness |
Cognitive changes | Preoccupation with the deceased, disbelief, or confusion |
Behavioral changes | Social withdrawal, crying, sleep disturbances, appetite changes |
Physiological effects | Fatigue, somatic complaints, immune changes, heart rate variability |
Duration | Normal grief typically diminishes over weeks to months |
Complicated grief | Persistent, intense grief lasting >6 months with functional impairment |
Differential Diagnosis
Condition | Key Feature | Notes |
Major depressive disorder | Persistent sadness, anhedonia, guilt unrelated to loss | Grief often has waves and context-specific triggers |
Adjustment disorder with grief | Emotional or behavioral response within 3 months of loss | Resolves with adaptation over time |
Bereavement-related depression | Severe, prolonged, functional impairment after loss | May require therapeutic intervention |
Normal grief | Gradual adaptation and improvement over time | Does not significantly impair daily functioning |
Pediatric considerations
Children may not verbalize grief; observe behavioral regression, irritability, or somatic complaints.
Age-appropriate explanations and support are essential.
Geriatric considerations
Older adults may experience grief compounded by loss of peers, independence, or health.
Grief may exacerbate chronic illness or cognitive decline.
Limitations
Subjective experience varies widely among individuals and cultures.
Grief may coexist with depression or anxiety, requiring careful clinical differentiation.
Screening tools (e.g., Inventory of Complicated Grief) may be needed for complex cases.
Patient counseling
Validate the patient’s feelings and normal reactions to loss.
Encourage social support, expression of emotions, and participation in rituals.
Educate about stages of grief and the typical course of emotional adjustment.
Monitor for complicated or prolonged grief that may require psychotherapy or pharmacologic support.
Conclusion
Grief is a natural emotional response to loss that follows a recognizable, though individual, pattern of adjustment. Proper assessment and supportive counseling facilitate adaptation, prevent complications, and help patients integrate loss into their lives.
References
Worden JW. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. 5th ed. New York: Springer; 2018.
Stroebe M, Schut H. The Dual Process Model of Coping with Bereavement. Death Stud. 1999;23(3):197–224.
Bonanno GA. Loss, Trauma, and Human Resilience. Am Psychol. 2004;59(1):20–28.
Kübler-Ross E, Kessler D. On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. New York: Scribner; 2005.