Anticipatory Grief: Symptoms and How To Cope

Grief. We’ll all experience it at some point. But there may be times in your life when you’re expecting to feel grief years or months before it even happens. Known as anticipatory grief, it’s a coping mechanism to help us prepare for an unavoidable loss like the death of a loved one.

“Everybody is going to face some type of loss in their life. None of us gets out of this lifetime without having experienced some type of grief,” says psychologist Regina Josell, PsyD. “The extent to which people experience anticipatory grief can vary, but everybody is going to experience it on some level at some point.”

So, how do you know if you’re dealing with anticipatory grief? And can anticipatory grief be a good thing? Dr. Josell explains how it all works and what symptoms to look for.

What is anticipatory grief?

“It’s a collection of symptoms — cognitive, behavioral, emotional — that we experience in anticipation of an impending loss,” explains Dr. Josell. “We most commonly associate anticipatory grief with somebody who is very ill or dying — either one’s own impending death or a loved one. But it can also be in reference to other types of losses such as an illness or a forced job change.”

How is anticipatory grief different from traditional or conventional grief?

“There is overlap,” says Dr. Josell. “Conventional grief happens after the loss — it’s a reaction to the loss, whereas anticipatory grief is considering what is to come. It’s thinking about what’s going to happen as opposed to reacting to something that has already happened.”

And you may think anticipatory grief is a bad thing. But Dr. Josell says there are some benefits to it.

“Anticipatory grief can have benefits. It can help prepare somebody for the grief when it actually happens,” she says.

Anticipatory grief can help you think through certain situations like having to set up hospice for a loved one or making funeral arrangements. It helps you face your fears rather than avoid them, with the hope that you can navigate your grief when the loss occurs.

“It can be an opportunity in the sense that it gives people a chance to finish unfinished business,” says Dr. Josell. “If you know that a loss is imminent, there is an opportunity to try to transition ahead of time, look towards the future and say goodbyes.”

Symptoms of anticipatory grief

Anticipatory grief is like a snowflake — no two people’s symptoms are exactly the same.

Common anticipatory grief symptoms include:

• Overwhelming emotions such as sadness, anger and loneliness.
• Difficulty sleeping.
• Loss of appetite.
• Difficulty concentrating.
• Being preoccupied and replaying different scenarios in your head.
• Withdrawal from others.

Stages of anticipatory grief

You may have heard of the five stages of grief: denial, anger, bargaining, depression and acceptance. Researchers have coined the four stages of anticipatory grief as:

• Acceptance. During this stage, you recognize that a loved one’s death is unavoidable. You may feel emotions such as sadness, denial, anger and experience depression.
• Reflection. This is when you start to come to terms with how you’re feeling. In addition to feeling anger, you may also feel regret, guilt and remorse.
• Rehearsal. As you go through this process, you start to think about how you’ll feel during and immediately after the loss. For example, with a loved one’s death, you think about how you’ll act and what things you may need to do such as make funeral arrangements.
• Imagining the future. During this stage, you begin to visualize what your life will look like after the loss.

“These stages aren’t all linear — not everybody goes through them all,” notes Dr. Josell. “It’s not that we check one off and then we’re on to the next one. Sometimes, we ping-pong back and forth.”

She adds that there’s an overlap between the stages of anticipatory grief and traditional grief. And it’s important to note that anticipatory grief can turn into prolonged grief disorder or complicated grief.

“Grief can become detrimental when it starts to overwhelm you. It can start to interfere with your ability to manage everyday tasks, your ability to go to work or take care of your home and your children,” she explains. “It can cause you to withdraw from others to where you feel loneliness, a sense of isolation and depression. You may even experience suicidal thoughts or turn to drug use or alcohol use. All of those can be signs that your grief is taking over in a negative way.”

How to deal with anticipatory grief

Dr. Josell says it’s important to start off by normalizing the experience of anticipatory grief.

“It’s normal for people to anticipate loss and to have a reaction to an impending negative experience,” she says.

Here’s how to cope with anticipatory grief:

• Talk about what you’re going through. Don’t hesitate to share and talk with other people about what you’re feeling. “When we think that we’re unique and the only person who’s ever experienced something, it makes everything worse,” says Dr. Josell. “Talking with other people who have been through a similar experience or have had similar kinds of symptoms can be very helpful.”
• Feel your emotions. You may have been taught to ignore your emotions — don’t let people see you cry or become upset. But that’s not a healthy way to deal with your emotions, says Dr. Josell. “We get the message to push those emotions down, that they’re not good, they’re not healthy,” she explains. “But what happens is your emotions burst out another way.” Your emotions can manifest in overeating or even turning to alcohol and drugs. So, feel what you feel. “When we let ourselves feel it, those emotions tend to dissipate a lot more quickly than if we try to hold them back or ignore them.”
• Take care of yourself. Practice self-care often. “When we’re not in a good place, we stop taking care of ourselves,” notes Dr. Josell. “Make sure you focus on sleep and a healthy diet, while making an effort to move your body, drink plenty of water and being around other people that make you happy.”

When to get help for anticipatory grief

So, how long does anticipatory grief last? It varies from person to person.

“Often, it can last until the loss happens. Some people can anticipate losing a parent way before a parent is ill or old,” clarifies Dr. Josell. “And then for others, they don’t experience anticipatory grief until there’s some kind of loss right in front of them.”

Then typically, after you have a loss, you’ll experience grief. And grief can last anywhere from six months to a year or more.

“I tell people it’s normal to spend one to two years not being or feeling like yourself,” says Dr. Josell. “Does that mean that there’s no improvement along the way? No, there will be improvement along the way. But people are still going to be grieving a long time after a loss.”

So, when should you seek help for anticipatory grief?

“People can get help at any stage,” says Dr. Josell. “You don’t have to wait for things to become complicated. It doesn’t have to be at a state where it’s interfering with your life for you to get help. What I find helps with grief more than anything is letting people tell their story without judgment and without advice. Allow people to feel their emotions — and validate and normalize what their experience is. Then, it’s important to focus on how they can take care of themselves through the process.”

Good grief

It’s important to remember that grief — whether anticipatory or traditional — is normal.

“If you love somebody, you’re going to experience loss at some time and you’re going to have some thoughts and feelings about that,” says Dr. Josell. “It helps to feel your feelings, to take care of yourself and to let people know what you’re going through.”

And remember, you may be feeling sad, angry and depressed thinking about losing a loved one and how you’ll miss them. But don’t give up hope.

“It will get better — it absolutely will get better. Anticipatory grief gets better. Conventional grief gets better,” reassures Dr. Josell. “Does it ever stop hurting? Not entirely, but you’re going to be able to function and enjoy life again.”