Cancer Support & Coping What Is Anticipatory Grief? By Lynne Eldridge, MD Updated on July 15, 2023 Medically reviewed by Adjoa Smalls-Mantey, MD, DPhil Print Table of Contents View All Table of Contents Definition Examples Characteristics Symptoms Benefits Stages Coping Anticipatory grief is a state of deep, painful sorrow that occurs before an impending loss. It can affect people facing the impending death of a loved one or their own death. The term can also be applied to a loss not associated with death, such as the anticipation of losing a breast during a mastectomy, of facing an impending divorce, or of being diagnosed with a progressive condition like Alzheimer's disease. Anticipatory grief, also known as preparatory grief, can help people cope by planning and preparing for the loss. Others contend that it has the opposite effect and can lead to prolonged grief disorder (PGD) in which painful thoughts persist for more than six months after a loss. This article explains what anticipatory grief is, what it can look and feel like, and how to cope as you come to terms with the loss of someone or something important in your life. Oliver Rossi / The Image Bank / Getty Images This article is directed more toward someone who is grieving the impending loss of a loved one rather than someone facing death who may be navigating the five stages of grief, What Is Anticipatory Grief? Anticipatory grief is defined as grief that occurs before a loss. The term is often used in the context of death but can encompass the impending loss of things not related to death. Anticipatory grief is common both among caregivers and those being cared for, often occurring simultaneously. Anticipatory grief is more than just normal grieving that starts early. It is often regarded as a means to process and resolve issues related to a dying person or a life-changing event. It may provide you with a means to proactively address your feelings and the likely consequences of the loss, dealing with them now rather than after the fact. Younger people tend to experience anticipatory grief more often and more traumatically, in part because they will have experienced loss less often than an older person and may have a more conceptual view of death. A 2017 study in the Journal of Hospice and Palliative Nursing reported that among adults with terminal cancer, those under 25 tended to view death as an "extinction." As a result, they experienced anticipatory grief more often and more severely than adults 25 and older. What Are Examples of Anticipatory Grief? Anticipatory grief can be triggered by many different things, including: Getting a terminal diagnosis, such as stage 4 cancer Being diagnosed with a progressive disease like Alzheimer's disease, cystic fibrosis, muscular dystrophy, or macular degeneration Learning that your unborn baby may have a congenital disorder based on prenatal tests Having to address end-of-life care, such as hospice Caring for a child with a chronic disease or a developmental disorder like autism Awaiting an organ transplant Having to undergo amputation or potentially disfiguring medical procedures like mastectomy or colostomy Life-changing situations like an impending divorce, a child leaving home for college, or having to move out of one's house The deterioration and impending death of a pet The implications of these events can be multi-faceted. They may involve concerns about finances and whether you're going to be able to support yourself and your family afterward. They may involve feelings of guilt, such as not wanting to continue a pregnancy due to a birth defect or not wanting to watch a loved one deteriorate. Or, you may start to fear how others will perceive you or if they will abandon you after the loss. Anticipatory Grief vs. Grief After Death: What Are the Differences? Anticipatory grief is similar to "conventional" grief after death insofar as they involve many of the same emotions. But with conventional grief, the emotions you experience are the direct consequence of a loss. Anticipatory grief is the grief that you expect to experience, much of which is conceptual and can change over time. Anticipatory grief is sometimes described as a "rollercoaster" because you can shift back and forth between feelings of distress for several days and feelings of normalcy for several days. There may also be a part of you clinging to the hope that the diagnosis is wrong, buoying you at one moment and triggering intense anxiety at another. With conventional grief, your emotions and actions are reactive. With anticipatory grief, your emotions and actions are largely proactive. A study of Swedish females who had lost a spouse determined that 40% found the pre-loss stage more stressful than the post-loss stage. What Are the Symptoms of Anticipatory Grief? The emotions associated with anticipatory grief are similar to those that occur after a loss. They can fluctuate unexpectedly and include: Loss of control of one's emotions: This includes intense sadness and tearfulness that comes out of nowhere or is easily triggered. Fear, irritability, and anger: Beyond the fear of death, you may fear the changes that will follow a death. In addition to dealing with your own anger, you may have to deal with the anger of the dying person. Loneliness and isolation: Caregivers often find others backing away from them during a serious health crisis. On the other hand, caregivers with anticipatory anxiety will often feel lethargic and unmotivated and will readily withdraw from social situations. Anxiety: Caregivers often feel like they're living in a state of heightened anxiety, manifesting trembling, edginess, a racing heart, and other symptoms. Guilt: Feelings of guilt can occur if you want a loved one to be free of pain, even if it means dying. Or, you may feel the opposite and want a loved one to stay even if means suffering. Intense preoccupation with the dying person: This can occur to the point of fixation, making it difficult to manage your health, work, or daily living. Rehearsal of the death: You may be visualizing what it will be like without your loved one. If you are dying, you may be imagining how your loved ones will carry on without you. What Are the Benefits of Anticipatory Grief? Studies are conflicted on whether anticipatory grief is beneficial or not. It appears to differ by the individual. For some, it may help them sort out their feelings and make preparations for moving forward. Many bereavement experts contend that anticipatory grief allows a person to: Confront their fears rather than avoid themDeal with any unfinished business, both practical and emotionalClarify any misunderstanding or express what should have been said earlierSay their goodbyesMake preparations for their life moving forward By doing so, a person may have less distress and be better able to navigate bereavement when the loved one dies. For others, however, anticipatory grief may only serve as a prelude to conventional grief, neither bolstering the person for the harsh reality of their loss nor preparing them for life ahead. Some studies have shown that anticipatory grief can be like "holding your breath" until the real pain begins. One study issued by the National Cancer Institute found that widows who stayed with their dying husbands until death could only truly mourn once the death had occurred. Other studies suggested that anticipatory grief—especially in situations where there is deep, unrelenting sadness—was in risk factor for prolonged grief disorder, a psychiatric condition in which a person has a persistent longing for a lost loved one. According to the American Psychiatric Association, between 7% and 10% of bereaved adults meet the criteria for PGD with symptoms persisting for six months or more, including: Feelings that a part of oneself has diedA sense of disbelief about the deathAvoidance of anything that reminds them about that deathDifficulty engaging with friends, pursuing interests, or planning for the futureEmotional numbnessFeeling that life is meaninglessFeeling alone or detached from others In some cases, the grief can be so intense that it interferes with your ability to cope. It is also common for people to develop depression in the midst of profound loss. It can be hard to tell grief and depression apart. Seek help from a mental health professional if you are having a hard time coping. A therapist can help you decide if you're dealing with "normal" grief or "complicated" grief. What Are the Stages of Anticipatory Grief? Facets of the traditional five stages of grief—denial, anger, bargaining, depression, and acceptance—can occur with anticipatory grief and move back and forth in the same way as well. However, the stages of anticipatory grief differ if you are the caregiver. In this context, the stages are considered to involve: Acceptance: Coming to terms that the loved one's death is inevitable, the process of which may include sadness, anger, denial, and depressionReflection: Coming to terms with feelings about the dying person, including regret, guilt, remorse, or angerRehearsing the death: Anticipating your feelings and actions during and immediately after the deathImaging the future: Providing yourself a roadmap through the bereavement process How to Cope With Anticipatory Grief It’s important to let yourself grieve. Find a friend or another loved to help you: Share your feelings openlyMaintain hopePrepare for death Some people may wonder why you are grieving before the death has happened. Some may even become angry about it. Keep in mind that letting go doesn’t mean you have to stop loving the person you're losing. During this stage, you can begin to find a safe place in your heart to hold memories that will never die. Summary If you are facing the end of your life or the death of someone close, grief may come before death does. Anticipatory grief refers to the sorrow and other feelings you experience as you await an impending loss. It has some benefits: It may help you find closure, settle differences, or prepare yourself for the pain of letting go. This kind of grief can come with lots of other emotions, including anxiety, guilt, fear, and irritability. You may lose sleep, have problems concentrating, making decisions, or remembering things. All of these symptoms are normal. It's also perfectly normal not to have anticipatory grief. It's a good idea to reach out for emotional and practical support if grief is keeping you from functioning day to day. Coping With Anticipatory Grief 7 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Rogalla KB. Anticipatory grief, proactive coping, social support, and growth: exploring positive experiences of preparing for loss. Omega (Westport). 2020 May;81(1):107-29. doi:10.1177/0030222818761461 Zordan RD, Bell ML, Price M, Remedios C, Lobb E, Hall C, Hudson P. Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: a cohort study. Palliat Support Care. 2019 Oct;17(5):507-14. doi:10.1017/S1478951518001013 Coelho A, de Brito M, Barbosa A. Caregiver anticipatory grief: phenomenology, assessment and clinical interventions. Curr Opin Support Palliat Care. 2018;12(1):52-57. doi: 10.1097/SPC.0000000000000321. Johnson J, Lodhi MK, Cheema U. Outcomes for end-of-life patients with anticipatory grieving: insights from practice with standardized nursing terminologies within an interoperable internet-based electronic health record. J Hosp Palliat Nurs. 2017 Jun;19(3):223–31. doi:10.1097/NJH.0000000000000333 Johansson AK, Grimby A. Anticipatory grief among close relatives of patients in hospice and palliative wards. Am J Hosp Palliat Care. 2012;29(2):134-138. doi:10.1177/1049909111409021 National Cancer Institute. Types of grief reactions. American Psychiatric Association. Prolonged grief disorder (PGD). By Lynne Eldridge, MD Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit