Grief does not always look like the picture most of us carry: a death, a funeral, a period of mourning that others can see. Sometimes it starts before anyone has died. Sometimes nobody around you treats it as grief at all.
Over the past eighty years, clinicians have given names to some of these experiences. Here is what the main terms mean and where each came from.
Why does it help to name a kind of grief?
A name tells you that other people have been here, often enough that someone studied it. That can be a relief if you have been wondering whether what you feel even counts as grief. A name also makes it easier to find the right book, group or therapist.
Two cautions. With one exception, these terms are descriptions and not diagnoses, and they overlap. Nothing below is a way to sort your grief into normal and not normal.
What is anticipatory grief?
Anticipatory grief is, in the National Cancer Institute's (NCI) words, "a grief reaction that occurs in anticipation of an impending loss." It includes many of the same symptoms as grief after a loss. The American Psychological Association's Dictionary of Psychology credits the concept to the U.S. psychiatrist Erich Lindemann, who introduced it in 1944.
NIH News in Health says it is common among people who are long-term caregivers. It is not universal, though. The NCI reports that about 25% of patients with incurable cancer experience it. The NCI also corrects a common belief, that grieving ahead of time leaves less grief for later: "There is not a fixed volume of grief to be experienced." The guide to anticipatory grief goes further.
What is disenfranchised grief?
The term comes from Kenneth J. Doka's 1989 book Disenfranchised Grief: Recognizing Hidden Sorrow. The APA Dictionary of Psychology defines it as "grief that society (or some element of it) limits, does not expect, or may not allow a person to express." Its examples include parents grieving a stillborn baby, teachers after the death of a student, nurses after the death of a patient, and people who have lost an animal companion and are expected to keep their sorrow to themselves.
The dictionary notes that this kind of grief "may isolate the bereaved individual from others." It is also called hidden grief. Many losses that involve no death fall here, and Grieving a Loss That Is Not a Death covers them.
What is ambiguous loss?
Dr. Pauline Boss coined the term in the 1970s and published the book Ambiguous Loss in 1999. Her website says it differs from ordinary loss "in that there is no verification of death or no certainty that the person will come back or return to the way they used to be." She describes two types:
- Physical absence with psychological presence. The person is gone but still very much present in your mind. Her examples include a missing person, divorce and immigration.
- Psychological absence with physical presence. The person is here but changed. Her examples include Alzheimer's disease and other dementias, traumatic brain injury and addiction.
With no clear ending, there is often no moment when other people gather around you, and no obvious point at which mourning is supposed to start.
What is traumatic grief?
The APA Dictionary of Psychology defines traumatic grief as "a severe form of separation distress that usually occurs following the sudden and unexpected death of a loved one," in which numbness and shock are often accompanied by a sense of futility. Deaths by accident, disaster, homicide or suicide are examples.
Grief after such a death can come together with trauma reactions, and the American Psychiatric Association says the risk of prolonged grief is greater when a death is very sudden or happens under unnatural circumstances. That is a risk and not a prediction. The guide to grief after a sudden or traumatic loss covers this, including resources for people who have lost someone who died by suicide. Dr. Rabin's work with trauma is described separately. If you are having thoughts of suicide yourself, call or text 988, or call 911 in an emergency.
Are delayed and absent grief real?
You may have been told that if you do not cry now, it will catch up with you later. The evidence for that is thin. The NCI describes delayed, absent, inhibited and chronic grief as traditional labels with "very limited empirical validity," and says reviews have not found evidence for inhibited, absent or delayed grief. It suggests these patterns may be better explained "as forms of human resilience and strength."
One study that followed 205 older adults through the death of a spouse found a delayed pattern in 8 of them, or 3.9%. So it can happen, and the diagnostic manual DSM-5-TR allows for symptoms that begin a year or more after a loss. It is not the usual course. The VA's National Center for PTSD adds that a shocking death can leave a person numb, which may delay grieving, and that this is nothing to judge yourself for.
What are complicated grief and prolonged grief disorder?
These are two names for the same clinical problem. "Complicated grief" is the older research term, which itself replaced "abnormal" and "pathological" grief. The current term is prolonged grief disorder, which was added to DSM-5-TR in March 2022. It is the one entry on this page that is a diagnosis.
It describes grief that stays intense and gets in the way of daily life long after a death: at least 12 months for adults under DSM-5-TR, along with other criteria. The American Psychiatric Association estimates that 4% to 15% of bereaved adults experience it. Only a clinician can assess it. See the guide to prolonged grief disorder.
Most grief, including grief that fits one of the names above, does not need therapy. A 2007 review in The Lancet put it plainly: "grief is not a disease and most people adjust without professional psychological intervention." If you would like support with a loss that others have trouble seeing, Dr. Rabin offers grief and loss therapy in Brookline and works with anticipatory grief, old losses and losses other than a death.
Keep reading
Sources
- National Cancer Institute, Grief, Bereavement, and Coping With Loss (PDQ), Health Professional Version (2024)
- American Psychological Association, APA Dictionary of Psychology: anticipatory grief
- American Psychological Association, APA Dictionary of Psychology: disenfranchised grief
- Pauline Boss, Ambiguous Loss: FAQ
- American Psychological Association, APA Dictionary of Psychology: traumatic grief
- American Psychiatric Association, Prolonged Grief Disorder (2025)
- Stroebe, Schut and Stroebe, Health outcomes of bereavement, The Lancet (2007)
- Bonanno, Wortman, Lehman, Tweed, Haring, Sonnega, Carr and Nesse, Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss, Journal of Personality and Social Psychology (2002)
- Prigerson, Boelen, Xu, Smith and Maciejewski, Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale, World Psychiatry (2021)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.
