The Many Faces of Grief: Anticipatory, Traumatic, Disenfranchised, and Ambiguous Loss
By: Joy McCrady, MS, LCPC, NCC
Maybe you’ve wondered why your grief doesn’t look like anyone else’s. Why you started mourning months before the death. Why you feel so alone with a loss other people don’t seem to count. Why you’re grieving someone who is still alive.
One of the questions grieving people ask most often is some version of: Am I doing this wrong? After more than a decade of walking alongside people through loss, first as a hospice bereavement counselor and now in private practice, my answer is almost always the same. You’re not doing it wrong. You may be carrying a kind of grief that no one has named for you yet.
This article is a map. It won’t tell you how to feel, but it may help you recognize where you are.
Grief isn’t one thing (and the “stages” were never a checklist)
Most of us learned about grief through the “five stages”: denial, anger, bargaining, depression, and acceptance. Elisabeth Kübler-Ross first described them in 1969 from her work with people who were dying, not with the people grieving them. Over time, the stages became a roadmap many people assumed they were supposed to follow in order.
Real grief rarely moves in a straight line. Grief researchers Margaret Stroebe and Henk Schut describe a more accurate pattern in their dual process model: we move back and forth between facing the loss (missing, remembering, crying) and facing life after it (paying bills, returning to work, finding new routines, making meaning out of the loss). That back-and-forth isn’t avoidance or relapse. It is how humans have been designed to carry something too heavy to hold all at once.
What is anticipatory grief?
Anticipatory grief is mourning that begins before a death, often during a long illness, a dementia diagnosis, or years of watching someone struggle with addiction. You may grieve the future you had expected, the conversations you can no longer have, and the person as they used to be.
Many people feel guilty about this, as if grieving early means giving up. It doesn’t. Anticipatory grief is love that sees what is coming. It also doesn’t “use up” grief ahead of time; the death itself can still land with enormous force and powerful waves of mixed feelings.
What is traumatic grief?
When a death is sudden, violent, or unexpected (an accident, a suicide, an overdose, a medical emergency), grief and trauma can become tangled together. You may have intrusive images, a racing heart when the phone rings, trouble sleeping, or a sense that the world is no longer safe.
In traumatic grief, the trauma and the grief keep interrupting each other. It becomes hard to miss the person because remembering them pulls you straight back into how they died. Part of healing is untangling the two, so that the way they died takes up less focus than on the way they lived.
What is disenfranchised grief?
Grief researcher Kenneth Doka coined the term disenfranchised grief in 1989 to describe grief that isn’t openly acknowledged, socially supported, or publicly mourned. Some examples:
The death of an ex-spouse, an affair partner, or a friend no one knew you were close to
Pregnancy loss, infertility, or a failed adoption
The death of a pet
Stigmatized deaths, such as suicide, overdose, or a death in prison
The loss of a faith, a church community, or a professional identity
When no one else recognizes a loss, people often stop recognizing it themselves. Grief doesn’t disappear because it isn’t allowed; it tends to go underground and show up as anxiety, irritability, or exhaustion.
What is ambiguous loss?
Family therapist and researcher Dr. Pauline Boss coined the term ambiguous loss to describe losses that have no clear ending. She describes two types:
Physically absent, psychologically present: someone is gone but not confirmed dead, or gone from daily life (a missing person, an estranged child, a deployed or incarcerated family member)
Physically present, psychologically absent: someone is here but not fully here (a parent with dementia, a partner changed by addiction, a traumatic brain injury, or serious mental illness)
Ambiguous loss is especially exhausting because there is no acknowledged ritual or funeral, but still needs to be tended to.
Cumulative and secondary losses
Sometimes grief is heavy because it isn’t just one loss. Cumulative grief happens when losses stack up faster than we can mourn them. Examples could be losing multiple family members in the same year or losing a loved one and making a major move or changing jobs in a short period of time. Secondary losses are the ripples that follow a death: income, a home, a role (caregiver, spouse, “the one who holds the family together”), a shared social circle, or a sense of who you are.
Both deserve to be grieved. Naming them can explain why a loss that “should” be getting easier suddenly feels heavier.
When grief gets stuck: prolonged grief disorder
Grief has no deadline, and waves of it can return for years on birthdays, holidays, and ordinary Tuesdays. For some people, though, grief doesn’t soften over time. In 2022, the DSM-5-TR added prolonged grief disorder to describe intense, persistent grief (such as longing for or preoccupation with the person, identity disruption, deep emotional pain, or feeling that life is meaningless) that continues most days at least a year after a death for adults and makes daily life hard to manage.
This diagnosis is not a label for loving too much. It is a way of recognizing that some grief needs more support, and that support works.
How therapy can help with grief
Grief counseling doesn’t ask you to “move on.” It helps you carry the loss in a way that leaves room for your life. Depending on what you’re carrying, that might mean:
EMDR to process traumatic images and moments that keep replaying
Intensive Short-Term Dynamic Psychotherapy (ISTDP) to make room for the anger, guilt, and sorrow that grief often hides
Internal Family Systems (IFS) to get to know the parts of you that are protecting you from the full weight of the loss
Somatic and polyvagal approaches to help your body feel safe enough to grieve
Frequently asked questions
What are the different types of grief? Common types include anticipatory grief (before a death), traumatic grief (after a sudden or violent death), disenfranchised grief (a loss others don’t recognize), ambiguous loss (a loss with no clear ending), and cumulative grief (several losses at once). Many people experience more than one type at the same time.
What is traumatic grief? Traumatic grief happens when a death is sudden, violent, or shocking, and trauma symptoms such as intrusive images, panic, or hypervigilance become tangled with mourning. Trauma-informed therapies like EMDR can help separate the two so grief can move more naturally.
When should I see a grief counselor? Consider reaching out if your grief feels unmanageable, if the circumstances of the death keep replaying, if you feel alone with a loss others don’t recognize, or if months later you’re struggling to function. You don’t have to wait until you are in crisis to deserve support.
You don’t have to carry this alone
Whatever shape your grief has taken, it makes sense. If you’d like support that honors both the love and the complexity of your loss, I offer grief counseling through telehealth throughout Maryland and in person in Severna Park. You’re welcome to schedule a free 15-minute consultation, and I’ll reach out within one business day.