Clinically reviewed by Bülent Ada, BSc.(Psychol.)(Hons.), MAPS · Updated March 2026

Grief is one of the most universal human experiences — and one of the most misunderstood. We inherit frameworks for understanding it (stages, timelines, milestones) that, while well-intentioned, can leave people feeling as though they are grieving incorrectly when their experience does not fit the expected shape.

This article draws on current clinical evidence to offer a more accurate and, we hope, more useful picture of what grief actually looks like — including when it becomes complicated, what forms of loss often go unrecognised, and when professional support can make a meaningful difference.

If you are grieving right now, this article is written with you in mind. You are not doing it wrong.

Moving Beyond the Five Stages

Most people have encountered the Kübler-Ross model — the five stages of grief: denial, anger, bargaining, depression, and acceptance. Elisabeth Kübler-Ross developed this framework in 1969 from her work with terminally ill patients, not with bereaved people. It was never intended as a universal map of bereavement.

Contemporary grief researchers have largely moved on from the stages model, not because it captures nothing true, but because grief does not unfold in a linear sequence. The five stages can create unhelpful expectations — that grief should progress in a predictable order, that reaching “acceptance” is the destination, or that lingering in earlier stages means something has gone wrong.

The current evidence-based literature offers more flexible and accurate frameworks.

The Dual Process Model (Stroebe & Schut, 1999) describes grief as an oscillation between two orientations. In loss-orientation, the person is engaged with the grief itself — the pain of missing, memories, yearning, emotional processing. In restoration-orientation, they are attending to the secondary changes that death brings — adjusting to new roles, rebuilding identity, managing practical demands. Healthy grieving involves moving between these two orientations over time, not working through them in sequence.

Continuing Bonds theory offers another useful reframe. Rather than grief being a process of “letting go” or “moving on,” this model recognises that many people maintain an ongoing inner relationship with the person they have lost — through memory, ritual, values, and a continuing sense of presence. This is not pathological. For many people, it is an important part of integrating loss into ongoing life.

These frameworks do not tell you how to grieve. They acknowledge that grief is not a problem to be solved on a schedule.

What Bereavement Actually Looks Like

Grief rarely resembles a tidy emotional arc. In practice, it is often non-linear, unpredictable, and shaped by the particular relationship that has been lost, the circumstances of the death, your personal history, and the support available to you.

Some people experience intense acute grief in the early weeks, then find it softens with time. Others feel a delayed response — functioning adequately in the immediate aftermath, then being caught off guard by grief weeks or months later. Some experience waves that come without warning: triggered by a song, a smell, an anniversary, or nothing identifiable at all.

Physical symptoms are common and often underacknowledged. Grief can produce fatigue, changes in appetite, difficulty concentrating, a sense of unreality, and somatic discomfort. These are not simply “stress” — they are part of how the body responds to loss.

Grief also affects people differently across cultural, religious, and family contexts. There is no single right way to grieve, and what looks like healthy mourning in one context may look different in another.

Prolonged Grief Disorder: When Grief Becomes Complicated

For the majority of people, the intensity of acute grief naturally softens over time. Daily functioning gradually returns. The loss is integrated — not forgotten or resolved, but held differently.

For some people, this natural adaptation does not occur. Grief remains as acute, consuming, and functionally disabling months or years after the bereavement. This is now recognised as a distinct clinical condition.

Prolonged Grief Disorder (PGD) was formally added to the DSM-5-TR in 2022. The diagnostic criteria include persistent yearning or longing for the deceased, difficulty accepting the loss, emotional numbness or bitterness, a sense that life is meaningless without the person, and identity disruption — a feeling that part of oneself died with the loved one. These symptoms must be present at a clinically significant level for at least twelve months after the death (six months for children) and must cause meaningful impairment in daily functioning.

Research suggests PGD affects approximately 10% of bereaved individuals — which, given how common bereavement is, represents a substantial number of people. Risk factors include the nature of the death (sudden, violent, or traumatic deaths carry higher risk), the closeness of the relationship, a prior history of anxiety or depression, and limited social support.

PGD is distinct from depression, though the two can co-occur. It is also distinct from the ordinary grief that follows significant loss — the distinguishing features are the intensity, duration, and functional impairment involved.

Grief After Suicide Loss

Losing someone to suicide is a particular form of bereavement that carries its own specific weight. Those bereaved by suicide — sometimes called “survivors of suicide loss” — often experience a grief complicated by shock, guilt, anger, stigma, and an often tormenting search for explanation.

A note on language: the phrase “committed suicide” carries outdated and stigmatising associations with crime or sin. Current clinical and public health guidance prefers “died by suicide” — language that is both more accurate and more compassionate.

Grief after suicide loss can be complicated by several factors that are less common in other bereavements. Guilt — a feeling of responsibility, of wondering what could have been done differently — is extremely common and can be both consuming and clinically significant. Stigma, both internalised and social, can make it harder to speak openly about the death, narrowing the support networks that would otherwise be available.

Trauma responses are also common, particularly when the bereaved person discovered the body, witnessed the death, or received sudden news without warning. In these circumstances, bereavement and PTSD can be intertwined, each requiring attention in its own right.

Grief after suicide loss does not follow the same trajectory as other bereavement, and general bereavement support is not always sufficient. Specialist support from a psychologist with experience in suicide bereavement, or peer support through organisations like SANE Australia, can make a significant difference.

Anticipatory Grief

Grief is not only experienced after death. Anticipatory grief refers to the grief that arises before a loss — when someone you love has a terminal illness, when you are watching a parent’s cognitive function decline with dementia, or when you are caring for someone in the final stages of life.

Anticipatory grief can involve many of the same experiences as post-death bereavement: sadness, yearning, anxiety about the future, and a sense of mourning the person as they once were even while they are still present. It may also involve grieving the relationship itself — the conversations you can no longer have, the plans that will not be realised.

Anticipatory grief is not always recognised as “real” grief by those around the carer, which can leave people feeling isolated in an already depleted state. Palliative care teams and psychologists with experience in carer wellbeing can provide meaningful support during this period.

Disenfranchised Grief: Losses Others May Not Recognise

Some losses are not recognised as significant by the broader culture — which means the grief they produce is also not validated. Psychologist Kenneth Doka introduced the concept of “disenfranchised grief” to describe exactly this: grief that is not acknowledged, mourned publicly, or supported by social rituals.

Disenfranchised grief can arise from:

Pet loss. The death of a companion animal can produce profound grief, yet people are often told to “just get another one” — a response that misses the depth of the bond and the genuine nature of the loss.

Pregnancy loss and miscarriage. Grief after miscarriage, stillbirth, or pregnancy termination is often invisible — the pregnancy may not have been widely known, and social rituals of mourning are largely absent. Yet the loss can be significant, and the grief is real.

The death of an ex-partner or estranged family member. When a relationship has ended — through separation, estrangement, or family conflict — the death of that person can still produce genuine grief, complicated by the ambiguity of the relationship.

Grief for a living person. This applies particularly to families navigating a loved one’s dementia. Watching someone’s personality, memory, and connection to you gradually diminish can produce what some researchers call “ambiguous loss” — mourning someone who is still physically present.

Grief after estrangement. Cutting off contact with a family member, or being cut off, can produce a form of grief that is rarely spoken about and carries its own complexity.

If your grief is not being recognised or validated by those around you, that does not mean it is not legitimate. It may simply be that the frameworks available to those around you are not broad enough.

When Grief Needs Professional Support

Most grief does not require professional intervention. It is a natural human response to loss, not a disorder to be treated. However, professional support can be genuinely useful — and sometimes necessary — in a number of circumstances.

Consider seeking support when:

• Grief feels as intense at twelve months as it did in the early weeks
• You are having difficulty functioning at work, in relationships, or in daily life
• You are experiencing symptoms of depression — persistent low mood, loss of pleasure, hopelessness — alongside the grief
• You are having thoughts of suicide or self-harm
• The death was sudden, violent, or traumatic, and you are experiencing intrusive memories, avoidance, or hypervigilance
• You are grieving a suicide loss and finding it difficult to process alone
• Grief has led to increased alcohol or substance use
• You are a carer for someone with a terminal illness and are struggling with anticipatory grief and burnout

It can also be worth seeking support simply because grief is hard, and having a space in which it can be held with professional skill and care is a valuable thing — not a sign of weakness or pathology.

Evidence-Based Treatments for Complicated Grief

When grief has become complicated — particularly in the context of Prolonged Grief Disorder — evidence-based treatments are available.

Complicated Grief Treatment (CGT), developed by Dr Katherine Shear and colleagues at Columbia University, is a manualised therapy specifically designed for PGD. It draws on elements of IPT and CBT, and has demonstrated effectiveness in randomised controlled trials.

Cognitive Behaviour Therapy (CBT) adapted for grief addresses unhelpful thinking patterns and avoidance behaviours that can maintain complicated grief.

Interpersonal Therapy (IPT) focuses on the relationship disruptions and role changes that accompany significant loss, and has evidence support for grief-related depression.

Where grief is complicated by trauma, trauma-focused approaches — including Trauma-Focused CBT and EMDR — may be indicated alongside or prior to grief-specific work.

You can read more about depression and PTSD — both of which can be intertwined with complicated grief — on our conditions pages: depression and PTSD and trauma.

Resources and Support

If you are grieving and would like to speak to someone, the following services are available:

• Lifeline: 13 11 14 — 24 hours, 7 days. Crisis support and referral.
• Beyond Blue: 1300 22 4636 — 24 hours, 7 days. Mental health support including grief-related depression.
• GriefLine: 1300 845 745 — Specialist telephone and online grief support; staffed by trained volunteers.
• SANE Australia: 1800 187 263 — Mental health support, including for those bereaved by suicide.

A Final Word

Grief is not something to be fixed or finished. It is a process of integrating loss into ongoing life — one that takes as long as it takes, and looks different for every person.

If your grief has been complicated — by circumstance, by the nature of the loss, by a lack of support, or simply by its persistence and intensity — that is not evidence of weakness. It may be evidence that you need, and deserve, more support than most of us can give ourselves.

Mind Health Associates works with people navigating grief, loss, and the complex emotions that can follow bereavement. If you would like to explore whether psychological support might help, we welcome you to contact us or visit our services page.

Frequently Asked Questions

Are the five stages of grief real?

The five stages came from Elisabeth Kubler-Ross’s work with dying patients, not bereaved people, and were never meant as a universal map. Grief does not unfold in a fixed order, and expecting it to can leave people feeling they are grieving incorrectly. Contemporary models, like the Dual Process Model and Continuing Bonds, describe grief more accurately.

What is Prolonged Grief Disorder?

Prolonged Grief Disorder, formally added to the DSM-5-TR in 2022, describes grief that remains intense, consuming and functionally disabling at least twelve months after a death (six months for children). Features include persistent yearning, difficulty accepting the loss, emotional numbness, and identity disruption. It affects roughly ten per cent of bereaved people and is distinct from ordinary grief and depression.

How long is it normal to grieve?

There is no fixed timeline, and grief looks different for every person and relationship. For most people the intensity of acute grief gradually softens as the loss is integrated, though waves can return for years. Grief becomes a clinical concern when it stays as acute and disabling at twelve months as in the early weeks.

What is disenfranchised grief?

Disenfranchised grief is grief that society does not readily acknowledge or support, so the bereaved person may feel their loss is not validated. Examples include pet loss, miscarriage and pregnancy loss, the death of an estranged family member or ex-partner, and grieving a living person with dementia. The grief is genuine even when others do not recognise it.

When should I seek professional help for grief?

Consider support if grief feels as intense at twelve months as at the start, if you cannot function day to day, if depression symptoms or thoughts of self-harm are present, if the death was sudden or traumatic, or if you are grieving a suicide loss. Seeking support is not a sign of weakness; grief is genuinely hard.

Related reading

• Grief and bereavement support
• Depression treatment services
• How depression differs from sadness

About the author: Bülent Ada is the Principal Psychologist and Founding Director of Mind Health Associates in Parramatta, Sydney. With over 20 years of clinical experience, Bülent specialises in adult mental health, trauma, mood disorders, and evidence-based psychological treatment. Learn more about Bülent

This article is for informational purposes only and is not a substitute for professional mental health advice. If you are experiencing mental health concerns, please consult a qualified health professional.

Ready to take the next step? Mind Health Associates offers evidence-based psychological support in Parramatta and via telehealth across Australia. Contact us to enquire about appointments.