Bereavement and grief: symptoms, how long it lasts and how to cope

The NHS says most people experience grief when they lose something or someone important to them, and that bereavement, grief and loss can cause many different symptoms. It also notes that grief is not confined to death: it can follow the end of a relationship, losing a job, moving to a new place or someone close becoming seriously ill.

It is therefore a normal response and not an illness, although it can bring on illness-like symptoms and can sit alongside depression or anxiety, which is why recognising when it is becoming harder to cope matters.

The NHS lists shock and numbness, usually the first reaction, with people describing being in a daze; overwhelming sadness with lots of crying; tiredness or exhaustion; anger towards the person you have lost or the reason for the loss; and guilt, for example about feeling angry, about something said or not said or not being able to stop the person dying. It says these feelings may not be there all the time and powerful feelings may appear unexpectedly.

Cruse adds that in the early days some people feel numb or nothing at all, and may carry on as if nothing happened, focusing on tasks such as cancelling bills or organising the funeral. Reality may set in later, with unexpectedly deep emotions, while others feel a strong range of emotions from the start.

Cruse says grief affects the body in ways you might not expect. Appetite may fall, food may taste strange or be hard to swallow, or you may eat more or only comforting foods. Sleep is commonly disturbed, with nightmares, a racing mind or painful waking after dreaming the person is alive. Anxiety can bring breathlessness, heart palpitations or even a panic attack, and Cruse suggests contacting a doctor if these occur regularly. It also describes physical pain and a reduced ability to fight minor infections, advising speaking to a GP if pain or eating worries persist for several weeks.

Cruse says there are no set stages or time limits. After the first year it is common to find the second year just as difficult or harder, because people around you may have returned to normal and there may be less space to talk, and dates such as anniversaries, birthdays and festivals can be painful. After several years, most people adapt and return to some kind of normal life, with grief triggered by films, songs or smells but life filled with other things. The NHS says your grief might feel chaotic and out of control but the feelings will eventually become less intense over time.

The NHS suggests talking about your feelings to a friend, family member, healthcare professional or counsellor, considering peer support, taking regular exercise to improve mood and sleep, and eating regular meals. It advises not trying to do everything at once, setting small targets, not telling yourself you are alone, and avoiding alcohol, cigarettes, gambling or drugs to relieve grief because they can contribute to poor mental health. Cruse suggests gradually rebuilding a night-time routine, gentle exercise such as walking or yoga, and small manageable meals.

For most people grief becomes less intense over time, but the NHS says for some it lasts many months or years, which is known as prolonged grief disorder or complicated grief. Its symptoms include very difficult feelings such as sadness or guilt that do not ease as months go by, spending a lot of time thinking about the person who has died, difficulty accepting the death, not being able to return to everyday activities and suicidal thoughts. You are more likely to have it if the death was traumatic or sudden and unexpected. The NHS advises seeing a GP if you have these symptoms.

If you are having thoughts of ending your life, tell someone now: contact a GP, use NHS 111, or call 999 if you are in immediate danger.

The NHS describes denial, anger, depression, bargaining and acceptance, but stresses that you may not experience all of them, they may not happen in a particular order and you may not move smoothly between them. It says acceptance does not mean you like the situation, only that you are ready to move forward. Cruse questions whether the five stages are a true roadmap and offers the "growing around grief" idea, in which grief does not shrink but life grows around it.

The NHS says that if you are under 18, you can find out about mental health support for children and young people, and that adults can refer themselves to NHS talking therapies from 18 (16 in some areas). For specialist support after the death of a baby or young child, the NHS names The Lullaby Trust, and for the sudden unexplained death of a child, SUDC UK. Cruse Bereavement Support lists children and young people support among its services.

A GP, school or health visitor is usually the first point of contact if a child is struggling after a bereavement, and difficulty eating or sleeping or a long period of low mood are reasons to ask for help.

The NHS says feelings after bereavement should ease gradually, but if you are feeling increasingly depressed or anxious you may need medical help, and it advises seeing a GP if you are struggling with stress, anxiety or low mood, have had low mood for more than 2 weeks, or are not helped by what you are trying. If you are 18 or over (or 16 in some areas) you can refer yourself to NHS talking therapies. Charities such as Cruse, Mind and the Lullaby Trust are named by the NHS for specialist support, including after suicide or the death of a child. Private counselling is another route; check the counsellor's professional registration and ask about experience with bereavement.

On the NHS, a GP can assess your mental health and refer you, and adults can refer themselves directly to NHS talking therapies. Charities such as Cruse, Mind, The Lullaby Trust and SUDC UK offer specialist bereavement support.

Private counselling or therapy is another route. Check the counsellor's professional registration, ask about their experience with bereavement and how many sessions they expect, and tell your GP if your mood is very low.