Grief is not a disorder and it does not follow a sequence. The five-stage model, widely adopted from Kübler-Ross's work, was developed from observations of terminally ill patients facing their own deaths — not from research on bereavement. The empirical literature does not support a stage model. The most common trajectory following loss is resilience, not staged recovery.
Worden's tasks model offers a more clinically useful framework: four tasks rather than stages — accepting the reality of the loss, processing the pain, adjusting to a world in which the person or thing is absent, and finding a way to maintain connection with what was lost while moving forward. Tasks, unlike stages, are not sequential and can be returned to repeatedly.
Grief presents with significant physical and cognitive features that are often underestimated: chest tightness, fatigue, disrupted sleep, memory problems, confusion, and a sense of unreality. Searching behaviour — the impulse to reach for the phone to call the person who has died — is a normal function of the attachment system, not a sign of pathology.
Several forms of grief frequently go unrecognised in clinical and social contexts. Disenfranchised grief occurs when the loss is not publicly acknowledged or socially supported — grief for a relationship that was not visible, a pregnancy loss, the loss of a pet, or someone lost to suicide or addiction. Ambiguous loss, developed by Boss, describes losses that lack clarity or closure — a missing person, or a family member with advanced dementia who is physically present but psychologically absent. Cumulative grief occurs when losses accumulate faster than they can be processed, a pattern common in healthcare workers, older adults, and communities that have experienced systemic trauma.
Prolonged Grief Disorder, introduced in the DSM-5-TR, describes a grief response remaining intense and impairing beyond twelve months, affecting an estimated 10% of bereaved individuals. It is associated with elevated risk of suicidality, substance use, and physical health deterioration, and responds to Complicated Grief Treatment — an evidence-based intervention drawing on CBT, interpersonal therapy, and exposure-based work.
In neurodivergent adults, grief has features not well represented in the mainstream bereavement literature. Alexithymia can make grief difficult to access or name emotionally, even when it is present physiologically and behaviourally. For autistic and ADHD adults, the loss of a significant person frequently involves the additional loss of shared routines, predictable environments, and a reliable source of co-regulation — features that carry particular weight for a neurodivergent nervous system. Grief support relying heavily on verbal emotional processing may not be the most effective approach for all neurodivergent clients.
Dr Melanie du Preez
Registered Clinical Psychologist | HPCSA PS0073547
26 years clinical experience | Neurodivergent-affirming | Trauma-informed | Maudsley/FBT certified