7 Stages of Grief & How Bereavement Impacts the Brain

Grief is a natural, yet unfortunate part of life. Loved ones die, health declines, and plans sometimes do not work out. All of these situations and more lead to bereavement—an emotional, physical, or psychological response to mourning a loss. While a period of bereavement is normal and even healthy, the grief process varies depending on the individual. The complex differences are due to how bereavement impacts the brain.

How does grief affect the brain?
How does grief affect the brain?

What Is Bereavement?

Bereavement is a term describing the emotional, physical, and psychological responses to death. It is a period of grief and mourning following a loss. Any loss can potentially lead to bereavement including death, illness, divorce, a close friend moving away, or even plans that did not come to fruition.

Grief is the emotional reaction of bereavement. For example, feeling guilt, depression, or anger after a family member dies. Contrarily, mourning is the outward expression of grief. Hosting funerals, wearing black, and partaking in traditions are expressions of mourning.

The bereavement process may manifest differently depending on the individual. Age, whether the loss was expected or unexpected, the relationship to the person who has passed, and if the presence of a strong support system all affect how someone grieves and how long the bereavement period lasts. Anybody who suffers a significant loss can experience bereavement. People of all ages, genders, and ethnicities endure bereavement because grief is a natural part of human life.

7 Stages of Grief

Originally proposed by Elisabeth Kübler-Ross, the 5 stages of grief follows a series of emotions people display throughout the bereavement. It applies to death, as well as terminally ill patients. The progression of the grief stages is not linear. Some skip stages entirely or oscillate back and forth between stages, while others remain in certain stages of the grief cycle for a prolonged period.

The 5 stages of grief include:  

  1. Shock or Denial—When faced with great loss, shock is typically the first stage. Shock is the initial numb feeling and denial is the disbelief over what has occurred.
  2. Anger—Anger is the feeling of frustration after a loss. The person realizes they cannot live in denial and may blame others.
  3. Bargaining—Bargaining involves the attempt to prevent or reverse loss through compromise or negotiation. This stage is strongly associated with religion by bargaining with a higher power. For example, “I will go to church every Sunday if you bring him back.”  
  4. Depression—Depression is an overwhelming sadness over the loss. This depression differs from clinical depression, as a major loss is a reason for the behavioral and mood changes.
  5. Acceptance—Eventually, the bereaved person comes to terms with reality. They understand that life continues despite the loss and that they will be okay. They accept the negative and positive aspects of life.

How Bereavement Impacts the Brain: Physical Symptoms

Although the grieving process of bereavement seems to be emotional, psychological, or mental, physical symptoms do result. Grief can potentially cause symptoms in nearly every body system. Studies (Buckley et al., 2012) show that those who are bereaved have a greater risk of dying from heart disease, cancer, and stroke.

  • Gastrointestinal distress—The first physical evidence of grief is often upset of the gastrointestinal tract like diarrhea, nausea, and stomach pain.
  • Weight loss or gain—Forgetting to eat or using food as a coping method brings on weight fluctuations.
  • Decreased immunity—Bereavement is known to lower the immune system. According to Harvard research, grief affects neutrophils which are the white blood cells that fight infection.
  • Sleep disturbances—Someone who is grieving may suffer from nightmares, insomnia, or frequent nighttime awakenings. Excessive sleeping is also common, especially in those with depression.
  • Fatigue—The lack of sleep and stress from the emotional aspects of grief result in feeling exhausted and run down.
  • Muscle aches—The emotional toll of bereavement leaves one tense. That tension causes migratory pain in the muscles.
  • Headaches—Headaches are another symptom of grief exacerbated by constant stress.

How Bereavement Impacts the Brain: Brain Chemicals

Bereavement disrupts the homeostasis of the body. Grief actually increases brain activity. The amygdala, prefrontal cortex, and the insula—all areas of the brain that control emotional processing and pain—are impacted because intense emotional pain triggering the brain’s reward center creating “addiction” to the person or circumstances lost. However, the brain is deprived of the “reward” in bereavement.

The negative emotions associated with bereavement continue due to the impact on hormones and neurotransmitters which deliver messages to neurons throughout the nervous system. Death of a close loved one is especially problematic. The relationship provides increased levels of dopamine, feel-good endorphins, and oxytocin that the brain is accustom to. Following a death, the brain has to adjust to new combination of brain chemistry because they no longer receive that support. A surge of stress hormones like cortisol takes their place instead.  

How Bereavement Impacts the Brain: The Autonomic Nervous System

All bodily functions meant to occur automatically are controlled by the autonomic nervous system. For example, breathing, stabilizing heart rate and blood pressure, digesting food, sweating, and more. The sympathetic and parasympathetic nervous systems are two divisions of the autonomic nervous system that are highly involved in the body’s fight-or-flight stress response.

The autonomic nervous system has a role in bereavement. As grief triggers the release of cortisol, it heightens activity of the autonomic nervous system. This is a natural response to survive the in the presence of a threat. While grief is typically not a life-threatening situation, the body perceives it as such.

How Bereavement Impacts the Brain: Cognitive Symptoms

Everyone possesses specific skills known as cognitive skills that allow cognition, which is the process of thinking. These skills allow us to learn, process information from our environments, make decisions, remember, and pay attention. Memory, attention, logic and reasoning, visual and auditory processing, and processing speed are the top cognitive skills.

Bereavement and grief alters the brain’s chemical makeup and cognitive symptoms can result. Mourning distracts the brain from its baseline processes. While the brain is in overdrive trying to cope with loss, memory recall decreases, organization and planning are sporadic, and concentrating on simple tasks is difficult. In a study at Cambridge University, individuals with complicated grief had less brain matter volume than those not experiencing grief. A decline in cognitive skills correlate with brain matter reduction.

Psychological Disorders From Bereavement

Bereavement impacts the brain in numerous ways. Individuals of all ages, genders, and races who have suffered a loss are susceptible to psychological disorders such as complicated grief, post-traumatic stress disorder, depression, and anxiety.

Complicated Grief

Within a year of bereavement, an individual normally reaches a stage of acceptance and moves on despite their grief. According to Dialogues in Clinical Neuroscience, 7% of the bereaved develop complicated grief. Complicated grief occurs when an individual fails to adjust to life after loss given time. The traditional stages of bereavement continually worsen in complicated grief.

An individual with complicated grief is in a perpetual state of mourning. They are numb and detached from their emotions, isolate themselves from social activities, avoid reminders of the loved one who has passed, persistently focus on death, are depressed, feel guilt that they did something wrong or could have prevented the death, and are unable to enjoy life.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental disorder which develops after witnessing a traumatic event. It is common in those who are bereaved, as grieving a loss is often associated with a traumatic event such as an abuse, an assault, an accident, or illness. The death itself can be a trigger. Someone with post-traumatic stress disorder has intense flashbacks, nightmares, anxiety, changes in mood, and unwanted memories of the event. They repeatedly relive their trauma.

Depression and Anxiety

Depression is a mental disorder marked by persistent, unexplained sadness lasting greater than two weeks. Anxiety is characterized by excessive worry and fear disproportionate to the situation. Both depression and anxiety are part of the stages of grief.

Symptoms of anxiety and depression related to bereavement are sleep disturbance, changes in mood, lack of appetite, difficulty concentrating, a lack of interest in activities, irritability, phobias, and panic attacks. These symptoms are more likely to persist in those who are grieving a loss that has triggered the development of psychological disorders. Grief can also exacerbate the symptoms of anxiety and depression present before the loss.

How Bereavement Impacts the Child Brain

The human brain is not fully developed until age 25. The amygdala dominates the thinking of children and teenagers, while adults think with the pre-frontal cortex. The prefrontal cortex is responsible for restraining impulses, executing appropriate behaviors, and rationalizing outcomes of decision making. With the prefrontal cortex underdeveloped, children are unable to weigh the consequences of their decisions. Thinking primarily with the amygdala leaves their decisions open to the influence of strong emotions rather than rationality.

When a child experiences bereavement, they express their grief differently. Many children appear as if they are not bothered by grief because they express their emotions through play, art, or music. They are prone to sudden outbursts of anger, sadness, and fear. Children are also more likely to develop anxiety and regression of behaviors. For example, thumb sucking, bedwetting, or refusing to sleep without their parents.

7 Stages of Grief & How Bereavement Impacts the Brain
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Adults supporting young children through grief should be completely open by preparing them for what to expect at the funeral, answering questions directly about the loved one who has passed, and not forcing them to share their emotions until they are ready.

Coping with Grief

There is no right or wrong manner of grieving. Here are the top tips for coping with grief:  

  • Exercise—Physical activity releases feel-good endorphins that boost mood. The exercise does not have to be intense. Merely walking has the benefit of coping with the mood swings caused by grief.
  • Sleep—The body is under significant stress during bereavement, but the brain recovers quicker from stress while asleep.
  • Cognitive Behavioral Therapy—Cognitive behavioral therapy is a type of talk therapy intended to identify beliefs and thought patterns contributing to unwanted behavior and then implementing techniques to change those behaviors. Speaking with a mental health professional during cognitive behavioral therapy is especially useful in complicated grief.
  • Maintain hobbies—Partaking in old hobbies combats depression and anxiety because it maintains a familiar routine when other aspects have life have changed due to loss.
  • Express emotions—Although a brief time spent in denial is expected, even healthy, after loss, expressing emotions is imperative to healing. Expressing emotions creatively through art, journaling, music, or painting is an outlet for those struggling to express emotions verbally.

References

Buckley, T., Sunari, D., Marshall, A., Bartrop, R., McKinley, S., & Tofler, G. (2012). Physiological correlates of bereavement and the impact of bereavement interventions. Dialogues in clinical neuroscience14(2), 129–139.

Pérez, H.C., Ikram, M.A., Direk, N. Prigerson, H.G. (2014). Cognition, structural brain changes and complicated grief. A population-based study. Cambridge University Press, 45(7). https://doi.org/10.1017/S0033291714002499.

Shear M. K. (2012). Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in clinical neuroscience, 14(2), 119–128.