The concept of ‘grief’ is defined in the Landelijke Richtlijn Rouw (National Mourning Directive) as “The total physical, emotional, cognitive, spiritual and behavioural experience that occurs after the loss of a person with whom a meaningful relationship existed“. Loss does not only mean the death of a loved one, but also the loss of a loved one to a serious illness, such as dementia.

  • Physical reactions: decrease or increase in sleep and/or appetite, headache, loss of energy, decrease or increase in need for intimacy and sexuality.
  • Emotional reactions: sadness, loneliness, fear, guilt, shame, aggression, powerlessness, pessimism, nightmares, relief, contentment.
  • Cognitive reactions: decreased focus or self-esteem, confusion, tension, compulsion, thinking too much about the deceased, hopelessness.
  • Spiritual reactions: loss of life perspective, decrease or increase in faith.
  • Behavioural reactions: increased irritation, withdrawal, avoidance of people or situations.

Mourning is a different experience for everyone; one person may suffer more from physical symptoms and less from cognitive symptoms, while for the other, it is the other way around.

Complicated grief

Complicated grief is when the previously described symptoms of grief persist for a long time or are very serious, resulting in a long-term effect on your social or professional functioning. Complicated grief can lead to psychological problems, such as depression.

Complicated grief can manifest itself in several ways. It can be a chronic form of grief, in a negative way, or one that causes many physical complaints to arise. Therefore, it can also be either an under-reaction or an over-reaction to the loss of a loved one.

The main differences between grief and depression are shown below.

Mourning Depression
Feelings Desire, loss, despair Gloom, dullness, no positivity
Behaviour Search behaviour, effort to focus on the outside world Passivity, no longer experiencing joy
Thoughts “I can’t bear that he/she is no longer there”

“Life is meaningless”

“I am a worthless person”

“The world is unfair”

“The future is hopeless”

How does complicated grief arise?

Processing loss is seen as an active process in which four stages of grief are central:

  1. facing the reality of loss
  2. experiencing the pain of loss
  3. adapting to life without the deceased
  4. beginning to return to your regular daily routine

Failure to complete the first two stages can create obstacles or freeze the grieving process. If emotions are not experienced, they are suppressed. Suppressing emotions can disrupt your entire body and requires considerable physical effort. Your body begins to tense up to stop the emotions. For example, you clench your jaw, hold your breath or tense your neck and shoulders. These are strategies to suppress emotions and to deny yourself the experience. A good metaphor for this process is pushing a ball under water: it takes energy and becomes increasingly annoying, because the ball (emotion) keeps coming back up. The deeper you push it down, the more tension will build up. You can release some of this tension by exercising a lot, being easily angered or by reacting bluntly to people around you. It can also manifest itself in physical complaints, such as headaches.

What can you do?

In order to get the grieving process going again, it is important to come to terms with the loss. Confrontation with reality is important for this, for example by looking at photos of the funeral or talking about the lost loved one. It is important to experience the pain of the loss. It is impossible not to feel pain when you lose someone you have loved very much. If you do not feel the pain, it is because you are consciously or unconsciously suppressing or denying it. This can come back later and manifest itself in physical complaints, periods of sadness and/or aggression. Regularly writing or talking about the lost loved one can help you accept and process the loss and pain.

The end result of the process is to integrate the loss into your life, so that you can think of the lost loved one without experiencing intense pain every time; the grief will always be present.


  • Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, ​​P., (2017). Protocol-based treatments for adults with psychological complaints.
  • Keirse, E., & Kuyper, M.B. (2010). Mourning Guideline. Version 2. VIKC, Association of Integral Cancer Centers. (
  • Omgaan met emoties

Continue reading about

Previous article

Next article

Heb je vragen hierover? Stel je vraag aan je eigen professional. Geen verbinding met een professional? Stel je vraag hier

Ask your question to a professional or former client!