How bereavement affects adults Bereavement and grief can affect adults in a number of ways because everyone reacts differently to the experience of losing a loved one. Dr Ann Dent outlines the symptoms you may have and explains how various difficult factors may complicate the healing process.

In this article

All grief is different After the funeral

Do men and women grieve differently? If you aren't there at the death

Emotional effects of identifying the body When there's no body to mourn

There's no right or wrong way to grieve. We all have different personalities, ways of coping and past experiences. No two people's grief will be the same. Each of us is likely to experience a wide range of feelings, which may vary from day to day.

Physical symptoms may include: hollowness in the stomach, over-sensitivity to noise, tightness in the chest or throat, weakness in muscles, lack of energy, a dry mouth, fatigue and breathlessness.

Feelings may include: sadness, anger, guilt, self-reproach, anxiety, loneliness, helplessness, hopelessness, shock, emancipation, relief, numbness and yearning for the dead person.

Behavioural changes may include: insomnia and sleep interruption, appetite disturbances, absent-minded behaviour, social withdrawal, dreams of the deceased, avoiding reminders of the deceased, sighing, restless overactivity, crying, visiting places or treasuring objects that are reminders of the lost loved one.

Thoughts may include: disbelief, confusion, preoccupation with the deceased, a sense of presence of the deceased, auditory and visual hallucinations.

The first week or so after a death is a busy time: telling others, registering the death and making funeral arrangements. The full reality of the death may not hit you until after this time, when friends and family may have moved away and the real pain of grief begins.

Confusion, disorganisation, anger and guilt are common

After the initial impact, you may find that you're up one minute and down the next. This is normal. Confusion, disorganisation, anger and guilt are common feelings which may fluctuate over the coming months, giving way to apathy, sadness and depression as time goes on.

The following comments were all expressed by bereaved people and show the variety of feelings that can be experienced:

• Guilt - "If only we hadn't rowed just before the accident. I feel so guilty that I gave him a hard time before he died."
• Anger - "I was so angry, I wanted to hit out at God and the world. I wanted to hurt everyone just like I'd been hurt. I wanted to destroy. He'd left me and I hated him for it."
• Longing - "My whole being ached for her. I could think of nothing else. Every minute I thought she'd come through the door again. Again and again I'd hear her voice, see her in the crowd. Each time I thought of her it was like a knife in my heart."
• Exhaustion - "I'd been feeling restless and couldn't sleep. I paced and ranted. Now, I have an opposite reaction. I sleep a lot but still feel worn out. I don't even want to see the friends who've kept me going. I sit and stare, too exhausted to move."

Women tend to have more intense reactions than men and find it easier to talk to others about their feelings. For this reason, they may have more available support than men.

Sometimes men may 'act strong', which may not reveal their true emotions. Men feel as deeply as women but may feel it's wrong to show their vulnerability. Many try to keep busy and avoid talking about the death. This is their way of coping and should be respected, but it's not wrong or weak for men to seek help.

Most of us would want to be present when a loved one dies. It's the last thing you'll do for the dying person and for many it seems right to be with them until the end of their life. Being present may help to confirm the reality of the death and assist you in your grieving.

Sometimes this isn't possible, however, and you may be left feeling guilty, angry or cheated - particularly when someone's died after a long illness. You'll want to know that your loved one died peacefully, free of pain and not alone. In the case of sudden death, where you haven't been present, you may want to know that everything was done to save the life of your loved one. You'll want to know what has happened, or who or what's to blame. It's natural to seek causes for the death and ways of making sense of it.

To have to identify someone who we've loved can be frightening, distressing and stressful, especially when there's been injury to the body. Many of us won't have seen a dead body and therefore have no idea what to expect.

Personnel in the mortuary should be able to guide and help you. Whenever possible, ensure that you're accompanied by a close and trusted friend or relation, who can then take you home afterwards. Recognising the body as your loved one may cause great shock either at the time or some time later. You may feel numb for a few hours or even days until the reality sinks in.

Sometimes, due to the circumstances of the death, the body of your loved one is either missing, can't be retrieved or can't be found. This can be extremely distressing, as you may have no confirmation that your loved one is dead. In such cases it's difficult to acknowledge and accept the death, making it hard to begin grieving fully.

It's advisable that you seek help to talk through your feelings and to assist you through the grieving process. Cruse Bereavement Care offers help to the bereaved through a network of support groups throughout the UK. It also publishes a range of leaflets on bereavement.

Cruse Bereavement Care
Cruse House, 126 Sheen Road, Richmond TW9 1UR
Tel: 020 8939 9530
Website: www.crusebereavementcare.org.uk