What Is Anticipatory Grief—And How Is It Different From Regular Grieving? Here's What Experts Say
This type of grief can pose unique challenges.
Grief is associated with the period after a death or traumatic change in a person's life. But when the grieving process starts long before the actual loss, it's called anticipatory grief.
"Anticipatory grief is the collective thoughts, feelings, and emotions we have before a loss occurs," Diane P. Brennan, LMHC, founder of Life & Loss Mental Health Counseling in NYC, tells Health. Here's what to know about anticipatory grief, and why it's different from regular grieving.
Types of anticipatory grief
Though anticipatory grief is used as a general term, it doesn't have a single, precise definition, M. Katherine Shear, MD, a psychiatry professor at Columbia University and director of the Center for Complicated Grief, tells Health.
"It's used in different ways by different authors," Dr. Shear says. One Frontiers in Psychiatry article defines it as "expectations and emotions" associated with fear of losing a loved one. A review in The Family Journal describes it as "uncertainty, fear, and sadness associated with expecting the impending loss of a loved one which can lead to adverse health outcomes."
Anticipatory grief also refers to "pre-death grief" in the context of a terminal illness in which there are already losses. For example, the ill person no longer has the same physical, mental, or social functioning, says Dr. Shear. Or there has been a loss of reciprocity in the relationship or plans for the future.
Preparatory grief, the grief experienced by dying patients related to loss of their own life, is another type of anticipatory grief. "This is often misunderstood as grief related to bereavement," Dr. Shear says.
Anticipatory grief vs "regular" grief
The big difference between anticipatory grief and regular grief is that anticipatory grief occurs before the loss, while regular grief occurs after the loss, explains Brennan.
For example, someone may experience anticipatory grief when a person they love is diagnosed with a terminal illness. "We know they will die from it, so we begin to anticipate the loss and experience grief starting at the time of the diagnosis," Brennan says. Another example of anticipatory grief is when someone is expecting layoffs at work, or preparing for the breakup of a close relationship.
While the grief felt before a death or other type of loss is not necessarily less intense as grief experienced afterward, it may come with some particular challenges. First of all, not everyone experiences anticipatory grief in the same way. Those who are trying to come to terms with their loved one's imminent death may struggle with the idea of letting them go, while holding onto hope that they won't actually die, for instance.
What anticipatory grief can feel like
Generally, it may not be particularly helpful to try to split the grieving process into defined stages. "I often begin talks by saying that grief is universal but how we define it is not," says Dr. Shear. "That said, there is general consensus in the field that grief can be defined as the response to a meaningful loss and that the two are inextricably linked, i.e. there is not meaningful loss without grief and no grief without meaningful loss."
She adds that the hallmark of grief is yearning, longing, and/or frequent, insistent thoughts of the deceased or other loss.
"In general, grief is complex and variable, containing a wide range of thoughts, feelings, behaviors, and physiological changes, as well as social and spiritual responses," Dr. Shear says. "The specifics of what we experience are unique to the grieving person and their relationship with the deceased (or other loss)."
In other words, two people grieve the loss of the same person differently and the same person grieves two different losses differently—and this is true of any form of grief.
That said, loss of a loved one is highly stressful, and there are typical early "defensive responses" that can become problematic when they persist and are overly influential in mental functioning. These include disbelief and protest, counterfactual thinking, caregiver self-blame or anger, excessive proximity seeking (efforts to escape from the painful reality), or excessive avoidance of reminders of the loss. Some of these resemble the five stages of grief model (known as the Kübler-Ross model), which theorizes that those who experience grief go through a series of five emotions: denial, anger, bargaining, depression, and acceptance.
Dealing with anticipatory grief
It's helpful to think of grieving as a process that begins with accepting your current reality, says Dr. Shear. Another crucial step is to accept grief, including all its painful and positive emotions. If you can, reach out to a trusted friend or family member to make light of what you're going through. Simply acknowledging what you're feeling can make a big difference, and it may help to form connections with others who are feeling the same way.
If you're grieving the impending loss of a loved one, it may help to find ways to spend meaningful time together, and perhaps create opportunities to have conversations you've been avoiding. As difficult as they may be, you don't want to regret not telling them how you feel about them when you have the chance.
A difficult aspect of anticipatory grief is the feeling that your own life is on hold. But many people don't feel comfortable expressing this to others, out of fear that they come across as being selfish or insensitive.
Also, it can be hard to predict when someone will die, so anticipatory grief often lasts for a long time. This can take a huge toll on the griever's physical and mental health.
"It's important to remember that you—the grieving person—matter too," Dr. Shear says. This means taking care of yourself, practicing mindfulness and self-compassion, making a ritual of simple pleasant activities (like reading, having relaxing baths, and cooking yourself nice meals), and taking some time to start to plan at least one project for the future that connects with a strong personal interest or value—something you find satisfying.
How to Be OK When You're Not OK Check out Health's special series on life after loss.