Styles of Expressing Grief

Grief is universal, but it is not experienced or expressed in the same way by everyone.

A person’s grief can be shaped by relational and contextual factors, including social identities and lived experiences such as race, ethnicity, religion, sex, gender identity, sexual orientation, socioeconomic status, attachment style, and geographic location.

Early experiences with loss, family and cultural norms around emotional expression, and the presence or absence of supportive environments may also influence how grief is processed and expressed.

Grief is so personal. It’s like a thumbprint. There’s no two that are the same.

Paola Ayora, MD, MPH / Assistant Professor of Child Psychiatry in the Child Study Center at Yale School of Medicine.

In this video, Paola Ayora, MD, MPH, an Assistant Professor of Child Psychiatry in the Child Study Center at Yale School of Medicine, reflects on the deeply personal nature of grief.

Each Loss Is Unique

The nature of the relationship to the deceased plays a central role in a person's grief experience. Two people who experience the same loss, such as siblings grieving the death of a parent, may have very different emotional responses based on the dynamics of their individual relationships.

Even within the same person, grief can differ from one relationship to another. For example, grief following the death of a spouse may be shaped by changes in companionship, identity, or future plans, while grief related to the death of a parent may involve themes of caregiving, legacy, or early attachment.

In this video, courtesy of WPSU, Jimmy Hilliard reflects on how his grief experience following the stillbirth of his son differed from his grief after the death of his mother.

Each relationship activates different emotional, developmental, and relational threads, shaping a unique grief response.

Early attachment experiences shape how people relate to others and cope with separation, including death. There are four commonly described attachment styles, and an individual’s style may influence how they experience grief, regulate emotions, and seek or avoid support.

Secure attachment is often associated with more adaptive grieving. Individuals with this style may be more likely to trust their capacity to cope, reach out for support, and integrate the loss over time.

Anxious attachment may be associated with more intense grief responses, including persistent yearning, heightened vigilance, and difficulty accepting the loss. These individuals may be more prone to rumination and challenges with emotional regulation.

Avoidant attachment is often linked to suppressed or delayed grief. Individuals with this style may minimize emotions, withdraw from others, or appear unaffected, while carrying unresolved grief internally.

Disorganized attachment, which is often associated with early trauma or inconsistent caregiving, may contribute to challenges in processing grief. Individuals may experience significant emotional dysregulation, alternating between emotional numbing and overwhelming distress.

Recognizing these patterns can help healthcare professionals offer attuned, nonjudgmental support that meets individuals where they are emotionally.

Cultural norms, media portrayals, and personal expectations can shape assumptions about how grief should look, often emphasizing sadness, tears, or withdrawal. In practice, grief can show up in many ways and may not always appear outwardly distressing.

Researchers Kenneth Doka and Terry Martin described several common grieving styles that can be useful for healthcare professionals to understand. Two of the most frequently discussed are:

A person stands with head lowered, hands covering face.

Intuitive Grieving

Often involves strong emotional expression
May include crying, talking about the loss, or naming emotional pain
Outward expression tends to reflect the person’s internal experience

An older adult wearing gloves cleans a window with a cloth and spray bottle, engaged in a household task in a bright indoor space.

Instrumental Grieving

Often more cognitive or action-oriented
May involve problem-solving, planning, or physical activity
A person may appear stoic or unaffected, which does not mean they are not grieving

In addition to differences in grieving styles, there are also differences in grief systems. Family communication patterns (FCPs) can shape a person’s grief experience by influencing how emotions are discussed, expressed, or managed within the family.

Some individuals are raised in more open systems, where emotions related to loss are acknowledged and expressed.

Others grow up in more closed systems, where grief may be minimized, discouraged, pathologized, or expected to remain private.

Open Grief System

Emotions related to loss are named, validated, and expressed openly
Grief is acknowledged as a normal part of life
Support is more likely to be offered and accepted
Often present in families, cultures, or communities that model vulnerability

Closed Grief System

Emotions related to loss are hidden, minimized, or discouraged
Grief may be framed as weakness or something to move through quickly
Grief is often experienced in isolation or silence
Often present in families, cultures, or systems that prioritize stoicism or self-reliance

A person raised in a more closed grief system may appear emotionally detached or “fine,” even when they are deeply affected. Recognizing this dynamic can help healthcare professionals avoid misinterpreting outward behavior and support greater attunement to less visible signs of distress.

Clinical Insight: High-Functioning Doesn’t Mean Pain-Free

Some individuals cope with grief by staying busy, immersing themselves in work, or taking on additional roles or responsibilities. In settings where productivity is often equated with wellness, this can be misinterpreted as being “over it.” This pattern can appear in both patients and colleagues. Functioning, competence, or continued performance do not mean the absence of grief. For some, action is how grief is managed and expressed.

Healthcare settings can also function as relatively “closed” grief systems, where professional norms, institutional culture, or workflow demands may limit how openly grief is expressed. When the culture of the workplace does not align with a person’s own grief practices or support systems, it may create additional barriers as they process their own grief.

Understanding how grief is expressed can help healthcare professionals move beyond assumptions and provide more responsive support.

A patient or colleague who appears composed or returns to routine quickly may still be experiencing significant distress.

Because grief varies, support is most effective when it is individualized. People grieve in different ways, and these differences do not reflect the depth or legitimacy of their grief.

Person with headscarf working on laptop.

Meeting patients and colleagues with openness rather than expectation can help support emotional and psychological safety.

Core Concepts for Grief-Sensitive Care