Any sexual activity with a child (by an adult or another child) is sexual abuse. It causes physical and emotional pain. It has long-term effects on the child. And it is a crime. Recognizing childhood sexual abuse isn’t easy. Children are often afraid and embarrassed to tell someone. Many times, the abuser is someone the child knows and trusts. This could be a family member or someone living in the child’s home. It also can be a stranger.

Path to improved health

You do not need to be overly suspicious of sexual abuse. The risk of childhood sexual abuse is low. A stable family home lowers a child’s risk of sexual abuse. However, parents should always keep a watchful eye on any form of childhood abuse. These physical and behavioral signs should raise concern:

• Your child tells you they have been touched inappropriately or sexually.
• Your child is behaving sexually inappropriately around others (this includes touching others inappropriately).
• Your child uses sexually inappropriate language.
• Your child’s knowledge of sex seems to be more than it should be at their age.
• Your child seems withdrawn and doesn’t want to be hugged by some or all of their family members, family friends, teacher, or a particular person.
• Your child is suffering from depression or anxiety.
• Your child has harmed themself.
• Your child is making comments about their low self-worth.
• Your (young) child has blood in their underwear.
• Your (young) child is complaining of pain in their genital area.
• Your child has injuries in their genital area, such as bruising, bleeding, or swelling. The injuries might cause your child pain when walking or sitting.
• Your child shows signs of infection in their urinary or genital area. This would include frequent burning, itching, or discharge.
• Your child becomes pregnant.
• Your child has new academic changes (falling grades, missing assignments, repeated absences).
• Your young child is regressing, such as wetting the bed or thumb sucking.
• Your child is acting overly concerned for a sibling.
• Your child has changes in hygiene, such as refusing to take a bath (in younger children). Older children may shower more (to cleanse themselves of what they perceive as shame and embarrassment).
• Your child is suddenly receiving gifts or money from a person in authority (a teacher, coach, etc.).

If you know your child has been sexually abused, report it to the police. Take your child to the doctor for an exam. Ask your child’s doctor for the name of a counselor or psychologist. Talk to your local police about tracking sex offenders in your neighborhood or city.

Things to consider

Certain situations put children at a higher risk of sexual abuse. Your child may also be at higher risk if they:

• Live in a home where the parents are divorced and/or living with stepparents
• Live in a home without either parent (in foster care)
• Live in a rural or low-income area
• Have been a victim of another type of abuse, such as physical or emotional
• Spend long periods of time alone with people in authority (teachers, clergymen, coaches, babysitters, etc.)

Girls and children with intellectual disabilities face a higher risk. Remember, childhood sexual abuse can occur between a male and female, as well as in same-sex situations.

Questions to ask your doctor

• What other things could explain injuries to my child’s genitals?
• How young can a girl become pregnant?
• What are the signs of sexually transmitted diseases or infections in boys and girls?
• What is the treatment for sexually transmitted disease?
• Can my child eventually overcome the emotional pain of childhood sexual abuse?
• What physical or behavioral signs should I look for if I suspect my child is the one sexually abusing a child?
• How do I raise a concern with my child about possible sexual abuse?

Resources

National Institutes of Health, MedlinePlus: Sexual Abuse in Children – What to Know

Rape, Abuse & Incest National Network: Child Sexual Abuse

The U.S. Department of Justice National Sex Offender Public Website: How to Identify

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Caring for a loved one who is chronically ill can be challenging. Many family caregivers also work outside the home. If you do, you might feel overwhelmed by the difficulty of balancing all your responsibilities. You’re not alone.

Path to improved health

If you are having trouble balancing work with caregiving, there are some things you can do. Here are some tips to help you ease the burden.

Research employer policies and programs

Talk with your human resources department and look through your employee manual. Determine whether your company has policies in place or benefits available to help you manage your roles. Examples may include:

• The Family and Medical Leave Act (FMLA) – gives eligible employees 12 weeks per year of unpaid leave. They can use this to care for an ill family member. Taking this leave would not impact your health insurance coverage or job security.
• Employee assistance programs – help employees deal with problems that might affect their work. Often, these programs include short-term counseling and referrals to services in the community.
• Flex time – allows you to work a flexible work schedule. If your company offers flex time, your employee handbook should define it. Usually, there is a core period of time when you must be at work. You then create your schedule around these hours. For example, you may choose to work from 10 a.m. to 6 p.m., or from 7 a.m. to 3 p.m.
• Telecommuting – allows you to work from another location, such as your home or your loved one’s home.
• Job sharing – when two people work part-time to share a job normally held by one person full-time.

Talk to your supervisor

Think about your company’s policies and what changes would help you better manage your responsibilities. Draft a proposal, then schedule a meeting with your supervisor to talk it over. Be honest about your situation and open to any ideas your supervisor may have. Be sure to communicate how the changes you’ve proposed will benefit your employer.

Be an activist

Your company or supervisor might not be able to accommodate your requests. Try not to be upset. Instead, set an example. Work with human resources to help your company’s leaders understand caregivers’ needs. Keep the channels of communication open and try again after some time has passed.

Things to consider

Some people have done everything they can to balance work with caregiving, but they still need help. If this is your experience, here are some resources that can help:

• Referral services – Many local, county, or state governments have agencies on aging. They can help you locate programs and services in your area. The U.S. Administration on Aging offers information on area agencies and other services. This can be found through its online Eldercare Locator tool.
• Adult day care – These centers offer social and therapeutic activities in a safe environment. They often provide meals, personal care, medical care, and even transportation.
• In-home care – This can be an informal arrangement with a friend, neighbor, or volunteer. It can also be a formal arrangement with a private aide or a home care agency.

Questions to ask your doctor

• What can I do to keep from getting overwhelmed when trying to balance work with caregiving?
• What signs should I look for that I’m doing too much?
• Can you fill out FMLA paperwork for me to give to my employer?
• Can you refer me to an agency on aging so I can find more help caring for my loved one?

Resources

U.S. Administration on Aging: Eldercare Locator
U.S. Department of Labor: Family and Medical Leave Act

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Professional therapy and counseling can improve your mental wellness. This therapy can help people who are experiencing emotional or behavioral problems. Also, it can help people who have a mental health disorder. Therapy is sometimes called psychotherapy or talk therapy. Many times, therapy is used in combination with prescription medicine to treat a mental health disorder. Therapy will usually improve the results you get from the medicine.

There are different types of mental health providers. Professionals trained in psychotherapy include those representing the following types:

• Psychiatry
• Clinical psychology
• Mental health counseling
• Clinical social work
• Marriage and family therapy
• Rehabilitation counseling
• Psychoanalysis

Fee structures and access to prescriptions is different for each. For example, a psychiatrist has a medical degree and is allowed to write prescriptions. A counselor does not have a medical degree and is not allowed to write a prescription. Your doctor can suggest a professional that is right for you.

Some people do not want professional therapy or counseling. They feel ashamed of their problems. Others believe therapy and counseling are for seriously mentally ill or “crazy” people. However, this is not true. Don’t let shame and fear stop you from getting the help you need. Good mental health is part of your overall health and wellness.

Path to improved health

Different types of therapy use different techniques. In most types of therapy and counseling, the person receiving treatment talks with a professional therapist. However, therapy is more than just talking about your problems. Therapy can teach you new ways to think about the situations that bother you. It can help you cope with feelings and situations. It can help with feelings of anger, fear, anxiety, shyness, and panic. It also can give you tools to help fight low self-esteem and depression.

Therapy can help treat a variety of problems. Some common reasons people seek therapy include:

• Depression
• Marriage problems, infidelity, divorce, or other relationship issues
• Sexual problems
• Stress and anxiety
• Addictions and compulsions
• Grief, loss, or bereavement
• Anger
• Career choice
• Parenting or family problems
• Phobias
• Insomnia
• Fertility issues
• Chronic pain or illness
• Domestic violence or abuse
• Eating disorders

If you are not sure if therapy and counseling are right for you, talk to your family doctor. Your doctor can refer you to a trained professional who can help with your problems.

If you choose therapy or counseling, you’ll talk about any problems you’ve been having and how you’ve been feeling. You’ll also talk about your goals for therapy. You and your doctor will decide how frequently you will meet. Your doctor, therapist, or counselor will help you decide what’s right for you.

Things to consider

Different kinds of therapy and counseling are based on different ideas about how the brain works. Also, it considers what causes people to act in certain ways. Many therapists use more than one type of technique to help you. Common kinds of therapy include:

• Family counseling. This helps family members understand problems within the family and how to resolve them.
• Cognitive therapy. This is sometimes called cognitive behavior therapy. It’s based on the idea that your thoughts cause your feelings and actions. If you change the way you think about something, you can feel or behave better even if the situation doesn’t change. This kind of therapy helps you understand negative or false thought patterns. Negative thought patterns cause troubling feelings and behavior.
• Behavior therapy. Sometimes called behavior modification therapy, this treatment focuses on changing unwanted or unhealthy behaviors. You replace them with healthy ones. This treatment involves using a system of rewards and reinforcement of positive behavior.
• Psychoanalytic therapy. This type of treatment encourages you to think and talk about memories and feelings from the past. These memories will help you understand how you act and feel today.
• Group therapy. Group therapy is led by a qualified professional. He or she facilitates a small group of people who have similar issues or problems. Groups can improve honesty with others. Members support each other during times of crisis.
• Couples therapy or marriage counseling. This treatment can help couples solve problems together, communicate in healthier ways, and learn to work out differences.

Questions to ask your doctor

• What if my partner or child is resistant to therapy?
• How do I find a therapist that’s right for me?
• Can my child’s therapist tell me what they talked about?
• Will my therapist recommend prescription medicine?
• What if I don’t like my therapist? Can I change?

Resources

National Alliance on Mental Illness: Types of Mental Health Professionals

National Institute of Mental Health: Psychotherapies

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Mental illness is a common health problem and nothing to be embarrassed about. It happens because of a change in your brain. It includes a range of conditions, such as depression, anxiety, and bipolar disorder. Mental illness affects people’s thoughts, feelings, and behavior. Most often, people have and show early signs of illness. Learn what these signs are so you or someone you know can get help.

Path to improved health

Warning signs of mental illness vary by person and problem. Below are some of the most common signs. Talk to your doctor if more than one of these occur. Also note if they happen suddenly.

• Changes in mood. Your feelings may alter over time or all of a sudden. In addition, they can shift back and forth. For instance, you may feel happy or excited one day or in a certain situation. Then, you may feel sad or upset the next day or in a new situation.
• Changes in sleep.You may be sleeping too much and feel like you can’t get out of bed. Or you may feel like you don’t need to sleep much at all.
• Fear or uneasiness. You may start to feel afraid, anxious, nervous, or panicked.
• Decreased performance. Your work suffers. You may find it harder to complete things that once were easy or enjoyable. If you’re in school, you may notice your grades begin to drop.
• Lack of interest. There are several things that can cause you to lose interest in certain things or people. This can lead to broad or complete withdrawal.
• Altered senses. Your basic senses—sound, smell, touch, or sight—may become more or less sensitive.
• Lifestyle changes. You may sleep longer than usual or have a hard time sleeping. You also could develop an eating disorder, where you eat more, less, or not at all.
• Troubled mind. It’s possible to have clouded thinking that makes it hard to focus, remember, or process things.
• Changes in behavior. Your actions may alter in ways that are abnormal for you.
• Loss of control. Over time, you may lose the ability to manage stress, tasks, or life’s demands.
• Out of touch with reality. Mental illness can cause you to become detached from your surroundings. You may feel lost, distant, or numb. You may have hallucinations or nightmares. You may forget how to relate to others or show care or concern.

Other possible warning signs include:

• Alcohol or drug abuse
• Sexual abuse
• Feelings, thoughts, or actions of anger or violence
• Unexplained physical symptoms, such as stomach pain and headaches

Things to consider

It’s important to know the signs of mental illness because it affects so many people. You or someone you know may have a problem at some point in your life. If you know the warning signs, you can detect them early. The sooner you see a doctor and get diagnosed, the sooner you can begin treatment.

Don’t ignore these warning signs. It can make mental illness worse and cause harm to others. When you learn about mental illness, share information with others, and talk about your story, you help stop the stigma.

When to see your doctor

Contact your doctor if you have multiple warning signs. They will do an exam and discuss your state of health. Only a doctor can diagnose mental illness. If someone you know displays these signs, talk to them about your concerns. Suggest that they visit a doctor to find out what’s going on.

Seek help right away if you have thoughts of murder or suicide. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). As of 2022, you can also dial 988 for the Suicide and Crisis Lifeline.

Questions to ask your doctor

• How can I tell if I have a mental illness?
• How can I tell if someone I know has a mental illness?
• Are there other warning signs I should look for?
• What are the best resources to use if I want to learn more about mental illness?

Resources

American Academy of Family Physicians, Mental Health Myths

Mental Health America: Mental Illness and the Family: Recognizing Warning Signs and How to Cope

U.S. Department of Health & Human Services, mentalhealth.gov: What to Look For

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If you have depression, your doctor may prescribe medicine to treat it. This medicine is called an antidepressant. There are many types of antidepressants. Finding the one that’s right for you can take time. It’s important to work with your doctor to find it.

Path to improved health

Your doctor will consider many factors when choosing the antidepressant medicine to give you:

• If you were depressed before and a certain antidepressant worked well, that medicine might be the right choice for you again.
• If any of your brothers, sisters, parents, uncles, or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you, too.
• The choice of an antidepressant depends on your health. Certain antidepressants may have a bad effect on a health problem you have. That medicine wouldn’t be the right choice for you.
• Antidepressants can have side effects. The right medicine for you may be the one that gives you the fewest side effects.
• The choice of an antidepressant may depend on how often you must take it. It is important to take antidepressants as prescribed and daily medications may make this easier.
• Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and your budget.
• Your doctor will likely choose a medicine they have experience prescribing.
• Some antidepressant can help you with sleeplessness, anxiety, and lack of energy if these are part of your symptoms.
• If you’re taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
• Some antidepressants don’t work well with certain foods. If your doctor gives you one of these antidepressants, they will let you know which foods you should stop eating.

Keep in mind that antidepressant medicines are not “downers”  or “uppers.” You will not get  high when you take them. They are not addictive.

You’ll know if your antidepressant is working based on how you feel. You’ll be able to sleep better. You’ll have more energy to meet your day-to-day obligations. You can take care of yourself. Your appetite will be closer to normal. You’ll have an increased desire to engage in life. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

While antidepressants can help with symptoms of depression, that’s only part of the treatment. These medicines work best when you try to have an active lifestyle with exercise, get eight hours of sleep a night, and eat healthy foods. Your doctor may also recommend working with a counselor to help you improve the thoughts of depression.

How to take antidepressants

Antidepressants are usually taken every day. It can take 1 or even 2 months to see the full results. You may need to try different doses or change medications to find the antidepressant that works best for you.

Your doctor will let you know how long to take your antidepressant. If this is the first time you have been treated for depression, you will probably continue to take this medicine for at least 6 months after you begin to feel better. If this is the second time you’ve been depressed, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a longer time.

Do not stop taking antidepressants suddenly.  You can get unwanted side effects if you stop taking your antidepressant suddenly. If you want to stop taking your medicine, talk to your doctor first. They can try to help you avoid these side effects.

Alcohol and antidepressants

Talk to your doctor about drinking alcohol while taking an antidepressant. You should be careful about drinking until you know how the medicine affects you. The effects of alcohol can combine with the effects of the antidepressant and cause problems. Regular heavy drinking can make it harder to treat depression. Certain kinds of medicine can lead to seizures for heavy drinkers.

Antidepressants and other medicines

Antidepressants can effect many other medicines. If you’re taking an antidepressant, tell your doctor about all other medicines you take, including over-the-counter (OTC) medicines and herbal health products (such as St. John’s wort). They can let you know if your regular medicines may cause problems when combined with an antidepressant.

Antidepressants for children and teens

In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and behavior in children, teens, and young adults. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesn’t mean that people in this age group shouldn’t take antidepressants. It means they should be carefully monitored by their doctor and loved ones while taking the antidepressant.

Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you’re worried your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

Things to consider

All antidepressants have some side effects. However, not all people taking antidepressants have these side effects. Most of the side effects happen in the early weeks of therapy and lessen over time. You may experience the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness
• Insomnia
• Muscle twitching
• Nausea
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Tremor
• Vomiting
• Weight gain or loss

Talk to your doctor if these side effects don’t go away. They may change your dosage or suggest another medication.

Considerations for women

If you’re planning to get pregnant, talk to your doctor about your medicines before you try to get pregnant. If you accidentally get pregnant while taking an antidepressant, tell your doctor right away. Your doctor will know if your antidepressant is safe to take while pregnant.

Most medicines you take can pass into your breast milk. That means it may be passed on to your baby. If you’re planning to breastfeed or you currently breastfeed, talk to your doctor about your medicine.

In most cases, it’s okay to take birth control pills or hormone replacement therapy (also called HRT) at the same time as depression medicines. Taking hormones may even help some depressed women feel better. However, if your birth control pills seem to be causing symptoms of depression, discuss it with your doctor. They may suggest you use another method to prevent pregnancy for several months to find out if your birth control pills are causing depression.

Antidepressant discontinuation syndrome

Antidepressant discontinuation syndrome can occur if you suddenly stop taking your antidepressant medicine. Antidepressant discontinuation syndrome is not dangerous or life threatening. It usually goes away within a week. The symptoms include:

• Anxiety
• Feelings of sadness
• Irritability
• Fatigue
• Headaches
• Nausea and vomiting
• Dizziness

You’re more likely to have antidepressant discontinuation syndrome if you stop taking certain antidepressants, such as paroxetine and sertraline. However, you can get symptoms from stopping any antidepressant medicine.

If you accidentally missed a dose of your antidepressant medicine, start taking it again as soon as possible. If you’re out of medicine, call your doctor so they can refill your prescription.

If you decided to stop taking your antidepressant medicine on your own, talk to your doctor about why you stopped. For example, was the medicine causing an unpleasant side effect? Did it cost too much? Your doctor can help by altering your dosage or suggesting another antidepressant.

If your doctor recommended you take a lower dosage of your medicine and you’re experiencing symptoms of antidepressant discontinuation syndrome, talk with your doctor. You may need to take a higher dosage before weaning your body from the medicine completely.

To keep antidepressant discontinuation syndrome from happening again, take your medicine exactly as your doctor tells you. If you want to stop taking it, talk to your doctor first. Just because you’re unable to stop taking your medicine suddenly doesn’t mean you’re addicted. Your body often needs time to adjust to lower levels of the medicine. That’s why your doctor may recommend tapering off an antidepressant rather than abruptly stopping it.

Questions to ask your doctor

• How can I know if I have depression?
• Are there ways to treat depression that don’t involve medicine?
• If I am depressed, should I also be talking to a mental health professional?
• Are there coupons I can use to help lower the cost of antidepressants?
• How long will it take to get the dosage right for my medication?
• How will I know the medicine is working?

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Mental health or psychiatric conditions are common. Many times, they run in families. Some of the most common mental health conditions are depression, anxiety, and bipolar disorder. These illnesses and others like them interfere with your thoughts, feelings, and behaviors. Learning you have a mental health condition can be upsetting. But there is hope. There are a variety of treatments available for mental health conditions. Don’t be afraid to ask for help.

Path to improved health

There are several types of treatment for mental health problems. They include:

• Psychotherapy or counseling. This also is called talk therapy. It is one of the most common treatments for mental health disorders. It involves talking about your problems with a mental health professional but is so much more. The is an education element, a focus on relaxation exercises and coping skills as well as stress management. There are many types of talk therapy. Some common ones include cognitive behavioral therapy or dialectical behavior therapy. Talk therapy is often done one-on-one. It can also be done in a group setting or with your family. Individual and group talk therapy is sometimes helpful. This type of therapy can be useful even for those who do not have a mental health condition and are simply going through challenging life situations (grief, divorce, etc.).
• Prescription medicine. Prescription medicine is another popular treatment method. Medicines for mental disorders make changes to brain chemicals that are involved in emotions and thought patterns. Medicines don’t cure psychiatric conditions or health problems. But they can improve your symptoms. They can make other treatments, such as counseling, more effective. There are many kinds of prescription medicines available that work in different ways. Your doctor will make a recommendation and share any side effects.
• Support groups. Self-help and support groups can help you gain insight into your condition. They can provide friendships, support, resources, and tips on how to live with your condition. They also help address the feelings of isolation that often go along with mental health conditions.
• Other therapies. There are many types of therapies people use to help treat mental health problems. These can include physical activity, such as exercise or yoga. They can also include creative therapies. These are therapies done using means of expressing yourself creatively. They can include using art, music, movement, or writing.
• ECT or other brain stimulation therapy. Electroconvulsive therapy (ECT) is a safe procedure that sends electric currents into the brain. This causes changes in the brain that can improve and even reverse troubling symptoms. ECT and other brain stimulation therapies are often used when other kinds of treatment haven’t worked.
• Eye Movement Desensitization and Reprocessing (EMDR) therapy. This type of therapy is used to relieve psychological stress. It has become an effective way to help treat trauma, especially post-traumatic stress disorder (PTSD).
• Hospital or residential treatment program. Sometimes your mental health issues become so bad that you need to receive treatment in a hospital or a long-term program. This can happen when you can’t take care of yourself. Or it happens when you are in danger of harming yourself or others.

Not every treatment works or is necessary for everyone. Some people benefit from a combination of treatments. Your doctor will help you find the treatment that’s right for you.

Things to consider

Sometimes, there is an unfair stigma that surrounds mental health and mental conditions. This stigma can prevent people from getting the help and support they need. They are afraid of what people will think of them. So they don’t seek treatment. Their condition often gets worse. Sometimes people even take their own lives because the stigma of mental illness kept them from seeking help.

Healthcare professionals, educators, and organizations are working to overcome the stigma. Individuals and their loved ones are more likely to speak up about mental health disorders. They are encouraged to get treatment.

Look for these signs that you or a loved one may be experiencing signs of mental health conditions:

• Feeling sad or depressed
• Trouble concentrating
• Extreme feelings (including fear, guilt, sadness, or anger)
• Withdrawal from friends or activities
• Extreme mood changes
• Alcohol or drug abuse
• Unexplained hostility or violence
• Inability to cope with stress or your feelings
• Delusions, paranoia, or hallucinations (such as hearing voices)
• Thinking about hurting yourself or others

Don’t be afraid to ask for help. You have many treatment options available to you. Mental illness is nothing to be embarrassed by or ashamed of. Being aware of mental health issues and learning the truth can help you and others. It can even save lives.

Questions to ask your doctor

• I have some of these symptoms. Could I have a mental health condition?
• What is the best kind of treatment for me?
• Do I need to take prescription medicine? Do I need to see a psychiatrist?
• Do I need psychotherapy?
• Can you recommend a counselor or therapist I could see?
• Is this a temporary problem or is it permanent?
• Will I need treatment for the rest of my life?
• What can I do at home to help me recover?
• How can I explain to other people the mental problem that I’m having?

Resources

MentalHealth.gov: Local Organizations with Mental Health Expertise

National Institutes of Health, MedlinePlus: Mental Disorders

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Grief is a person’s normal, healthy response to a loss. It describes the emotions you feel when you lose someone or something important to you. People grieve for many different reasons, including:

• Death of a loved one, including pets
• Divorce or changes in a relationship, including friendships
• Changes in your health or the health of a loved one
• Losing a job or changes in financial security
• Changes in your way of life, such as during retirement or when moving to a new place

The loss that triggers grief isn’t always physical. You can experience grief if you or a loved one are diagnosed with a major disease or face a serious illness. You may grieve plans you had made, or the ways life will change.

Grief is different for everyone. It can include many emotional and physical symptoms, including:

• Feelings: Anger, anxiety, blame, confusion, denial, depression, fear, guilt, irritability, loneliness, numbness, relief, sadness, shock, or yearning
• Thoughts: Confusion, difficulty concentrating, disbelief, hallucinations, or preoccupation with what was lost
• Physical sensations: Dizziness, fast heartbeat, fatigue, headaches, hyperventilating, nausea or upset stomach, shortness of breath, tightness or heaviness in the throat or chest, or weight loss or gain
• Behaviors: Crying spells, excessive activity, irritability or aggression, loss of energy, loss of interest in enjoyable activities, restlessness, or trouble falling or staying asleep

Grief is sometimes described as a process of 5 stages: denial, anger, bargaining, depression, and acceptance.

These reactions to loss are normal. However, not everyone who is grieving experiences all of them, and not everyone experiences them in the same order. It is common to cycle back through some of these reactions, stages, and symptoms more than once.

Path to improved well being

There is no “right” way to grieve. Everyone is different. Give yourself time to experience your loss in your own way. At the same time, remember to take care of yourself:

• Feel your loss. Allow yourself to cry, to feel numb, to be angry, or to feel however you’re feeling. It hurts, but it’s natural and normal.
• Attend to your physical needs. Get enough sleep, eat a well-balanced diet, and exercise regularly.
• Express your feelings. Talk about how you’re feeling with others. Or find a creative way to let your feelings out. This could include art, music, or writing in a journal.
• Maintain a routine. Get back into your normal routine as soon as you can. Try to keep up with your daily tasks so you don’t get overwhelmed.
• Avoid drinking alcohol. Alcohol is a depressant that can affect your mood, so it could make you feel even more sad.
• Avoid making major decisions. It takes time to adjust to a loss and get back to a normal state of mind. Making an impulsive decision as you’re grieving could add more stress at an already difficult time. Try to wait a year before making a big change, like moving or changing jobs.
• Give yourself a break. Take breaks from grieving by participating in activities you enjoy. It’s okay to not feel sad all the time. It’s good for you to laugh.
• Ask for help if you need it. You don’t have to struggle. Seek out friends, family, clergy, a counselor or therapist, or support groups. If your symptoms aren’t getting better or you feel like you need extra help, talk to your family doctor.

There is no set timetable for grief. You may start to feel better in 6 to 8 weeks, but the whole process can last from months to years. You may start to feel better in small ways. It will start to get a little easier to get up in the morning, or maybe you’ll have more energy. This is the time when you’ll begin to reorganize your life around your loss or without your loved one. During this time, it may feel like you go through a series of ups and downs. You may feel better one day, but worse the next. This is normal.

Over time, you’ll begin to find interest in other people and activities again. If you’ve lost a loved one, it’s normal to feel guilty or disloyal to them during this time. It’s also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays, or other special occasions.

Things to consider

While it’s normal to feel sad after a loss, the feelings associated with grief should be temporary. Sometimes the feelings last longer, or you may have trouble dealing with your emotions. When this happens, grief can turn into depression. The symptoms of grief and depression are similar. Signs that you could be depressed include:

• Not feeling any better as time passes
• Having ongoing difficulty with eating or sleeping
• Feelings disrupting your daily life
• Relying on drugs or alcohol to cope
• Thinking about hurting yourself or others

If you feel like you’re having trouble dealing with your emotions, ask for help. Your family doctor can help you treat your depression so you can start to feel better. He or she can also help you figure out what other kind of support you need. This could include a support group, individual therapy, or medicine.

Questions to ask your doctor

• Is what I’m experiencing normal?
• Could I be depressed?
• Should I go to a counselor or therapist?
• How long will it be until I feel better?
• Would medicine help me feel better?

Resources

American Society of Clinical Oncology: Understanding Grief and Loss

U.S. National Library of Medicine, Medline Plus: Grief

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