Anxiety: The Overlooked Stage of Grief

You have heard them before—at this point, they have become part of the parlance of grief and loss—denial, anger, bargaining, depression, and acceptance. These “five stages of grief,” introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, are widely accepted and understood as common to the emotional process that follows the death of a loved one. While there have been additions and suggestions to Kübler-Ross’ original model over time, most notably by David Kessler, one of her students, who suggested that “finding meaning” be added to the process, the main tenets of the model remain resonant and relevant today. Even so, grief is more complex than this classic model illustrates. It can include a plethora of emotions that can occur alongside the five that have been popularized over the years.

One of these other emotions that falls within the common feelings associated with grief and loss is anxiety. A 2012 article in Current Psychiatry Reports concludes that “anxiety is a natural response of the attachment system to separation from a loved one … Confrontation with one’s own death is also a natural trigger of anxiety … [and] loss of a loved one can trigger the onset of a [diagnosable] anxiety disorder that, when present, can derail the mourning process and prolong acute grief” (Shear et al., 2012).

Essentially, loss causes us to feel a sense of abandonment, thoughts of our own mortality, and symptoms associated with anxiety disorders, all of which can be commonly found in an individual’s emotional response to loss and can complicate the widely accepted “framework” of the grieving process.

Loss of Safety

Anxiety thrives on perception of threat; in other words, the more we believe we are at risk, the more anxiety we feel. While the death of a loved one is not necessarily a direct or tangible threat to our own safety, it can trigger intense feelings of worry and uncertainty. Unexpected or traumatic deaths can shatter an individual’s sense of safety and predictability.

A 2016 study found that symptoms of anxiety were strongly associated with prolonged grief (Eisma et al., 2016). Furthermore, personalization of the loss (turning our thoughts towards our own mortality) is common and can bring about a sense of vulnerability and worry.

In some cases, this loss of safety can exhibit as post-traumatic stress disorder (PTSD), which has been shown to be statistically significant as related to the death of a close loved one (Buur et al., 2025). PTSD is strongly associated with anxiety and can cause anxious responses such as intrusive thoughts, rumination, panic-like physical symptoms, hypervigilance, and sleep disturbance (National Center for PTSD, 2023). The loss of safety and certainty that often accompany loss is a common cause of grief-related anxiety.

Health Anxiety

When the loss of a loved one is the result of a traumatic or prolonged illness such as cancer, it is not uncommon for survivors, and particularly caregivers, to experience health-related anxiety.

In my 2023 book, Understanding and Coping with Illness Anxiety, I discuss this phenomenon: “Those who care for sick family members may be more prone to illness-related anxiety based upon the sheer proximity to illness and the personalized nature of caring for a closely related individual … [this] comes with its own trauma: a constant exposure to disease and sickness, as well as a need to always be vigilant for health changes, emergencies, or urgent situations” (Lane, 2023).

Continued or long-term exposure to unpleasant or frightening stimuli can cause us to experience heightened anxiety and worry and, in the case of health anxiety, the closeness to illness can trigger worries about our own physical health status. Not only is the bereaved person coping with the actual loss, but they are also coping with complicated feelings about their own health based upon the continued negative stimulus of caregiving.

Fear of Further Loss

When a traumatic event occurs, a common emotional response is hypervigilance, which we might summarize as “self-preservation.” Basically, in an effort not to re-experience the traumatic event, we become hyperaware of possible threats. This can look like rumination, fixation, and a general sense of being on “high alert.”

In her book, Trauma and Recovery, Judith Herman writes, “After a traumatic experience, the human system of self-preservation seems to go onto a permanent alert, as if the danger might return at any moment” (Herman, 1992).

Existing in this state of high alert, while seemingly protecting us from future danger, can actually cause us to experience disruptive anxiety and struggle to feel present in our lives. Though experiencing a loss can be shocking, it does not predict that more loss is about to occur—but the anxious mind struggles to make this distinction, and we can become fixated on the possibility of an additional loss.

An Evolving Framework

The human experience of grief has an evolutionary component to it; rather than being a phenomenon we can rigidly describe, grief has a certain nebulousness about it which allows us to continually broaden our understanding of the experience. Kübler-Ross’ work helped us formulate an initial psychological understanding of emotional processes related to grief and loss while also leaving space for further exploration and depth. As we continue to broaden our understanding of the psychology of grief, we must recognize the role that anxiety plays in what is a complicated and nonlinear process.

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