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Understanding Anticipatory Grief

“Why Am I Already Grieving?”

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Updated April 15, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Anticipatory grief is a common grief reaction among people who are facing the eventual death of a loved one. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), this kind of grief is not often discussed. Because of this, some people find it socially unacceptable to express the deep grief and pain they are experiencing and receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope at this difficult time?

As a quick note, this article is directed more for someone who is grieving the impending loss of a loved one, but preparatory grief is also experienced by the person who is dying. Hopefully this article, as well as the link below on coping with anticipatory grief, will be helpful to both those who are dying, and those who are grieving a loved one’s death.

What is Anticipatory Grief?

Anticipatory grief is defined as grief that occurs before death (or another great loss) in contrast to grief after death (conventional grief). Rather than death alone, this type of grief includes many losses – such as the loss of a companion, changing roles in the family, fear of financial changes, and the loss of dreams of what could be. Grief doesn’t occur in isolation, and often the experience of grief can bring to light memories of other episodes of grief in the past.

 

Anticipatory grief can be similar to grief after death, but is also unique in many ways. Grief before death often involves more anger, more loss of emotional control, and atypical grief responses. This may be related to the difficult place – the in-between place people find themselves in when a loved one is dying. One woman told me that she felt so mixed up inside because she felt she kept failing in her attempt to find that tender balance between holding on to hope and letting go.

Not everyone experiences anticipatory grief. It is not good or bad to do so. Some people experience very little grief while a loved one is dying, and in fact find they don't allow themselves to grieve because it might be construed as giving up hope. Yet for some people, the grief before the actual loss is even more severe. A study of Swedish women who had lost a husband found that 40% of the women found the pre-loss stage more stressful than the post-loss stage.

Does Anticipatory Grief Help the Grieving Process Later On?

Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process. There is not a fixed amount of grief that a person experiences with the loss of a loved one. And even if your loved one’s health has been declining for a long time, nothing can really prepare you for the actual death.

 

Yet, while anticipatory grieving isn’t a substitute, or even a head-start for later grieving, grieving before death does give you opportunities for closure that people who lose loved ones suddenly never have.

Purpose of Anticipatory Grief

For those who are dying, anticipatory grief provides an opportunity for personal growth at the end of life, a way to find meaning and closure. For families, this period is also an opportunity to find closure. To reconcile differences. To and give and grant forgiveness. For both, it is a chance to say goodbye. The night my grandmother died I was lying in bed with her. She turned to me and said, "we’ll miss each other," and hugged me. It was her goodbye gift.

I receive emails often asking how I feel about a family member visiting a dying loved one. The comments I hear are, "I want to remember my loved one the way they were before cancer," or "I don’t think I can handle the grief of visiting." But anticipatory grief in this setting can be healing. One study found that anticipatory grief in women whose husbands were dying from cancer helped them find meaning in their situation prior to their husband’s deaths.

Though anticipatory grief doesn’t necessarily make the grieving process easier, in some cases it can make death seem more natural. It’s hard to let our loved ones go. Seeing them when they are weak, and failing and tired, makes it maybe just a tiny bit easier to say, "it’s okay for you to move on to the next place."

Symptoms

The emotions that accompany anticipatory grief are similar to those after a loss, but can be even more like a roller coaster at times. Some days may be really hard. Other days you may not experience grief at all. Listed are some of the typical emotions, but keep in mind that everyone grieves differently.
  • Sadness and tearfulness.
     
  • Fear – Including not just the fear of death, but fear about all of the changes that will be associated with losing your loved one.
     
  • Irritability and anger - You may experience anger yourself, but it can also be difficult coping with a dying loved one’s anger.
     
  • Loneliness – A sense of intense loneliness is often experienced by the close family caregivers of someone dying from cancer. Unlike grief after a loss, the feeling that it’s not socially acceptable to express anticipatory grief can add to feelings of isolation.
     
  • Desire to talk – Loneliness can result in a strong desire to talk to someone, anyone, who might understand how you feel and listen without judgment. If you don’t have a safe place to express your grief, these emotions can lead to social withdrawal or emotional numbness to protect the pain in your heart.
     
  • Anxiety - When you are caring for a loved one who is dying, it’s like living in a state of heightened anxiety all of the time. Anxiety in turn can cause physical symptoms such as tremulousness and shaking.
     
  • Guilt – For some people the time prior to a loved ones death can be a time of great guilt – especially if your loved one is suffering. At the same time that you long for your loved one to be free of pain (and hence, die), you fear the moment that death will actually happen. You may also be experiencing survivor guilt – a guilt that you will be able to continue on with your life while someone else will not.
     
  • Intense concern for the person dying.
     
  • Rehearsal of the death – You may find yourself visualizing what it will be like to have your loved one gone. Or if you are dying, visualizing how your loved ones will carry on after your death.
     
  • Physical problems - Such as sleep difficulty and memory problems.
     
  • Fears of loss, compassion and concern in children – One study found that fears about what was going to happen and how they would be cared for were very strong in children.

Treatment

Anticipatory grief is a normal process is the continuum of grief. But in some cases this grief can be so intense that it interferes with your ability to cope. It’s also common for people to develop depression when faced with all of the losses surrounding grief. Seek help with a mental health professional if you find yourself having difficulty coping.

Coping

It’s important to express your pain and let yourself grieve. Finding a friend or another loved one you can share your feelings openly with is extremely helpful, just as maintaining hope and preparing for death at the same time is difficult. It can be even harder as people may wonder why you are grieving – even become angry that you are grieving – before the actual death. Keep in mind that letting go doesn’t mean you have to stop loving your loved one – even after they die. During this stage some people begin to find a safe place in their heart to hold memories of their loved one that will never die. If you or a loved one are living with anticipatory grief, check out the following article for tips on what has helped others cope at this difficult time:

Next Step

Learn about tips for coping in this article:  10 Tips for Coping with Anticipatory Grief

Sources:

Cheng, J. et al. An exploration of anticipatory grief in advanced cancer patients. Psychooncology. 2010. 19(7):693-700.< http://www.ncbi.nlm.nih.gov/pubmed/19645075

Gilliland, G., and S. Fleming. A comparison of spousal anticipatory grief and conventional grief. Death Studies. 1998. 22(6):541-69.

Gross, J. et al. Anticipatory grief in adolescents and young adults coping with parental cancer. Praxis Kinderpsychologie und Kinderpsyychiatrie. 2012. 61(6):414-31.

Hottensen, D. Anticipatory grief in patients with cancer. Clinical Journal of Oncology Nursing. 2010. 14(1):106-7.

Johansson A., and A. Grimby. Anticipatory grief among close relatives of patients in hospice and palliative wards. American Journal of Hospital and Palliative Care. 2012. 29(2):134-8.

Johansson, A. et al. Anticipatory grief among close relatives of persons with dementia in comparison with close relatives of patients with cancer. American Journal of Hospital and Palliative Care. 2013. 30(1):29-34.

National Cancer Institute. Grief, Bereavement, and Coping With Loss (PDQ). Types of Grief Reactions. Health Professional Version. Updated 06/30/11. http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/HealthProfessional/page3

National Cancer Institute. Grief, Bereavement, and Coping With Loss (PDQ). Types of Grief Reactions. Patient Version. Updated 09/23/11. http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/Patient/page3#Keypoint4

Sutherland, N. The meaning of being in transition to end-of-life care for female partners of spouses with cancer. Palliative and Supportive Care. 2009. 7(4):423-33.

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