Psychological & Physical Effects of Grief

Posttraumatic stress disorder or PTSD is a mental health condition that sometimes occurs when a person experiences a trauma or witnesses a terrifying event or series of events. Once believed only to affect soldiers who had been in combat (it was then referred to as “combat fatigue”)  PTSD is actually a fairly common occurrence in people who have experienced trauma of any kind, including the sudden or traumatic death of someone they love. According to the American Psychiatric Association, PTSD affects approximately 3.5% of American adults each year, and about one in 11 Americans will experience symptoms of PTSD during their lifetime. 

Almost any traumatic event can trigger PTSD. However, some of the most common  triggers are:

• Serious accidents such as car wrecks
• Natural disasters
• Acts of war, combat
• Terrorist attacks
• Mass shootings
• Rape or sexual assault
• Being threatened with physical harm, sexual violence or rape
• Learning that any of the above has happened to a loved one (indirect exposure)
• The sudden death of a loved one

Additionally, people who have experienced prolonged suffering or who have undergone repeated trauma (such as victims of prolonged domestic abuse, child abuse, sexual exploitation or incest) often suffer from a particularly severe form of PTSD known as Complex PTSD. This kind of PTSD may also affect doctors, nurses, and the loved ones of people who die a difficult and painful death. Many individuals who were on the front lines of the recent coronavirus pandemic or who watched their loved ones die of COVID-19, for example, have gone on to develop complex PTSD. 

With that being said, it’s important to understand that not everyone who has an intense emotional reaction to a traumatic event meets the criteria for PTSD. Many people who are indirectly exposed to a terrifying event (such as the sudden, traumatic death of a loved one) develop a less prolonged condition known as acute stress disorder or ASD. Characterized by many of the same symptoms as PTSD[ link to what are the sx of PTSD), ASD develops shortly after a traumatic event and lasts less than one month. If symptoms persist beyond that time, the person is said to have PTSD. 

Sources

“The Burden of Loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4119479/ 

“What is Posttraumatic Stress Disorder (PTSD)?” American Psychiatric Association. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd 

“Complex PTSD: History and Definitions”. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp 

“Acute Stress Disorder”. Merck Manual Consumer Version. https://www.merckmanuals.com/home/mental-health-disorders/anxiety-and-stressor-related-disorders/acute-stress-disorder 

Complicated grief treatment is a psychotherapeutic approach that has been shown to be effective in alleviating the symptoms of complicated grief. This type of therapy is similar to psychotherapy techniques used for PTSD or depression, but it is specifically designed to address symptoms associated with complicated or prolonged grief disorder. Attachment theory, cognitive-behavioral therapy, or CBT, and other methods are used to help someone better adapt to and process their loss. A 16-session intervention utilizes a combination of these varied approaches in individual or group settings. 

Complicated grief treatment takes patients through phases of healing techniques that include seven core themes:

1.      Guiding patients to accept grief

2.      Monitoring and managing emotional pain

3.      Encouraging future-oriented thinking

4.      Reconnecting with others

5.      Mastering an ability to tell the story about the death

6.      Learning to live with reminders of the deceased

7.      Making a connection to memories about the deceased

Through these theme-oriented treatments, participants learn to better recognize their grief reactions while adjusting to the loss. Patients may be asked to hold imagined conversations with their loved one to reduce stress caused by thoughts about them. In some cases, they also may be asked to imagine and recount to the therapist the details of the death and revisit those details over a period of weeks. Similar to something called imaginative exposure where patients with phobias imagine a situation when they would experience anxiety from a specific trigger, this process may be too upsetting for some clients and does not yield a favorable outcome for everyone.

Some researchers believe more studies are needed to better understand the value of individual techniques related to complicated grief treatment. Aside from ensuring their efficacy, experts believe this could also help to drive more affordable options for patients, who may only need portions of therapy related to certain aspects of their grief.

For instance, cognitive-behavioral strategies can be used alone or in conjunction with other interpersonal psychotherapies to help those who suffer from prolonged grief disorder. CBT can address underlying symptoms associated with the disorder including sleep disturbances or insomnia. A pilot study shows promise for CBT-inclusive therapies as participants reengaged in positive self-care and with social resources. Improvement was also noted for symptoms of grief, depression, anxiety, and posttraumatic stress that often accompany complicated or prolonged grief disorder.

Pharmacological intervention is only used as an adjunct treatment option for complicated grief. It is most effective in treating underlying symptoms of depression when combined with other therapies. Studies show that support groups may help to reduce intensity of periods of acute grief, but do not address the long-term scope of grief.

Robert Neimeyer, professor emeritus of psychology at the University of Memphis, director of the Portland Institute for Loss and Transition and co-editor of “Grief and Bereavement in Contemporary Society,” recently told The Washington Post, “the most important goals of complicated grief therapy are to develop a narrative of what happened, to revise and re-create one’s relationship with the loved one, and to reinvent oneself.”

The bottom line is that patients who suffer from complicated grief or prolonged grief disorder should seek out treatment. The American Psychological Association warns that without treatment, the condition can persist indefinitely, leading to problems such as substance abuse, suicidal thinking, sleep disturbances and impaired immune function.

If you believe you have symptoms of complicated grief, or prolonged grief disorder, The Center for Prolonged Grief has a list of psychotherapists who specialize in many types of therapies specifically designed to address symptoms, or you can ask your healthcare provider to recommend someone.

Sources

“Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment”. Psychiatry Online. https://psychiatryonline.org/doi/10.1176/appi.focus.20200052 

“All About Cognitive Behavioral Therapy (CBT)”. PsychCentral. https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy 

“Exposure Therapy: How Imaginal Exposure Techniques Help with Phobias”. Dr. Joseph S Weiss. https://www.theanxietydocseattle.com/exposure-therapy-imaginal-exposure-techniques-help-phobias/ 

“A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/25113524/ 

“Grief interventions for people bereaved by suicide: A systematic review”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/28644859/ 

“Grief and Bereavement in Contemporary Society (Routledge Mental Health Classic Editions)”. https://www.amazon.com/Bereavement-Contemporary-Society-Routledge-Editions-dp-1032058919/dp/1032058919/ref=mt_other?_encoding=UTF8&me=&qid= 

“Prolonged grief disorder recognized as official diagnosis. Here’s what to know about chronic mourning.” Washington Post. https://www.washingtonpost.com/lifestyle/2021/10/21/prolonged-grief-disorder-diagnosis-dsm-5/ 

“Find a Therapist”. The Center for Prolonged Grief. https://prolongedgrief.columbia.edu/find-a-therapist-contact-us/ 

Anything that reminds you of the loved one who died can prompt grief – common triggers include holidays, birthdays, significant milestones and anniversaries (this is referred to as the “anniversary effect”). Knowing that a meaningful date is approaching can trigger grief far beyond the actual day itself. Sometimes even smaller events, such as hearing a song, visiting a familiar place, even a particular taste or smell, can provoke an intense emotional reaction. Essentially, grief can be sparked by anything that reminds a person of their loved one, making it a deeply personal and often unpredictable experience.

If you’re experiencing grief due to a trigger, it can be helpful to acknowledge that this is a normal response. Giving yourself extra time on and around meaningful days, planning specific acts of remembrance, reaching out to a trusted friend or family member, and taking time to reflect, whether by journaling, meditating or otherwise, can help you move through your feelings of grief.

Sources

How to Offer Support and Find Strength on a Trauma Anniversary”. Johns Hopkins Bloomberg School of Public Health. 

https://publichealth.jhu.edu/2024/the-anniversary-effect-of-traumatic-experiences

“Frequently Asked Questions about Grief”. Stanford – Grieving at Stanford. https://grieving.stanford.edu/how-get-help/frequently-asked-questions-about-grief 

The belief that grievers must “work through’ their grief in order to heal or move forward to a stage of reconciliation is extremely common, although not necessarily true. When Elizabeth Kubler Ross developed the five stages of grief in the 1960s, she did so based on the Freudian model of bereavement, which posited that successful mourning meant that one had to “detach” from the loved one who had died. This task, Freud believed, could only be accomplished by exploring one’s grief in great detail, often over the course of many years. Kubler-Ross embraced this theory, believing that to achieve the final stage of grief, acceptance, one had to “move through” each stage by outwardly expressing one’s emotions in some way. In her final book, “On Grief and Grieving, (published in 2005, one year after her death) she wrote “Telling your story often and in detail is primal to the grieving process. You must get it out. Grief must be witnessed to be healed.” 

Today, over 50 years later, many psychologists and grief experts continue to espouse these beliefs. For example, Dr. Alan Wolfelt, a noted psychologist who practices in the field of grief and loss, advises us that mourning openly and outwardly is the only way to effectively process a loss. In “ Mustering the Courage to Mourn” he writes:

“The pain of grief will keep trying to get your attention until you unleash your courage to gently, and in small doses, open to its presence. The alternative—denying or suppressing your pain—is in fact more painful. If you do not honor your grief by acknowledging it, it will accumulate and fester. So, you must ask yourself, “How will I host this loss? What do I intend to do with this pain? Will I befriend it, or will I make it my enemy?”

All this advice notwithstanding, a great deal of research has failed to demonstrate that any of it is true– at least not for everyone. For example, a 2007 study by Dr. George Bonanno and colleagues of Columbia University showed that people who “held in ” their negative emotions after the death of a spouse or a child were actually less depressed six months later than those who expressed their feelings outwardly. This finding also held true at 14 and 25 months after the loss occurred. According to Bonanno, this probably indicates that repressing feelings rather than expressing them has a protective effect on emotions. 

Several other studies have also suggested that “working through” grief may not be a necessary part of moving forward after a loss. For example, several studies led by Margaret Stroebe of Utrecht University showed that talking or writing about the death of a spouse did not help people adjust. Nor were women who lost their spouses who outwardly expressed their grief ultimately less depressed than those who did not. 

Bonanno’s work and that of other grief researchers have also belied the idea that grief is a long, slow process characterized by many months or even years of intense suffering. Although this is certainly true for some individuals, studies have shown that most people go through a period of brief, intense mourning followed by a series of ups and downs during which they experience both positive and negative emotions. Further, the majority of people begin to feel well enough to resume their lives relatively quickly, although periods of longing, loneliness, sadness and regret may persist for some time.

Sources

“Mustering the Courage to Mourn”. Center for Loss and Life Transition. https://www.centerforloss.com/2023/12/mustering-courage-mourn/ 

“Does repressive coping promote resilience? Affective-autonomic response discrepancy during bereavement”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/17469956/ 

Grief can indeed manifest as physical pain. Symptoms can include tightness in the chest and/or stomach, muscle tension, weakness, problems breathing and general body aches. Exhaustion, anxiety and the intense emotions associated with grief also can lead to a heightened state of stress — stress hormones can prompt an immune system response that results in inflammation in the body. Inflammation in turn can lead to feelings of sickness, pain, fatigue, gastrointestinal distress and more. If someone experiences these hormones chronically, as in prolonged grief disorder, more serious health issues such as cancer, chronic inflammatory disorders, mental health problems and earlier mortality may emerge. 

Supporting your body and immune system can ease physical symptoms of grief — being mindful of diet, exercise, thought patterns and sleep help promote resilience in the aftermath of grief. 

For more information about caring for yourself after a significant loss, see our Comprehensive Step-by-Step Planning Guide: The Grief Healing Process

For more information about caring for yourself after a significant loss, see our Comprehensive Step-by-Step Planning Guide: The Grief Healing Process

Sources

“How does grief affect your body?” UCLA Health. 

https://www.uclahealth.org/news/article/how-does-grief-affect-your-body

“Physical symptoms of grief”. Marie Curie. https://www.mariecurie.org.uk/information/grief/physical-symptoms 

It’s pretty common to experience feelings of relief or peace after the death of a loved one — especially if that person had been suffering from a long illness or faced significant challenges. In these cases, the end of their struggle can bring a sense of closure, letting you focus on positive memories together rather than the pain. Death can lead to a complicated mix of emotions, where gratitude for the person’s life coexists with grief over their absence. Recognizing these feelings is a natural part of the grieving process and reflects the complexity of human emotions.

Further, feeling relief can be a result of freedom from the burden of caregiving and stresses associated with illness — or of gaining a sense of safety if the person was difficult or abusive in life. The emotional and physical toll of watching a loved one suffer, or suffering because of them, can be overwhelming. Their passing may provide a sense of liberation from that distress. It’s important to acknowledge that these feelings are valid and part of the journey through grief. Each person’s experience is unique, and there are no rules, and no right or wrong way to feel during such a difficult time. Embracing a range of emotions without judgment can ultimately lead to healing and a deeper understanding of the relationship you shared.

Sources

“Why it’s OK to feel relieved when someone dies”.  Marie Curie. 

https://www.mariecurie.org.uk/talkabout/articles/relieved-when-someone-dies/313426

Broken heart syndrome, also known as stress cardiomyopathy or takotsubo cardiomyopathy, is a usually temporary heart condition triggered by extreme emotional stress. Stressors can include the loss of a loved one, a traumatic event like a serious argument, or even surprise good news. Physical events such as breaking a bone, major surgery or sudden severe illness can also provoke broken heart syndrome. Symptoms feel akin to those of a heart attack, including chest pain and shortness of breath, and are thought to be the result of stress hormones interrupting normal blood pumping and weakening the heart muscle. Broken heart syndrome is diagnosed by blood testing, echocardiography, EKG, heart x-rays, and more. 

Highlighting the profound connection between emotional and physical health, most patients recover fully within a few weeks — often with medical intervention — though longer term complications can occur. If experiencing any unusual chest pain, it’s a good idea to call 911 or otherwise seek medical attention to rule out an actual heart attack.

Sources

“Broken heart syndrome”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/symptoms-causes/syc-20354617

“Broken Heart Syndrome”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17857-broken-heart-syndrome

Grief and depression may look similar, but they are not the same thing. Grief is a healthy and expected reaction to loss, whereas clinical depression or major depressive disorder is a mental illness. The ups and downs that a grieving person experiences are not pathological and they are not evidence that they are clinically depressed.

With that being said, grief is sometimes mistaken for clinical depression by both lay people and healthcare professionals alike. People who are mourning a loss are often sad a great deal of the time; have little energy; lose interest in things they once enjoyed; and have disordered or disrupted sleep — all symptoms of major depressive disorder. These symptoms may also be present for a terminally ill person or their family, who may be experiencing anticipatory grief or preparatory grief, which is the type of grief often associated with the expectation of loss. 

And so it’s not surprising that when grieving people turn to professionals for help, they are often labeled as “depressed” and prescribed antidepressants. This is especially likely to be the case when a person is suffering from prolonged grief disorder or complicated grief, which is characterized by intense, debilitating emotional suffering long after a loss occurs. 

There are distinct differences between grief and depression. Most importantly, grief is always preceded by a loss, while depression often occurs without a specific preceding event. Additionally, people who are grieving tend to focus on the person who died or the loss that occurred. Someone who is experiencing a major depressive episode tends to focus more on themselves (e.g. “I feel sad, hopeless, lonely, worthless, etc.). 

Another key difference between grief and depression is in the ability to feel pleasure. Even in the midst of intense anguish, most grievers have moments when they can feel happy or at peace. They can laugh when someone tells a funny story about the person who died; they can enjoy being around loved ones and sharing memories of when the person was alive. People suffering from depression, on the other hand, are consistently unable to feel pleasure, and often derive little comfort from having others around. Further, the bereaved tend to experience a roller coaster of many intense emotions almost simultaneously, while people with major depressive disorder tend to have very muted emotional responses and may feel emotionally “stuck.”.

Lastly, clinical depression is often accompanied by feelings of worthlessness, loss of self-esteem and even self-loathing. Even in intense grief, most people retain a sense of their own worth. They may question whether life is worth living without the person they lost. They may also question their faith and long-held beliefs. But their sense of self tends to remain intact. 

Sources

“Depression (major depressive disorder)”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007 

“Grief vs. Depression: What You Need to Know and When to Seek Help” HIA Health. https://www.hiahealth.org/2025/05/01/grief-vs-depression-what-you-need-to-know-and-when-to-seek-help/ 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, PTSD is characterized by a distinct set of signs and symptoms that are grouped into four major categories: intrusion; avoidance; changes in thinking and mood; and arousal. The person must be experiencing symptoms from each category to meet the criteria for PTSD.

Intrusion Symptoms

PTSD may cause many unwanted, intrusive thoughts and experiences, including: 

• Unwanted, upsetting memories of the trauma
• Nightmares related to the trauma 
• Flashbacks (re-experiencing the trauma: this can be accompanied by a dissociative state, in which the person feels as if they are reliving the trauma real-time)
• Extreme emotional distress such as terror, panic attacks and even hallucinations when exposed to reminders of the traumatic event (for example, a domestic abuse survivor who hears a man shouting at his spouse.)
• Intense physical reactions such as nausea, vomiting, tremors, tingling, shortness of breath or chest pain when exposed to reminders of the traumatic event. 

Avoidance Symptoms

A person with PTSD will often go to enormous lengths to avoid:

• Distressing memories, thoughts, or feelings about the trauma. They may refuse to talk about what happened or even admit that it occurred (for instance, a victim of sexual assault who denies that she was raped. )
• External reminders, including people, places, activities, or situations that remind them of the trauma or bring up distressing memories of the event. This can include the actual location of the trauma (for example, a street corner where an accident occurred), places similar to the location (for example, all hospitals) or any person or situation that evokes sounds, smells or visual cues associated with the traumatic event.  

Changes in Thinking or Mood

This category includes a wide variety of cognitive, emotional and behavioral changes, including:

• Inability to recall important details of the traumatic event
• Inappropriately blaming oneself or others for what occurred
• Withdrawing from friends and loved ones
• Persistent negative emotions, such as anger, fear, guilt or shame
• Inability to enjoy once pleasurable activity
• Persistently low self-esteem or feelings of worthlessness
• A persistently negative view of oneself and the world (e.g. feeling unsafe, powerless, distrustful and/or hopeless to affect what happens in one’s life. 

Arousal Symptoms

Symptoms or arousal and hyper-reactivity include:

• Inappropriate anger, irritability or aggression
• Hypervigilance — a state of always being alert to dangers around you, even when none exist
• Extremely risky of self-destructive behavior
• An exaggerated startle response
• Difficulty sleeping
• Trouble concentrating 

Importantly, these symptoms must be preceded by exposure to a traumatic event or events that involve the threat of death, actual or threatened serious injury; or actual or threatened sexual violence. This can occur in any of the following ways:

• Direct exposure 
• Witnessing a trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to the trauma, usually in the course of professional duties (e.g., first responders, doctors, and nurses)

Sources

“Trauma-Informed Care in Behavioral Health Services”. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/ 

“Dissociative disorders”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215 

“Hypervigilance: What you need to know”. MedNewsToday. https://www.medicalnewstoday.com/articles/319289