What is Ambiguous Loss?

Unlike other forms of bereavement, such as complicated grief, not many people have heard of ambiguous loss, a term coined by Dr Pauline Boss in the 1970s, which refers to a type of loss that is unclear or lacks resolution.

Ambiguous loss is associated with a particular bereavement experience that doesn’t follow a typical grief pattern or trajectory.

For example, mourning a loved one who has died from a sudden accident or illness ( or other circumstance) is a more well-known type of grief where mourners are expected to grieve in specific stages.

A person might feel angry. Guilty. Devastated or in a state of utter disbelief. Some grievers can become numb and may not express their grief outwardly, at least not in the predictable way that many expect.

Whatever your particular grief experience might be, there is no right or wrong way to mourn the loss of someone you love and have forever lost, and anything goes.

However, ambiguous loss tends to live up to its name, the ambiguity of mourning someone under specific circumstances in which one is not necessarily expected to grieve.

This article will explore ambiguous loss and what you can expect if you are grieving someone under unfamiliar or culturally misunderstood circumstances.

If you need someone to lend a compassionate ear or are struggling to make sense of your feelings after something difficult has happened, help and support are always available.

Grief can be a profoundly complex and isolating experience; however, speaking to someone who can help you understand your feelings can be incredibly beneficial and, in time, may help you move toward healing and acceptance.

You are not alone – contact a friendly specialist at Centres for Health and Healing who can offer support and guidance.

What is ambiguous loss?

Various descriptions define ambiguous loss.

However, Chloe Swinton, founder of Ambiguous Loss UK, describes this type of bereavement experience perfectly:

“Ambiguous loss is an unclear loss, thought to be the most stressful type and often enduring, without closure or a goodbye. A psychological or physical absence from an external cause brings uncertainty, confusion and a sense of limbo. Grief is complicated, delayed or frozen, and often unresolved.” (Chloe Swinton, 2021.) 

Ambiguous loss can be challenging to cope with because it lacks closure or answers; essentially, no one has died, yet the mourner has great difficulty grieving and moving forward.

Those dealing with ambiguous loss often experience profound confusion, anxiety, anger, fear, and grief. 

According to Pauline Boss, ambiguous loss often occurs due to the following conditions:

• When a loved one is physically absent but psychologically present.
• When a loved one is psychologically absent but physically present.

Let’s explore these losses further.

Physical absence with psychological presence

This type of ambiguous loss occurs when your loved one is physically absent but psychologically or emotionally present. 

For example, when someone goes missing or has been kidnapped, their absence is physical, but their psychological presence continues to affect the family.

Other examples associated with this type of loss include:

• Deportation or genocide of a loved one or family member.
• Natural disasters, where you are uncertain about the whereabouts and safety of your loved one.
• Acts of war or terrorism (you may not know where your loved one is or whether or not they are alive).

This type of ambiguous loss can also occur due to a lack of contact or change in a relationship with someone you care about. 

Examples of this may include:

• Estrangement
• Incarceration
• Divorce
• Being separated from a loved one due to immigration

Many experts call this type of ambiguous loss “leaving without goodbye”.

Psychological absence with physical presence

In this case, a loved one is physically present but psychologically or emotionally absent. 

This can happen when a loved one suffers from a condition like Alzheimer’s disease, critical illness, addiction, or severe mental illness, causing them to be emotionally distant or unavailable.

This is called a psychological loss, where a person mourns how their loved one used to be. 

For example, a spouse may grieve how their partner once was before they developed a mental or physical illness. 

Bereavement specialists sometimes refer to this type of ambiguous loss as “goodbye without leaving.”

How to spot the telltale signs of ambiguous loss

Experiencing ambiguous loss can be incredibly challenging, as, among many things, it is characterised by profound uncertainty and a lack of closure. 

Individuals experiencing this type of grief feel dismissed, misunderstood, or like they are losing their minds.

For example, families of life-support patients commonly experience ambiguous loss; their loved one might be alive, but not in the ordinary sense. 

In this context, the individual is steeped in profound grief, often with minimal support or understanding from those around them.

Here, the patient’s “physical presence” and “psychological absence” fuels feelings of hope and despair. 

The carrot dangler of “potential recovery” versus the enduring threat of severe illness can be monumentally confusing to families of critically ill patients, an experience they often have to deal with alone.

How can you tell someone you’re grieving when no -one has died?

And more to the point, how can you know you’re grieving when there is so little awareness, support and understanding surrounding ambiguous losses? 

Telltale signs

Although each person experiences ambiguous loss differently, there are some common feelings and emotions you may go through, including:

• Confusion: Ambiguous loss can be deeply confusing because it doesn’t fit the traditional context of loss, where there is usually a clear outcome or event. This confusion can lead to a sense of disorientation, anxiety and bewilderment where you may feel misunderstood by those around you.
• Grief: Although there may not be a physical death, you will likely grieve the loss of what was or what might have been. This type of mourning can manifest as sadness, anger, emptiness and loneliness.
• Ambivalence: Feelings of love, frustration, hope and despair often coexist when dealing with ambiguous loss, and you may find it challenging to reconcile these conflicting feelings and emotions.
• Stress and anxiety: The uncertainty of ambiguous loss can lead to chronic anxiety and stress. The lack of closure or uncertainty can create ongoing emotional turmoil and distress.
• Identity and role confusion: When a loved one is psychologically absent but physically present, defining your role or identity in the relationship can be profoundly challenging. All this can lead to a loss of self and identity.
• Difficulty moving forward: Ambiguous loss can make finding closure and moving on with your life challenging. It may feel like you’re frozen or stuck in a permanent state of limbo.
• Isolation and withdrawal: You may feel isolated because others cannot fully understand or acknowledge your grief. You may also withdraw from social interactions to avoid further distress, exhaustion, or judgement.
• Hope and resilience: Despite the many challenges associated with ambiguous loss, some individuals and families find ways to maintain hope and strength. Over time, many learn to adapt to the uncertainty and seek support from each other or professionals.

No matter the cause of your grief, you must know that everyone experiences ambiguous loss in various ways, and peoples’ emotions and coping strategies can vary widely. 

Seeking support from therapists, grief counsellors, and support groups specialising in grief and loss can be beneficial in navigating these complex emotions.

Grief limbo

You may have heard of the term “grief limbo”, another way to describe ambiguous loss and refers to the state of being stuck or suspended in the grieving process.

It refers to a prolonged and unresolved period of grief where an individual (or family) cannot move forward or find a resolution. 

Individuals often feel their grief has been frozen or suspended, particularly when unresolved emotions, unanswered questions, or circumstances surrounding the loss are ambiguous, puzzling, or complex.

In grief limbo, people may find it difficult to fully process their emotions, accept the reality of the loss, or integrate it into their lives. 

This emotional stagnation or suspension of grief can be significantly distressing and profoundly impact your mental and emotional well-being. 

Experts say this may lead to complicated grief since individuals struggle to process their feelings, and as a result, they may become stuck in a grief cycle.

When this happens, the person becomes caught up in rumination about the circumstances surrounding their loved one, leading to excessive avoidance, unhealthy coping mechanisms, and excessive guilt and worry.

Bereavement counselling can be beneficial for individuals experiencing grief limbo or complicated grief.

A trained counsellor can provide support, tools, and coping strategies to help you navigate complex emotions and move toward acceptance and recovery.

It’s essential to recognise that each individual’s grieving process is unique, and there is no set timeline for when grief should resolve.

Risk factors 

Anyone can experience ambiguous loss for a multitude of reasons. 

However, researchers have identified the following factors that may put people at higher risk of this type of grief:

• Addiction: Families dealing with a loved one’s addiction may experience feelings of psychological absence; their loved one is no longer the person they once were because of substance abuse (or other addiction), suspending them into grief limbo or ambiguous loss.
• Chronic or critical illness: When someone you love suffers from a chronic or critical illness or disease, it can lead to feelings of psychological absence even when they are physically present, increasing your risk of ambiguous loss. This type of grief often occurs in families of life-support patients’. 
• Military or combat deployment: Families whose loved one works in the military are at risk of ambiguous loss due to physical absence with psychological presence.
• A missing loved one: Families of missing persons often experience ambiguous loss due to a loved one being physically gone but psychologically present.

Treatment options for ambiguous loss

Due to the complexity associated with ambiguous losses, treatment typically involves a combination of therapeutic approaches to help individuals and families cope with the unique challenges that may arise.

Various treatment options are available to help you manage the effects of this type of grief, including:

• Individual therapy provides a safe space to explore your emotions and feelings, identify coping strategies, and work through unresolved issues related to your loss. One-to-one counselling with a therapist specialising in grief and loss can be profoundly beneficial.
• Psychoeducation: Understanding ambiguous loss, what triggers it, and how to normalise your feelings and experiences can help reduce confusion and distress. Grief therapists usually provide education and insights about ambiguous loss, which can be particularly beneficial for mourners hoping to build context and meaning around what is happening in their lives.
• Cognitive behavioural therapy (CBT): CBT can help you identify and change unhelpful behaviours and thought patterns related to your grief and loss, including substance abuse, gambling, or distorted beliefs and perceptions.
• Narrative therapy: Encourages individuals to create a story or narrative about their loss, allowing them to make sense of it and eventually find meaning and purpose.
• Mindfulness therapy can help you manage the stress and anxiety associated with ambiguous loss. You may learn various relaxation techniques, including deep-breathing exercises and meditation, to help you cope with the uncertainty of your loss, allowing you to function more effectively.
• Self-care practices include caring for your physical health, cultivating social connections, and engaging in activities that bring you joy and fulfilment. This can be challenging at first, but with practice, you will eventually reap the rewards of taking better care of yourself.
• Ongoing aftercare and support: Ambiguous loss often presents a long-term challenge for individuals. For instance, families of critically ill patients may need help coming to terms with who their loved one was before their illness, who they are now, and who they are yet to become. Therefore, ongoing therapy and support may be necessary for individuals to cope with any challenges. 

How Centres for Health and Healing can help

Centres for Health and Healing provide personalised addiction and mental health treatment to clients in Toronto and surrounding regions.

Our integrated treatment programs are shaped around your individual needs, goals and preferences, and our treatment centre is client-focused.

We know that each individual has had their own unique experiences that have brought them to our centre. 

Therefore, we understand the importance of a personalised treatment approach that addresses the ‘whole’ person, not just their symptoms.

Our multi-professional team includes nurses, psychotherapists, counsellors and healthcare staff to ensure you get the most out of treatment.

Grief may deeply wound us and may not always look or feel like we imagine.

However, with proper care, support and understanding, we can learn to grow through our losses and become resilient and empowered despite the challenges and curveballs life may throw at us.

If you or a loved one are struggling to make sense of your feelings or need help processing your grief, we are here for you. 

Contact a friendly specialist at our Toronto recovery centre today to learn more about our treatment programs.

Additional resources you may find helpful

1. Are You Living in Grief Limbo? How to Cope with Ambiguous Loss, Psychreg, Beth Tyson, 28 May 2020
2. Ambiguous Loss UK