Grief following major bereavement has been described as having four classic phases:

• shock, numbness, disbelief

• protest, searching, pain

This model is a crude guide to a gradual process, which may take well over a year to complete. Similar reactions are found after other loss events such as death of a pet, break-up of a relationship, loss of a job, or mutilating surgery.

An abnormal grief reaction may be diagnosed if grieving is unduly prolonged, if grief cannot be expressed, or if there is denial that death has occurred. Bereavement may precipitate psychiatric illness, usually depression, or suicide in vulnerable people. Abnormal grief reactions are more common if the deceased was young, if the death was sudden or violent, or if the bereaved person's relationship with the deceased was complicated by guilt or ambivalence.

Psychotherapy is often appropriate for abnormal grief reactions; for example, the technique of 'guided mourning' to help the patient acknowledge and grieve the death.

If severe depression develops after bereavement, treatment should be prescribed in the usual way.


Brandon, S., Boakes, J., Glaser, D. and Green, R. (1998). Recovered memories of childhood sexual abuse. Implications for clinical practice. Br J Psychiatry 172, 296-307. Kennerley, H. (2006). Overcoming Anxiety. London: Constable & Robinson.

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