Anticipatory grief

Anticipatory grief refers to a grief reaction that occurs before an impending loss. Typically, the impending loss is a death of someone close due to illness but it can also be experienced by dying individuals themselves. The anticipated death can also be from non-illness-related causes such as high suicide lethality, high-risk lifestyle or gang involvement, or from non-death-related losses such as scheduled mastectomy, pending divorce, company downsizing or war.

The five stages (denial, bargaining, depression, anger and acceptance) proposed by Elisabeth Kübler-Ross in her model of grief to describe the process by which people cope after a loss can also be present in anticipatory grief. Anxiety, dread, guilt, helplessness, hopelessness, and feeling overwhelmed are also common. However, it is important to note that anticipatory grief is not simply normal grief begun earlier.

Features identified specifically with anticipatory grief include heightened concern for the dying person, rehearsal of the death and attempts to adjust to the consequences of the death. The period can allow people to resolve issues with the dying person and to say goodbye. It may provide some sense of orientation and access to the grieving process. For some, it prompts conscious closure before the end/loss.

Grief happening prior to a loss presents a compounding issue of isolation because of a lack of social acceptance. Anticipatory grief doesn't usually take the place of post-loss grief: there is not a fixed amount of grief to be experienced, so grief experienced before the loss does not necessarily reduce grief after the death. However, there may be little grieving after the loss due to anticipatory grief.

How often anticipatory grief occurs is a subject of some controversy. For example, a study of widows found that they stayed with their husbands until the death and could only mourn once the death had occurred. Researchers suggest that to start to grieve as though the loss has already happened can leave the bereaved feeling guilt for partially abandoning the patient.

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