What Are the Differences Between Anticipatory Grief and Grief After a Death?

Anticipatory grief, grief that occurs before a death, is common among people facing the possible death of a loved one or their own death. Most people are familiar with grief that occurs after a death, but anticipatory grief is not yet discussed very much.

As a result, some people feel that expressing their profound pain is socially unacceptable and do not receive the support they need. This article answers questions about what anticipatory grief is, its signs, and how best to cope during this difficult time.

This article is aimed mainly at someone grieving the approaching loss of a loved one, but the person who is ill also experiences this grief themselves.

I hope this article helps both people who are ill and those grieving the impending death of someone they love.

What is anticipatory grief?

Anticipatory grief is defined as grief that occurs before a death (or another major loss), rather than after it. Instead of involving death alone, this kind of grief includes many losses, such as losing a friend, changing family roles, fear of financial changes, and losing dreams of what might have been.

Grief does not occur in isolation. The experience often brings back memories of other past losses.

How does anticipatory grief differ from conventional grief?

Anticipatory grief may resemble grief after a death, but it also differs in many ways. It often involves more anger, more loss of emotional control, and atypical grief reactions.

Fears of being alone, of what life will be like without them, who you will be, and what you will do can create overwhelming anxiety and anticipatory grief. This may make the process more complex than conventional grief. You may be struggling with these concerns while your loved one is still beside you.

Not everyone experiences anticipatory grief, and experiencing it is neither good nor bad. Some people feel very little grief while a loved one is dying. They may realize that they are not allowing themselves to grieve because this could be interpreted as giving up hope. For others, grief before the actual loss is even more intense.

A study of Swedish women who had lost their spouses found that 40% considered the period before the loss more stressful than the period afterward. This suggests that anticipatory grief can often be the hardest part. One reason it can be more stressful and difficult is our fear of the unknown.

What is the purpose of anticipatory grief?

For a person who is dying, anticipatory grief may help them focus on what matters most and address unresolved issues. It may help them find meaning, closure, and a sense of peace.

For family members, anticipatory grief may provide an opportunity to reconcile differences, find closure, and adjust. It also offers both the patient and loved ones a chance to say goodbye.

Some people are reluctant to visit a dying loved one. They may want to avoid emotional pain or remember the person “as they were” before becoming ill. However, experiencing anticipatory grief offers important opportunities. Spending time with a loved one while they are weak may help you accept their death.

Although anticipatory grief does not always make grieving easier, it can sometimes make death seem more natural. Letting loved ones go is difficult. Seeing them weak, failing, and exhausted may make it a little easier to say, "it is all right for you to move on to the next place."

Does anticipatory grief help with grief after a death?

Anticipatory grief does not replace conventional grief or shorten the grieving process after death. There is no fixed amount of grief a person experiences when losing someone they love. Even if your loved one’s health has been declining for a long time, nothing can prepare you for the actual death.

Anticipatory grieving cannot replace later grief. Although it does not provide a head start on grieving, grief before death offers a chance to say goodbye that people who lose loved ones suddenly never have. The increasing value of your time together gives you an opportunity to remain present, to live “in the moment,” even when that is very difficult.

What are the signs of anticipatory grief?

The feelings accompanying anticipatory grief — in other words, its signs — resemble those that occur after a loss. The clearest difference from grief after death is that your mood may vary. Some days can be very difficult, while on others you may not feel sad at all.

Remember that everyone grieves differently. Some typical feelings associated with anticipatory grief are listed below:

• Sadness and tears: Sadness and tears may rise quickly and frequently when you least expect them. Even small things, such as a television commercial, can suddenly and painfully remind you that your loved one is dying.
• Fear: Fear is common and includes not only fear of death but also fear of all the changes associated with losing your loved one.
• Irritability and anger: You may experience anger yourself, but dealing with the anger of a dying loved one can also be difficult.
• Loneliness: A strong sense of loneliness is often experienced by the patient’s loved ones. Unlike grief after a loss, the feeling that expressing anticipatory grief is not socially acceptable can contribute to loneliness.
• A desire to talk: Loneliness can create a desire to talk with someone who understands how you feel and listens without judgment. If you have no safe place to express sadness, these feelings may lead to social withdrawal or emotional numbness (feeling no emotions) to protect the pain within.
• Anxiety: When someone you love and care for is dying, it can feel like living in a constant state of heightened anxiety. Anxiety can cause physical symptoms such as trembling and palpitations.
• Guilt: The period before a loved one’s death can bring profound guilt, especially if the person is suffering. While wishing that your loved one would not suffer, you fear the moment death occurs. You may feel survivor guilt because you will continue living while they will not.
• Intense concern for the person who is ill: You may find yourself extremely concerned about your loved one, with worries revolving around emotional, physical, or spiritual problems.
• Thoughts about death: You may imagine what it will be like when your loved one is gone. Or, if you are the person who is ill, you may imagine how your loved ones will carry on after your death. Many people feel guilty about these thoughts, but they are very normal and part of accepting the inevitability of death.
• Physical problems: These may include difficulty sleeping, changes in eating patterns, memory problems, and aches and pains such as headaches, back pain, or chest pain.

Any of these signs may be present at any time. You may find yourself reliving the same feelings of shock, questioning, or despair repeatedly. As noted above, there is no right or wrong way to experience sadness and grieve. This process is individual and unique for everyone.

Treatment and psychological support for grieving

Anticipatory grief is a normal part of grief as a whole. In some cases, however, sadness can be so intense that it interferes with your ability to cope. It is also common for people to develop depression when facing all the losses surrounding grief. The feelings of grieving can be difficult to distinguish from depression. If you are struggling to cope, we recommend seeking help from a mental health professional.

Coping with anticipatory grief

It is important to express your pain and allow yourself to be sad. Maintaining hope while preparing for death is difficult. Finding a friend with whom you can openly share your feelings is extremely helpful.

Remember that accepting your loved one’s death does not mean you must stop loving them. At this stage, some people begin to find a safe place in their hearts to hold memories of loved ones that will never die.

For more detailed coping methods, see our article “Coping with ANTICIPATORY GRIEF in cancer”.