Ambiguous loss is one of the most painful and misunderstood forms of grief because it lacks the clarity, concreteness, and closure that is often associated with losses like death. Unlike conventional grief, which usually follows a clear path characterized by intense sorrow that often decreases in emotional intensity over time, ambiguous loss can continue without resolution or closure and can leave individuals feeling frozen in a state of grief.

Psychologist Pauline Boss coined the term ambiguous loss in the 1970s to describe this specific experience because it lacks the sense of finality that often helps people both understand and process their grief. Most commonly, ambiguous loss is considered to be a relational rupture that is either physical or psychological. So, when someone is physically absent but psychologically present, or when someone is physically present but psychologically absent. In her work on this topic, Dr. Boss notes that family members have described physical ambiguous loss as “leaving without goodbye” and psychological ambiguous loss as a “goodbye without leaving”. Other areas, such as situational loss or feelings related to unmet hopes, dreams, and expectations, can also be considered ambiguous loss due to the feelings that are experienced. This includes unacknowledged heartache, the loss of a desired future, or the deep pain of uncertainty.

Let’s explore each of these areas:

(1) Physically Absent, but Psychologically Present

With this type of ambiguous loss, the person is physically absent, but their presence is felt, they are actively present in your thoughts and emotions, or their fate is unknown. A defining characteristic is the lack of clear physical evidence that the loss is permanent. This can cause feelings of anxiety, depression, heartache, anger, intense fear, or maybe even the desire to retaliate. Examples include:

• A missing loved one due to a traumatic event – kidnapping; missing after a natural disaster; genocide; a crime where the body is not found; plane crash after a hijacking;
• Changes in family dynamics – divorce; separation; estrangement; being cut off from a family member and losing contact; child abandonment; adoption; a closed surrogacy arrangement; foster care removal; parental incarceration; parents splitting custody and the children being separated to live in different states after forming a close bond
• Military Service – soldiers who are prisoners of war or missing in action (POW/MIA); family members away on extended deployment; military-ordered relocation of service to a new duty station for a long-term assignment
• Immigration, Emigration, Migration, or Deportation – when a loved one leaves to go to another country; unexpected family separation at the border; loss of family contact due to ICE raids; a loved one is removed from the country due to violation immigration laws;

(2) Physically Present, but Psychologically Absent

When people are physically present but psychologically absent, they are in your presence, but their mind, memory, or personality has changed so much that they might not recognize you or their surroundings. Additionally, the relationship and your interactions with them might be drastically different. This type of loss can be devastating in a different way because the loved one is still present, but is not the same as before. This can cause feelings of anger, regret, frustration, depression, despair, and even resentment. Examples include:

• Severe mental illness – a family member who is experiencing psychosis and has to be frequently hospitalized; a parent with schizophrenia who is unable to work and stays at home;
• Traumatic Brain Injury – a former ballerina who is unable to live independently due to cognitive deficits after an unexpected fall; a friend who survived a car accident but now struggles with increased emotional instability;
• Addiction – a strained sibling relationship due to drug use; a partner engaging in violent behavior while abusing alcohol;
• Chronic illness and degenerative diseases – a loved one who is unable to recognize you or remember their name due to Alzheimer’s Disease; a family member struggling with mobility due to Parkinson’s Disease or Amyotrophic Lateral Sclerosis (ALS);
• Lack of consciousness – a loved one being placed in a medically induced coma after a stroke; a child losing consciousness after falling into the pool;

(3) Situational Losses

Situational losses are unexpected, sudden events that can significantly disrupt an individual’s life, their stability, and sense of security. Unlike predictable life transitions, these losses can cause symptoms related to depression, trauma, emotional distress, anxiety, despair, or complex grief. They can also lead to financial strain. Examples include:

• Environmental factors – loss of possessions due to natural disasters; having to relocate to a new area and leaving a familiar life behind due to a house fire;
• Job loss – Being furloughed or laid off from your dream job; job displacement due to the closure of your department; dismissal due to downsizing
• Loss of health or body image – having a limb amputated after a car accident; losing a bodily function due to a chronic illness; experiencing memory loss due to a traumatic brain injury after a fall
• Other unforeseen circumstances – having to go to a new school in the middle of the school year due to financial stressors; deciding to quit your job in order to care for an ill parent or child; having to leave your neighborhood due to war, violence, or political unrest

(4) Unmet Hopes, Dreams, and Expectations

When life does not unfold as expected, when personal goals are unmet, or when relationships or even aspirations remain unfulfilled, individuals may experience disappointment, grief, or a sense of loss. This area represents a gap between the current situation and a desired outcome, which can lead to feelings of sadness, regret, resentment, frustration, isolation, or despair. Examples include:

• Dreams of parenthood – Having a deep yearning to be a parent or have another child, but struggling with infertility, miscarriage, perimenopause symptoms; not yet having a partner; not being able to afford fertility treatment; or existing health conditions that directly impact pregnancy planning
• Hope of marriage – Having the desire to be married, but not yet finding a potential partner year after year; not yet being proposed to by your partner of ten years
• Familial Relationships – hoping for a close relationship with an absent father; not being able to have the desired sibling relationship due to the death of an infant sibling;
• Social and emotional connection – longing for a group of friends to spend time with at work but not yet finding others to connect with; craving acceptance amongst others in the gym class but not yet being invited to the weekly social gatherings outside of the gym class; wishing for someone to vent to after a stressful day but not having the support system of your choice
• Unfulfilled career goals or career setbacks – Hoping to get into college but not being admitted anywhere; planning to be a lawyer but not passing the bar after multiple attempts; not yet being promoted after years of hard work; or not landing a job in your desired field after submitting multiple applications over the past few months
• Losing future plans due to unforeseen circumstances – bankruptcy, natural disasters, political unrest, unexpected violence, house fires, car accidents, robberies, foreclosure
• Other unmet expectations, hopes, or needs – Taking multiple doses of a GLP-1 but not losing the weight you expected; taking daily medication for alopecia but not having desired hair growth after a year; attending physical therapy twice a week for a year but not yet being able to walk independently again

In each of these areas described above, ambiguous loss is infused with both deep yearning and hope. While both losses, the death of a loved one is often unlike the pain that surrounds the deep desire for a disease to be cured, a relationship to change, or a healthy pregnancy to occur. Despite the difference, all types of loss should be acknowledged. Even the ones that are harder to “see”.

The Emotional & Psychological Impact Of Ambiguous Loss

Ambiguous loss can take a massive toll on individuals, couples, and families. Because ambiguous loss does not include common events like a funeral or celebration of life, it’s often not recognized by others, which can leave individuals without the support they need. Friends, family, coworkers, and neighbors might not know what to say, so this can feel isolating because it can feel awkward to talk about. Due to isolation and a lack of answers, individuals can find themselves stuck in a state of “frozen grief.” They can also feel extreme guilt for wanting to move forward with their life, exhaustion from holding onto hope, or even despair in having to shift their mindset. This can lead to chronic stress, anxiety, depression, isolation, or even financial constraints; however, each person copes in their own unique way.

How To Cope With Ambiguous Loss & How We Can Help

Because ambiguous loss lacks a clear ending, conventional grief models usually aren’t the most helpful. Individuals, couples, and families experiencing ambiguous loss might struggle with making sense of the uncertainty, struggle with grieving, and may find difficulty in finding closure in situations where their loss lacks clarity, concreteness, or resolution. Coping with ambiguous loss involves learning to name and acknowledge the loss, processing your feelings, recognizing that others might not understand your pain, overcoming emotional paralysis, allowing space for multiple truths to exist, redefining closure, reconstructing your identity, building resilience and nurturing hope, expanding your community, exploring next steps, and actively participating in activities to assist with continued growth and healing.

Therapists with expertise in ambiguous loss can help individuals not only feel seen and heard, but also assist them with navigating healing. Dr. Atiya Smith at Georgetown Psychology is a licensed clinical professional counselor with over 15 years of experience supporting children, adolescents, college students, and adults with navigating ambiguous loss. She also has experience supporting “surviving siblings”, mainly those who lost siblings during childhood and had to not only unexpectedly navigate shifts in family roles but also might have had to push their own emotions aside as children/teens in order to support their parents as they grieve. Dr. Smith works collaboratively with individuals and families to develop a treatment program that works through the complexities of ambiguous loss, builds daily coping skills, and practices how to process navigating grief without closure. Her approach to therapy includes Psychodynamic Therapy, Cognitive Behavioral Therapy (CBT), Transactional Analysis, and Expressive Arts approaches to best support each client’s unique needs. Dr. Smith sees clients in-person at our Bethesda, Maryland location as well as virtually.

Our Bethesda address is:

8120 Woodmont Avenue, Suite 660

Bethesda, MD 20814

To schedule a counseling appointment, or if you have any questions, contact Sarah Smathers, our Director of Client Services at, sarah@georgetownpsychology.com or call (301) 652-5550.

 

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