The types of loss — what you are actually carrying

There is no official list of losses, and nobody is in charge of deciding which ones count. What the research does show is that the category of loss predicts far less than two other things: how close the bond was, and whether anyone around you treated it as real.

Two things travel with every guide we write, including this one.

Where we offer a way through, it is the way that worked for us. It may not be the right answer for you, and we are not going to pretend our family is a study. When we tell you what we did, we are telling you a story, not giving you an instruction.

And where we give you a fact, we have gone and read the source. Every statistic on this page carries a named author, a publication and a year, listed at the back so you can check us. We do our best to keep it current. You should still do your own reading and compare — including on us. If you check something here and we have it wrong, that is the most useful message you could send.

What counts as a loss?

Three broad families, and they overlap constantly.

Losing a person. A child, a partner, a parent, a sibling, a grandparent, a friend, an ex-partner, a nephew or niece, a cousin, a pregnancy, an infant. Also a person who is still alive and no longer reachable — through estrangement, addiction, or an illness that has taken who they were.

Losing something that was not a person. An animal. A marriage. A job and the identity inside it. A body that worked the way it used to. A home. A faith. A country.

Losing something that never arrived. A child you could not conceive. The grandchildren you are not going to have. The version of your life you were two years into building. This is the one that gets least recognition and is often the hardest to explain to anybody.

What matters is that none of these is a tier. There is no ranking here, and we are not going to build one.

Why ranking losses is the mistake, and the evidence says so

The honest answer to “which loss is worse” is that the question has been asked properly once and it got a different answer than people expect.

Eckerd, Barnett and Jett-Dias (Death Studies, 2016) compared two groups directly — 211 people who had experienced the death of a pet and 146 who had experienced the death of a person, all within the previous two years, all college students. Human loss rated slightly higher on grief severity, but the effect was small. And the finding that mattered was this: closeness to the deceased was overwhelmingly the strongest predictor of grief severity, and other predictors generally dropped out of the model once closeness was in it.

One study, one narrow population. It cannot settle the question. But it points somewhere useful: the depth of the bond, not the category of the relationship.

There is a second reason to refuse the hierarchy, and it comes from bereaved parents themselves. Schoonover, Prokop and Lapid (Journal of Palliative Care, 2022) reviewed 52 studies of informal bereavement support from the standpoint of parents bereaved of stillborn, young and adult children. Among the things those parents most often named as unhelpful was the feeling that their type of death was not considered equal to other deaths.

So the rule cuts both ways, and we apply it to ourselves. Saying “nothing compares to losing a child” wounds the reader who lost a sibling, a dog, or a pregnancy at eight weeks. Saying “a miscarriage is just as hard as a stillbirth” is also a ranking — it asserts an equivalence nobody has measured. Write about the bond. Never about the league table.

The five shapes that cut across every category

These are not kinds of loss. They are properties a loss can have, and this is the part of the subject that is genuinely useful — because a reader who has been told “you are grieving a divorce” often finds more recognition in “your loss is ambiguous and nobody around you has acknowledged it” than in any category name.

1. Primary and secondary loss

The primary loss is the thing itself. The secondary losses are everything that came off it. A child dies; and then the school run goes, the friendships that existed through that school go, the income goes if someone stopped working, the second half of a marriage's plan goes, and the version of yourself who was that child's parent in the present tense goes.

This is a clinical description rather than a research finding, and we label it as such. It earns its place because of what it does for a reader: it explains why a loss keeps producing new losses months later, and why someone can be ambushed in year two by something that has nothing obvious to do with the death.

2. Ambiguous loss

A loss with no confirmation and no end point. The person is physically gone but not known to be dead — a missing person, an unresolved disappearance. Or the person is physically present but psychologically gone — dementia, addiction, a brain injury, an estrangement where someone is alive and across town and not speaking to you.

The concept is associated with the family therapist Pauline Boss, whose book Ambiguous Loss was published by Harvard University Press in 1999. One correction worth having, since it circulates wrongly: the 1999 book is where most readers meet the idea, but it is not where she coined it — her work on it runs back considerably further. If you see “Boss coined the term in 1999,” that is a bibliography error, not a fact.

What ambiguous loss is not is a measured quantity. There is no prevalence figure for it and no validated instrument. It is a lens, and a good one. It is not a statistic.

3. Disenfranchised grief

Grief that the people around you do not treat as grief. The clearest examples are a pet, a pregnancy, an ex-partner, a friend, an estranged relative, a colleague, and anyone outside the small circle the world recognizes as entitled to mourn.

The term is Kenneth Doka's, from the edited volume Disenfranchised Grief: Recognizing Hidden Sorrow (Lexington Books, 1989). Three cautions, because this is one of the most misquoted definitions in the field.

First, the widely circulated wording — grief that is not “socially sanctioned” — is Doka's own later rewording. The 1989 volume says socially supported. Second, we are not going to print a page number for it: two sources that cite the 1989 edition directly disagree about the page, and a third peer-reviewed paper renders the same sentence with “socially validated.” Nobody should quote a page until somebody has the 1989 book physically open. Third — and this is the one that matters most — there is no validated measure of disenfranchised grief and no prevalence estimate for it in any literature we could search. A 2026 paper in Omega describes this whole line of work, in its own abstract, as “pre-empirical.”

So: use it as a lens. Never as a number. And there is one concrete, checkable form of it worth knowing about, because it has a real effect on a real reader: bereavement leave policies that cover only a parent, spouse or child, and nothing else. That is disenfranchisement with a payroll department attached.

4. Anticipatory loss

Grieving before the death, during a terminal diagnosis or a long decline. It is real, it is widely described, and almost everything comforting said about it is wrong.

The claim to be careful with is that anticipatory grief softens the grief that comes afterwards. We went looking for the evidence behind that and did not find it. There is published work on pre-loss grief in caregivers in which the relationship runs the other way for some people — higher grief before the death predicting worse outcomes after it, not better. And Therese Rando, who did as much as anyone to establish the concept, wrote in 1988 that the term is a misnomer, because what is being grieved is not only a death that has not happened yet but a series of losses that have already happened.

If anyone has told you that you have had time to prepare, they have described a mechanism that the evidence does not support. You may also have spent that time watching, which is its own injury and is covered in the terminal-diagnosis guide.

5. Cumulative loss, and collective loss

Cumulative loss is more than one, close together, with no clear ground between them. Two deaths in a year. A diagnosis and then a job and then a marriage. The intuition is that each one lands on top of the last and the weight compounds.

We want to be careful here, because the one piece of good evidence we found does not support the intuition. Crawford and colleagues (European Child & Adolescent Psychiatry, 2021) used the Avon Longitudinal Study of Parents and Children, a UK birth cohort of 6,260 children, to look at pet death before age seven and mental health at age eight. Their finding on this specific question: “the developmental timing, recency, or accumulation of pet death was unassociated with psychopathology symptoms.” That is one cohort, one kind of loss, one age — not a law. But it is the only measured thing we have, and it says the compounding we all assume was not detectable there.

Collective loss is a loss that belongs to a group — a community, a workplace, a congregation, a country. A pandemic, a disaster, a shooting. Its distinctive feature is that the public mourning can be enormous and your own private loss can still be unattended inside it.

What you have been told that is not true

This is the part of the subject we would most want a stranger to read, because several of the most repeated claims about grief trace back to a single weak source that nobody checked. Each of these we chased to its origin.

“There are five stages of grief and you move through them”

No stage or phase model of grief has ever been shown to describe a sequence people actually move through.

Elisabeth Kübler-Ross's 1969 model came from in-depth interviews with terminally ill patients — no control group, no measurement, no follow-up — and she said herself that the stages were not strictly sequential and should not be interpreted as natural law. Note also what the model was originally about: people facing their own deaths, not people grieving someone else's.

The study most often cited as confirming the stages is Maciejewski and colleagues in JAMA (2007), 233 bereaved people. Read its own findings and they go the other way: “Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item” — from month one onward — and yearning, not depression or anger, dominated throughout. The paper carries a published erratum and three critique letters from senior figures in the field, all in JAMA in 2007. The replication attempt, Holland and Neimeyer (Omega, 2010), found “limited support” for stage theory and found that what actually predicted grief was not time since the loss but sense-making.

The frameworks are still useful vocabulary. They are not findings. Of the four in common use, the best founded is Stroebe and Schut's Dual Process Model (Death Studies, 1999), and it is the one built explicitly as a critique of the others — it describes oscillation between dealing with the loss and dealing with the rest of your life, including the need to take breaks from grieving.

“Grief counseling doesn't work, and 38% of people end up worse off”

That number comes from an unpublished 1999 doctoral dissertation and does not survive review.

Larson and Hoyt traced it (Professional Psychology: Research and Practice, 2007). The 38% figure rests on a statistic whose method was cited to an unpublished master's thesis and a conference presentation, neither available for review; Larson and Hoyt commissioned a blind review by national methodological and statistical experts, who found it “seriously flawed.” Most of the citations repeating it cite a later paper rather than the dissertation, so almost nobody repeating it has seen the source.

What the published evidence actually says is narrower and more useful. Currier, Neimeyer and Berman (Psychological Bulletin, 2008) pooled 61 controlled studies: general grief counseling offered to everyone shows little lasting benefit, largely because untreated people improve on their own — but interventions aimed at people showing marked difficulty adapting “had outcomes that compare favorably with psychotherapies for other difficulties.” Which is to say: if you are struggling, treatment works about as well as treatment for anything else.

“You have to work through it or it will come out later”

Unsupported, and its inverse is unsupported too.

Wortman and Silver's “The myths of coping with loss” (Journal of Consulting and Clinical Psychology, 1989) examined four assumptions: that depression after a loss is inevitable, that distress is necessary and its absence pathological, that a loss must be “worked through,” and that recovery and resolution are to be expected. Their conclusion: “available empirical work fails to support and in some cases contradicts them” — and these mistaken assumptions “may lead others to respond to those who have endured loss in ways that are unhelpful.”

So nobody gets to tell you that you need to let it out. And nobody gets to tell you that you are coping too well. The absence of visible distress is not evidence of suppression. We apply that in both directions, including to the kind thing people say — “you're handling this so well” sets a standard just as surely as “I worry you haven't really grieved yet.”

“Grief will make you stronger”

This is the one we are most careful about, because the Fund's own program is built on service and purpose — so we have every incentive to overclaim here and we are not going to.

Frazier and colleagues (Psychological Science, 2009) did the study that almost nobody cites. They measured people before and after a traumatic event, then compared actual pre-to-post change with scores on the standard Post-Traumatic Growth Inventory. The inventory's scores were generally unrelated to actual growth in the very domains it purports to measure. And perceived growth was associated with increased distress, while actual growth was associated with decreased distress — the two appear to be different processes.

What follows from that is a line we hold everywhere. A person may say their own life changed for the better, and that account is theirs to give. Nobody else may say it about them, and no guide should present growth as what grief does, or should do. Service helped our family. We will tell you that as a story. We will not tell you it is what happens.

“Suicides spike over the holidays”

December has the lowest average daily suicide rate of any month, not the highest. The Annenberg Public Policy Center's analysis of CDC provisional data for 2023 ranked December 12th of 12, with November 11th; August was highest and July second. In the 2023–24 holiday season, 58% of newspaper stories on the subject repeated the myth.

The case for extra support in December stands perfectly well on its own. It does not need a false statistic, and repeating that one may itself do harm.

“Every suicide leaves six survivors”

The figure was never empirically derived. It was an estimate from the early 1970s, based on average immediate-family size. Cerel and colleagues ran the survey — their paper is titled, bluntly, “How Many People Are Exposed to Suicide? Not Six” (Suicide and Life-Threatening Behavior, 2018) — and from a random-digit-dial survey of Kentucky adults, weighted and extrapolated, estimated roughly 135 people exposed per suicide death.

And then the caution that belongs in the same breath: 135 is exposure, not bereavement. The research team treats exposure as a continuum and does not claim 135 people are bereaved. How many are deeply affected is not settled.

The numbers, and why they disagree so wildly

You will see a figure for how many bereaved people develop a prolonged or complicated grief disorder. The honest range is wide, and the reason it is wide is the interesting part.

The spread from about 3% to about 50% is not disagreement about grief. It is four different things being counted: whose grief (general population, or bereaved, or bereaved parents, or people who sought help); which diagnostic criteria, since ICD-11 and DSM-5-TR differ materially; a screening questionnaire or a clinical interview; and how long after the death. A self-selected or clinically referred sample will always produce a high number.

What is defensible: estimates run from roughly 4% to 10% of bereaved adults, and higher — around 20% in one meta-analysis — among bereaved parents. The range is wide because studies count different populations with different criteria. There is no single agreed figure, and anyone who gives you one without naming the population is not being careful.

What nobody knows

We think a guide is more trustworthy for saying this out loud, so here is what we went looking for and could not find.

The true population rate of prolonged grief disorder. Not knowable from the current literature. No population-based study using a clinical interview on a representative sample exists that we could locate; researchers called for exactly that in 2017 and as far as we can tell it has not been done.

What percentage of people “never recover.” We looked for this specifically. There is no defensible figure. The nearest things are the prevalence range above and a set of trajectory studies whose proportions change depending on how many groups the statistical model is told to look for. “Never recover” is also not a thing anyone measures — it presumes recovery is what is being tracked, which is the assumption Wortman and Silver put in question. Nobody knows, and the question may be the wrong one.

Whether genuine post-traumatic growth happens after a bereavement, and how often. Established that the standard instrument does not measure change. Not established what should replace it.

Whether a predictable anniversary effect exists. This one surprised us. The best-designed study available — a self-controlled analysis of Danish national register data on people bereaved by suicide, where each person acts as their own control — found “no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays.” Other studies find effects in some sexes, some age bands and some narrow windows, with wide confidence intervals. And for a parent around the anniversary of a child's death, there is no study at all.

Which is why we are not going to tell you to brace for the date. Some people find certain days hard. Nobody has shown it is predictable, and telling you to expect a collapse might simply install the expectation. The researchers' own conclusion is the better advice: help should be available at all points, not rationed to the calendar.

What we have found to help

This is ours, not a finding, and it is the shortest section on the page on purpose.

Saying the name. Of everything in this subject, the cheapest useful thing is that people around a grieving person mostly stop saying the name of the person who died, and the grieving person almost always wants to hear it. The 2022 review of 52 studies found “talking with the spouse about the child who died” among the helpful strategies and “others actively avoiding or stopping all communication” among the unhelpful.

Doing something for somebody else. It is what our family did and it is why this charity exists. We are not going to dress that up as evidence. What the research supports is narrower than the internet claims, and we set out where it thins out in a separate guide rather than overstating it here.

Being asked. The single most actionable number we found in the whole literature is from Guldin and colleagues (World Psychiatry, 2017), Danish registers, 1,445,378 bereaved people: one in three people with a previous psychiatric diagnosis experienced suicide, self-harm or psychiatric illness within the first year of a bereavement. That argues for asking someone directly rather than assuming they are fine.

Common questions

How many types of loss are there?

There is no official number and no authority that decides. Losses are usually sorted into losing a person, losing something that was not a person, and losing something that never arrived — but the categories overlap constantly and the sorting matters less than people assume. What the evidence shows is that how close the bond was predicts grief severity better than which category the loss falls into.

What is disenfranchised grief?

Grief the people around you do not treat as grief — for a pet, a pregnancy, an ex-partner, a friend, an estranged relative, a colleague. The term comes from Kenneth Doka's 1989 edited volume Disenfranchised Grief: Recognizing Hidden Sorrow. It is a useful lens, but there is no validated measure of it and no prevalence estimate in any published literature we could search, so treat any statistic about it with suspicion.

What is ambiguous loss?

A loss with no confirmation and no end point: someone physically gone but not known to be dead, or physically present but psychologically gone — dementia, addiction, estrangement. The concept is associated with the family therapist Pauline Boss, whose book Ambiguous Loss appeared in 1999, though her work on the idea runs back considerably earlier. Like disenfranchised grief, it is a lens rather than a measured quantity.

Are there really five stages of grief?

No stage or phase model has ever been shown to describe a sequence people actually move through. Elisabeth Kubler-Ross's 1969 model came from interviews with dying patients, not grieving ones, with no control group and no follow-up, and she said herself that the stages were not strictly sequential. The study most often cited as confirming them found that acceptance was the most common response from the first month on — the opposite of what the model predicts — and it drew three published critiques and a failed replication.

Does anticipatory grief make the loss easier afterwards?

The evidence does not support that. For some caregivers, higher grief before the death predicts worse outcomes after it, not better. Therese Rando, who did as much as anyone to establish the concept, wrote in 1988 that the term is a misnomer, because what is being grieved includes losses that have already happened rather than only a death that has not.

What percentage of people never get over a loss?

There is no defensible figure, and we would rather say so than give you one. Estimates of prolonged grief disorder run from about 4% to 10% of bereaved adults and around 20% among bereaved parents, but those are diagnoses, not an answer to this question. "Never recover" is not something researchers measure, partly because whether recovery is the right thing to track is itself disputed.

Last reviewed 27 October 2026. Written by Austin's family. We are not clinicians, and nothing here is medical, legal or financial advice. Nothing on this page is behind a paywall, no organization named here pays us, and there are no affiliate links. See our editorial and sourcing policy.