When someone important to you dies, aftershock grief is a normal response. When we understand this natural process, take care of ourselves, and remember to seek support, grief can lead to healing and personal growth.

Everyone Grieves Differently

There are multiple factors such as your personality, support system, and coping skills that will govern how loss will affect you. The grief process is non-linear and there may be setbacks. Some people start to feel better after a few weeks and some people feel the pain of loss for years. It is critical to treat yourself with patience, kindness, and compassion through this process.

We all experience grief differently and we also express grief in our own ways too. Some people's sorrow may be more noticeable, others may keep their feelings of grief to themselves. Throughout the healing process, grief's manifestations may vary in amount and intensity. It can be both powerful and painful -- physically, emotionally, socially, and spiritually.

Normal Grief - a grief response that falls under an extremely broad umbrella of predictability. Reactions to a loss can be physical and psychological. It is not uncommon to experience periods of intense distress and feeling such as (but not limited to) the following: crying, dreaming of your loved one, anger, denial, despair, insomnia, fatigue, guilt, disorganization, disbelief, preoccupation with thoughts of your loved one, withdrawal, avoidance, numbness, relief, sadness, yearning, fear, shame, loneliness, helplessness, hopelessness, emptiness, loss of appetite, and weight gain or loss. Normal grief is marked by movement towards acceptance of the loss and a gradual alleviation of the symptoms, as well as the ability to continue to engage in basic daily activities.

Anticipatory Grief - the reaction to a death you were able to anticipate such as when an individual dies from a long term illness. As soon as you accept and understand someone you love is going to die, you begin grieving. Grief that occurs preceding a loss can be confusing, as you may feel conflicted or guilty for experiencing grief reactions about someone who is still here. Anticipatory grief is different than the grief response felt after a death and does not necessarily make the latter any easier. However, it can allow those who love the individual to slowly and gradually prepare for and absorb the reality of the loss. Also, for some but not all, it allows for meaningful time spent with the individual leading to a sense of closure and peace.

Complicated Grief - grief reactions and feelings of loss that are debilitating, long lasting, and/or impair your ability to engage in daily activities. People who are experiencing complicated grief believe that all of their happiness came from the person who has died and they no longer have any hope for happiness in their life now that their loved one has passed away.

Distorted Grief - extreme, intense, or atypical reactions to a loss, odd changes in behavior and self-destructive actions. Anger and hostility towards oneself or others are common.

Cumulative Grief - when one experiences a second loss while still grieving a first loss. This is also referred to as “bereavement overload” or “grief overload”.

Traumatic Grief - normal grief responses experienced in combination with traumatic distress suffered as a result of a loved one dying in a way perceived to be frightening, horrifying, unexpected, violent, and/or traumatic. Distress is extreme enough to impair daily functioning.

Collective Grief - grief felt by a collective group such as a community, society, village, or nation as a result of an event such as a war, natural disaster, terrorist attack, death of a public figure, or any other event leading to mass casualties or national tragedy.

Inhibited Grief - when an individual shows no outward signs of grief for an extended period of time. The individual inhibits their grief, eventually leading to physical manifestations and somatic complaints.

Absent Grief - when the bereaved shows absolutely no signs of grief and acts as though nothing has happened. Characterized by complete shock or denial, especially in the face of a sudden loss. This becomes concerning when it goes on for an extended period of time. This does not account for differences in how we grieve and it's important to note that just because you can't tell someone is grieving doesn't mean they aren't.

When to Seek Help

In many cases, grief may be a lifelong process; it is absolutely normal to feel the aftershock of loss for the rest of your life. If you ever experience thoughts that your life is not worth living, or if you find it difficult to complete daily tasks (such as cleaning or going to work), we recommend that you talk to a doctor or therapist.

In order to understand your grief and begin your unique healing process, it is so important that you practice self-care. Be sure to sleep and eat well. When you feel ready, try to participate in your usual hobbies and activities that bring you joy. Most importantly, accept your feelings and remember that grieving is a process.

Spending time with friends and family can also be key to healing. Speaking with others who are also grieving can help you feel connected and supported. Joining bereavement groups or speaking with a therapist may be a beneficial part of your grief journey.

Common Symptoms of Grief

Individuals may experience a range of physical and cognitive symptoms while grieving. These symptoms are perfectly normal and expected after a loss, and one need only become concerned if they last for an unusual amount of time.

  • Difficulty concentrating
  • Confusion or disorientation
  • Loss of appetite
  • Difficulty sleeping
  • Irritability
  • Crying spells
  • Loss of interest in activities
  • Withdrawal from others
  • Obsessive thoughts about the loss
  • Preoccupation
  • Desire to talk about the loss over and over

Stages of the Grieving Process

What you may experience -- this doesn't necessarily occur in order and can recycle. Everyone grieves a little differently.

DenialAnger and GuiltSadness and DespairAcceptance and HopeAfterwards
  • Disbelief
  • Numbness
  • Shock
  • Anger, sometimes misdirected
  • Guilt, sometimes misdirected
  • Sadness
  • Loneliness
  • Tearfulness
  • Depression
  • Reminders that bring new waves of grief
  • Acceptance of your loss
  • Adjustment to changes
  • Gradual lessening of feelings of grief

Coping with Grief and Loss

  • Give yourself time to grieve. Don't expect yourself to be fully functioning during this time period.
  • It may not feel like it now, but know that the pain will lessen in frequency and intensity with time.
  • Roller-coaster feelings are normal -- you are not “going crazy.”
  • It is okay to be angry. Find ways to express your anger that are healthy, such as journaling.
  • It is okay to be sad. Let yourself cry.
  • It is okay (and healthy) to laugh, even while grieving.
  • Take care of your body. Eating, resting, and exercising are important. Avoid excessive alcohol intake.
  • It is best to put off major decisions while one is in the initial stages of grief.
  • Know that while some people find their spiritual beliefs strengthen at times of loss, others find themselves questioning earlier beliefs. There is no “right” or “wrong” here.
  • Find a good listener. You may want to consider talking to a spiritual leader or a mental health professional, particularly if your close friends and relatives are experiencing their own loss at this time.
  • During times of loss, individuals sometimes experience thoughts such as, “What is the use of living?” Although it is very normal to have these thoughts, it is not okay to act on them. You should contact a health professional or call the National Suicide Prevention Lifeline at 800-273-8255 if you feel you might be going to act on these thoughts.


Duke HomeCare & Hospice
Duke Community Bereavement Services
1001 Corporate Dr.
Hillsborough, NC 27278

American Hospice Foundation
2120 L Street NW, Suite 200
Washington DC 20037

Duke Hospital Bereavement Services
Box 3137, Duke University Medical Center
Clearinghouse for information, resources, and support regarding grief, loss, dying, and death. Available for Duke patients, families, and staff.

Duke Hospital Pastoral Services
225 Baker House
Box 3112, Duke University Medical Center
Resource for pastoral and spiritual support for Duke patients, families, and staff who have experienced a death and need assistance dealing with the spiritual, religious, and/or ethical aspects of loss.