How To Recognize Anticipatory Grief

Reviewed by Dawn Brown, LPC, NCC

Published 01/08/2021

Grief begins when someone dies, right? Maybe not. Sometimes, people start to grieve before death happens. Anticipatory grief, also called pre-loss grief, often begins to happen when you realize you are about to lose someone important to you. Here’s how to recognize this type of grief and what to do about it.

Anticipatory Grief Definition

What is anticipatory grief? Psychologists define anticipatory grief as a grieving process that can happen before a significant loss, such as the impending death of a loved one. In other words, you anticipate or expect the loss to happen soon, and it triggers a grief process. You may feel anxiety, depression, sadness, and sorrow. Simultaneously, knowing that the person will die soon gives you opportunities to take care of practical matters and resolve relationship issues.

How Is Anticipatory Grief Related To Complicated Grief?

Anticipatory grief can lead to complicated grief when the grief process gets derailed. Complicated grief includes chronic grief, delayed grief, and absent grief. Chronic grief is the most common of the three, and it shows up as a devastating grief response that doesn’t get better over time.

If you feel that your anticipatory grief may have given way to complicated grief, there’s an easy way to get some answers. You can take a test online to check yourself for signs of complicated grief. You can also take an anxiety test or depression test if you know you’re having a mental health challenge but aren’t quite sure what it is.

Examples Of Anticipatory GGrieving

Examples of pre-loss grief can give you a clearer picture of what the term means. Here are several situations that might lead to anticipatory grief and the kinds of responses someone might have to them.

  • You find out that your spouse has terminal cancer. Even though their doctor says they will probably live a few more months, you begin to imagine what their death will be like and what it will be like to live without them.

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  • You recognize that your grandmother is showing more and more severe signs of Alzheimer’s Disease. You realize that she will soon be unable to communicate with you. You may feel a sense of loss even before this happens.
  • Your pet gets very sick. The vet says there’s nothing they can do to save your pet. You begin to miss your fur baby before they’re gone.
  • Your doctor tells you that due to your advanced diabetes, you will lose a limb. They schedule the surgery. You begin to feel anxious about your loss of mobility before the surgery day.
  • Your doctor tells you that you only have a few weeks to live. You begin grieving for yourself and respond to your grief with anger. Yes, even the person who knows they will die can experience anticipatory grief!

These are just a few examples, of course. Anticipatory grief can accompany any significant loss, and the response you have is unique to you. But if it’s a grief reaction, it’s essential to recognize it and take the right steps to deal with it.

Signs Of Anticipatory Mourning

Many of the signs of anticipatory grief are the same as a normal grief process. Others are unique to this particular type of suffering. Knowing and recognizing these signs may help yourself, or someone else goes through the grief process more successfully.

Common Symptoms Of Grief

First, consider the symptoms these two types of grief share. If you’re feeling either normal or anticipatory grief, you might experience:

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  • Sadness
  • Anger
  • Anxiety symptoms
  • Depression symptoms
  • A desperate need to talk
  • A feeling of emotional numbness
  • Unexplained fatigue
  • Fear
  • Feelings of guilt or self-blame
  • Loneliness
  • Trouble concentrating
  • Forgetfulness

Symptoms Specific To Anticipatory Grief

Because the person is still alive or the loss hasn’t happened yet, anticipatory grief brings another set of symptoms. Some of these are:

  • The intense concern for the person who is dying.
  • Imagining what their death will be like, often in great detail.
  • Making preparations for life without them.
  • Focusing on unfinished business with the dying person, whether it’s unfinished financial matters, getting an advance directive in place, or resolving relationship issues.
  • Going back and forth between hope that they’ll miraculously survive and fear that they won’t.
  • Sadness or anger when your loved one’s appearance, speech, or medical condition worsens.
  • Feeling overwhelmed by decisions you need to make for their care.

Anxiety Symptoms

Anxiety symptoms can be a part of anticipatory grief. Some of these symptoms include increased muscle tension, worry, trembling, raised blood pressure, or heart palpitations. These symptoms may show up when you’re with your loved one or between visits with them.

Depression Symptoms

Anticipatory grief can also cause many kinds of depression symptoms. Some of the most common ones are intense feelings of sadness, emptiness, hopelessness, fatigue, restlessness, insomnia or oversleeping, loss of appetite or overeating, and sometimes even unexplained physical pain.

Are There Stages In Anticipatory Grief?

You may have heard of the five stages of grief outlined by Elisabeth Kubler-Ross. These stages are denial, anger, bargaining, depression, and acceptance. These can all happen in anticipatory grief. However, three steps perhaps describe the anticipatory grief process more precisely.

  1. The shock that the loss is going to happen
  2. Denying that the loss will really happen
  3. Accepting the loss

Complicating this process is the fact that miracle cures do sometimes happen, even though they’re rare. Even if the doctor says there is no hope at all, you may find that hard to believe. After all, most people have heard of at least one situation in which a doctor proclaimed no hope and yet the person lived. This hope leads to a rollercoaster of emotions. You may get excited about the possibility of a cure one day and see how remarkably unlikely it is to happen the next.

Do You Have Grief After The Death If You Have Grief Before It?

For many years, scientists have been studying whether anticipatory grief can make grief after death easier. After all, it’s natural to assume that if you deal with the death before it happens, you’ll have already passed through the grief process – or at least most of it – by the time they die. However, scientists have not found evidence that this is true.

One review of scientific studies concluded that caregivers of terminally ill patients, who went through anticipatory grief, didn’t have better outcomes than those who didn’t have anticipatory grief. A more significant issue was whether the caregivers prepared themselves and the people they were caring for before the death. Those who were not well-prepared and had pre-loss grief were the most likely to have complicated grief problems after the death happened.

What Can You Do To Help Yourself Or Someone Else?

When someone you love is about to die, you don’t have time to hope and wish that things could be different. It is a time to make the most of every day you have left with them. You can help yourself and them by assisting them to enjoy their remaining time, connecting with them, and taking care of legal and financial matters.

Help Them Enjoy Their Last Days

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Your loved one may be going through intense suffering and pain. They may not be fully aware of what’s going on around them. Yet, there are things you can do to improve their quality of life even then. Instead of worrying about keeping them with you, focus on giving them small moments of happiness amidst their pain or confusion. Maybe that means singing or playing their favorite songs. Perhaps you can bring them a snack they enjoy. You could get a photo album or a scrapbook to go through as you talk about happy memories. Consider any small thing that you think might bring a moment of happiness or peace.

Connect With Them

Talk to your loved one if you can. Let them talk as much as they want and listen to what they have to say. Thank them for the part they played in your life or for some small thing they did for you that had a significant impact on your life. If you feel that you’ve hurt them in some way, now is your time to say you’re sorry or ask for their forgiveness. Tell them you love them.

Take Care Of Practical Matters

As the scientific review mentioned above discovered, those who were most prepared for the loss had better grief outcomes after death. Of course, you need to prepare yourself emotionally. But you may also need to take care of practical matters like legal and financial issues and funeral arrangements. Take enough time to deal with them appropriately. If your loved one needs to have a part in the decision and they’re able to, go over the details with them and allow them to have their say.

How To Deal With Your Own Feelings Of Anticipatory Grief

You can also do several things to help yourself deal with anticipatory grief and smooth the way to a better outcome after they die. Here are some self-care tips that help with this type of suffering.

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  • Talk to people you trust about what you’re going through
  • Speak with a therapist about how you’re coping with the upcoming loss
  • Give yourself permission to grieve
  • Express your feelings by journaling, making art, playing music, or writing poetry
  • Join a grief support group or to AA meetings if you have had problems with alcohol abuse
  • Take care of your mental and physical health to improve your stamina and make you less vulnerable to stress

Conclusion

It’s important to remember that anticipatory grief is a legitimate process. Yet, it’s a process that you need to manage well to have an excellent outcome to bereavement after the death happens. The first step is understanding what anticipatory grief is and recognizing it in yourself or your loved ones. You can then address essential issues, prepare for the loss, and give your loved one the best last days possible.