Cancer Support & Coping How Anticipatory Grief Differs From Grief After Death By Lynne Eldridge, MD facebook Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Lynne Eldridge, MD Medically reviewed by Medically reviewed by Doru Paul, MD on November 01, 2019 Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Learn about our Medical Review Board Doru Paul, MD Updated on November 19, 2019 Print Table of Contents View All Table of Contents What It Is Purpose Symptoms Treatment Coping Anticipatory grief, or grief that occurs before death, is common among people who are facing the eventual death of a loved one or their own death. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), anticipatory grief is not often discussed. Because of this, some people find it socially unacceptable to express the deep pain they are experiencing and fail to receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope at this difficult time? Oliver Rossi / The Image Bank / Getty Images As a quick note, this article is directed more to 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 another on how to cope with anticipatory grief later on), will be helpful to both those who are dying and those who are grieving a loved one’s imminent 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. Often the experience of grief can bring to light memories of other episodes of grief in the past. Differences From Grief After Death 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 remarked 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, and 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. Purpose 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, and to give and grant forgiveness. For both, it is a chance to say goodbye. One person related that the night their grandmother died they were lying in bed with her. She turned to them and said, "We’ll miss each other," and hugged them. It was her goodbye gift. Family members will sometimes avoid visiting a dying loved one. The comments they make include, "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 OK for you to move on to the next place." Does It Help Grieving Later On? Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process after death occurs. 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 provide opportunities for closure that people who lose loved ones suddenly never have. Symptoms The emotions that accompany anticipatory grief are similar to those which occur 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 associated with anticipatory grief. That said, keep in mind that everyone grieves differently: Sadness and tearfulness: Sadness and tears tend to rise rapidly and often when you least expect. Even small things, such as a television commercial may be a sudden and painful reminder your loved one is dying; almost as if it is again the first time you are aware of your impending loss.Fear: Feelings of fear are common and include not only 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.A 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, palpitations, and shaking.Guilt: The time prior to a loved one's death can be a time of great guilt—especially if they are suffering. While you long for your loved one to be free of pain, you fear the moment that death will actually happen. You may also experience survivor guilt because you will continue with your life while they will not.Intense concern for the person dying: You may find yourself extremely concerned about your loved one, and this concern can revolve around emotional, physical, or spiritual issues.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. Many people feel guilty about these thoughts, but they are very normal and are part of accepting the inevitability of death.Physical problems: Physical problems such as sleep difficulty and memory problems. Learn more about the physical toll of grief.Fears of loss, compassion, and concern for children: One study found that fears about what was going to happen and how they would be cared for were very strong in children who are facing the death of a parent or grandparent. While you may have heard of the stages of grief and the four tasks of grieving, it's important to note that most people do not neatly follow these steps one by one and find that they wake up one morning feeling they have accepted what has happened and have recovered. Instead, any of these stages may be present at any one time and you may find yourself re-experiencing the same feelings of shock, questioning, or despair many times over. As noted above, there is no right way to feel or grieve. Treatment and Counseling Anticipatory grief is a normal process in 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 and it can be difficult to distinguish grief from depression. Seek help with a mental health professional if you find yourself having difficulty coping. You should find out if you aren't sure whether you are coping with "normal" grief or instead "complicated" grief. Coping With Anticipatory Grief 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. Coping With Anticipatory Grief Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. 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 Gross, J. et al. Anticipatory grief in adolescents and young adults coping with parental cancer. Praxis Kinderpsychologie und Kinderpsyychiatrie. 2012. 61(6):414-31. doi:10.13109/prkk.2012.61.6.414 Additional Reading Cheng J. et al. An exploration of anticipatory grief in advanced cancer patients. Psychooncology. 2010;19(7):693-700. doi:10.1002/pon.1613 Coelho A, Barbosa, A. Family anticipatory grief. American Journal of Hospice and Palliative Care. 2017;34(8):774-785. doi:10.1177/1049909116647960 Hottensen D. Anticipatory grief in patients with cancer. Clin J Oncol Nurs. 2010;14(1):106-107. doi:10.1188/10.CJON.106-107