Loss is an inevitable part of life—and yet, it often feels unthinkable. Despite how universal the experience of death is, preparing for it can trigger intense emotions. Anticipatory grief describes the experience of mourning a loss that hasn’t yet happened. It’s common before an impending loss, but it can also occur when thinking about eventual loss—or when considering your own mortality.
Unlike grief that occurs after loss, anticipatory grief is often characterized by anxiety about what’s to come. It’s common to feel uncertainty, sadness, and stress as you plan for what’s next. Sometimes, anticipatory grief can help people better prepare. In this article, we’ll look at some common stages of anticipatory grief, how it impacts mental health, and discuss ways to cope.
What is anticipatory grief?
Have you ever learned that you were going to lose someone or something that you love? You may have felt shocked, or nervous about how life was going to change. These emotions are part of the experience of anticipatory grief—feelings of sorrow that occur before an unavoidable loss. Most often, we talk about anticipatory grief in reference to death, but it can also be triggered by receiving a diagnosis, finding out you have to leave your home, being served divorce papers, or thinking about aging.
While everyone experiences anticipatory grief differently, common symptoms include:
- Anger
- Anxiety
- Depression or emotional numbness
- Loneliness and isolation
- Loss of appetite
- Sadness
- Sleep issues
- Trouble focusing
The four stages of anticipatory grief
Grief experts often refer to the five stages of grief—denial, anger, bargaining, depression, and acceptance—in reference to grief after loss. A similar framework can also be helpful for understanding anticipatory grief. Keep in mind that these stages are not always linear; you may skip some stages, or bounce back and forth.
Acceptance
While some people may experience denial, acceptance can be a common reaction after receiving news of an impending loss. Dr. Patrick McGrath, chief clinical officer at NOCD, recalls immediately understanding his wife was going to die when they first received her cancer diagnosis. “I just knew what the [next] five years were going to be like,” he says.
Reflection
It’s common to reflect on your memories of the person, place, or experience you anticipate losing. You may feel regret over past arguments or opportunities not taken. Or, you may feel sad or grateful remembering your happy times together.
Rehearsal
Anticipatory grief is sometimes called preparatory grief, and the rehearsal phase is all about preparing for the loss. In cases of impending death, you may become preoccupied with making arrangements for a funeral. It’s also common to imagine scenarios, such as practicing saying goodbye.
Looking to the future
You may find yourself imagining what life will look like after loss. How will it feel to wake up everyday without your partner, parent, or pet? If you’re anticipating your own death, you might experience fears about what happens after you pass.
Anticipatory grief vs. grief after loss
Not everyone who deals with grief has the opportunity to experience anticipatory grief. Loss can happen suddenly, without warning. If you are in a position to experience anticipatory grief, you may find it helpful to have time to process your emotions, or prepare accordingly. “You could [say,] ‘I’m going to get the most out of every single day that I have up until then,’” Dr. McGrath says.
In some instances, anticipatory grief accompanies a new caregiving role—which can be both fulfilling and stressful. Dr. McGrath says he regrets sometimes becoming frustrated, while caring for his wife. But, he says it’s critical to give yourself grace when navigating grief.
Even those of us with the best intentions aren’t perfect, and that’s okay.
Dr. Patrick McGrath
How anticipating loss impacts mental health
Anxiety and depression
If you’re already managing an anxiety disorder, feelings of overwhelming dread may become more intense when faced with impending loss. Feelings of depression can also become heightened. You may find yourself feeling more disinterested in life, or struggling to complete the tasks necessary to prepare for the loss ahead. Anticipatory grief can also trigger anxiety and depression, even if you haven’t experienced these mental health conditions previously.
Avoidance
Anticipatory grief can also cause people to engage in avoidant behavior, even when feeling anxious about deaths that are further in the future. For example, if your anticipatory grief centers on your pet, who is young but will die before you, you may find yourself avoiding forming a close attachment—out of fear of loss. “People become afraid to get too close to something, because they think that they won’t be able to handle it when it’s not there,” Dr. McGrath explains.
If grief is impacting your life significantly in advance of a potential loss, or more than six months after a loss, it’s worth consulting a mental health professional—as you may be dealing with prolonged grief disorder.
OCD
OCD can also cause people to have difficulty navigating future loss. Obsessive-compulsive disorder (OCD) is a complex mental health condition characterized by intrusive thoughts, images, feelings, sensations or urges, often referred to as obsessions. In response to these obsessions, people with OCD typically perform compulsions—rituals or avoidant behaviors enacted in an effort to relieve the distress brought on by obsessions.
It’s common for people with OCD to have trouble tolerating uncertainty, so navigating death can be especially tough. Even without a looming loss, people with OCD may find themselves ruminating on issues related to mortality, wondering: Where do our souls go? Will I be reincarnated? What if I’m already dead and none of this is real?
While it’s natural to consider these topics to some degree, if you’re experiencing significant distress over these questions, you may be dealing with existential OCD—a subtype of OCD characterized by obsessions related to mortality and existence.
Responsibility OCD—a subtype marked by a person’s heightened sense of responsibility for the people and animals around them—can also impact how a person approaches grief and loss. Someone with responsibility OCD or harm OCD, another subtype (characterized by obsessions about harming oneself or someone else), may try to prevent loss by performing compulsions. Dr. McGrath says these behaviors are attempts to manage difficult feelings, but “none of those things are actually helpful.” While compulsions might feel good in the moment, they only give more power to your intrusive thoughts.
OCD vs. anticipatory grief
OCD can look similar to anticipatory grief, but anticipatory grief is a mental state, rather than a mental health condition. While anticipatory grief can lead to increased thoughts and anxieties about loss and mortality—and sometimes causes avoidant behavior—it is not typically characterized by compulsions. People navigating OCD, on the other hand, experience both intrusive thoughts and compulsions that may not be a reaction to an impending death.
It is possible to have OCD and also experience anticipatory grief. In these instances, it’s common for OCD symptoms to worsen, due to the stress of a looming loss. During periods of anticipatory grief, loss-related obsessions might include:
- Fears about the dying process
- Intense concerns about yourself or a loved one dying
- Worries about relationships after loss
- Fears about religious repercussions
In response, someone with OCD might perform compulsions, such as constant research, excessive prayer, reassurance-seeking, or checking on or avoiding sick or dying loved ones.
Coping with anticipatory grief
Consider ERP therapy
Exposure and response prevention (ERP) therapy is an evidence-based therapy that is highly effective for both OCD and anxiety. ERP works by disrupting cycles of intrusive thoughts through helping you confront your fears in a safer environment, with a specially trained therapist. Over time, you’ll learn to sit with your discomfort, without engaging in compulsions or anxiety-fueled behaviors.
If you’re navigating anticipatory grief about your aging parents, for example, your therapist might have you look at pictures of your parents when they were young, versus now. In doing so, you’d be encouraged to sit with the discomfort that emerges when thinking about their mortality. If your fear about your parents’ eventual deaths is causing you to avoid seeing them entirely, your therapist might work with you to begin calling your parents, to start.
ERP therapy can help you build resilience in the face of uncertainty about death and loss. In doing so, you’ll learn to resist avoidance and compulsions, helping you gain back time you might spend with loved ones.
Find support
While it can be tempting to try to ignore feelings of grief, it’s important to process your emotions. Otherwise, you can find yourself grappling with more severe distress later on. Consider consulting a trained therapist, joining a grief support group, or talking with trusted friends and family. It’s important to ask for help, so don’t be afraid to seek support for logistical tasks as well—like managing paperwork or household chores. Sometimes, even the smallest acts of care can help us get through the toughest days.
Practice self-care
When we support someone else through a loss, we often forget to take care of ourselves, or feel guilty for even thinking about it. Dr. McGrath remembers struggling to do things he enjoyed—like play golf—when his wife was so sick she couldn’t leave the house. Eventually, he realized that finding time for himself was critical. “I needed those breaks [to] be able to be better for her,” Dr. McGrath says.
Bottom Line
If you’re struggling with anticipatory grief, know that it’s completely understandable to be having a hard time—even if the loss you’re anticipating isn’t imminent. Grief can intersect with and exacerbate mental health conditions, so it’s important to pay attention to how you’re feeling and seek support when necessary. Remember, there are trained experts ready to help you take on whatever life throws at you, even the obstacles that seem insurmountable.
