Ambiguous Loss: Definition, How to Cope & When to Get Help

What Is Ambiguous Loss?

Ambiguous loss is a relational disorder caused by a lack of clarity or facts surrounding the loss of a loved one, as defined by Pauline Boss, Ph.D.¹ She referenced ambiguous loss and the grief resulting from it in cases of immigration, addiction, and catastrophic illnesses.

There are two types of ambiguous loss: Either the lost loved one is either physically absent but emotionally present, or physically present but psychologically absent.

“Ambiguous losses involve a lack of clarity regarding whether a loved one is in or out of the family. There are two types of ambiguous loss–one in which a person is physically present and psychologically absent, such as the case of Alzheimers or alcoholism. The second type is the opposite of the first–someone is physically absent and psychologically present, as in the case of someone who has gone missing in action or a child who is missing.” – Kelly Maxwell Haer, PhD, LMFT Executive Director of Boone Center for the Family at Pepperdine University

Boss believes that ambiguous loss is the most difficult type of grief to endure. The uncertainty of it takes over the lives of family and loved ones. Confusion and uncertainty prohibits them from beginning a traditional process of grieving, and can lead to complicated grief.²

The optimal outcome for someone who experiences ambiguous loss is to learn to incorporate meaning into their life while continuing to love and remember their missing loved one.³

Ambiguous Loss Vs. Anticipatory Grief

There are some similarities regarding ambiguous loss and anticipatory grief. These types of grief are both recognized as normal reactions to losses with uncertain and uncontrollable factors. These unknown circumstances can make it more difficult to cope and can cause the grief to grow into complicated grief in both instances. Both of these types of grief create feelings of helplessness and at times hopelessness.

Here are some of the differences between ambiguous loss and anticipatory grief:

Ambiguous Loss Examples

If someone is physically missing and there is no information on where they are or what their condition is, then ambiguous loss is the inevitable consequence. Their loved ones must learn to process these circumstances and navigate their lives as best they can.

Here are seven examples of circumstances that can cause feelings of ambiguous loss:

1. Kidnappings or unrecovered bodies: victims of violent crimes/kidnapping may or may not be found and recovered. Their location and status can be uncertain or never resolved. This can lead to feelings of guilt, confusion, anger, helplessness, guilt, hopelessness
2. Those who are deployed in the military: if engaged in active combat, members of the military are often not allowed to share information or communicate with loved ones about where they are. This is especially frightening for loved ones during times of war or when military personnel are stationed in unstable countries.
3. Chronic mental health problems: people with ongoing chronic mental health problems face ongoing daily struggles and challenges. They’re physically present but not emotionally or psychologically available. Symptoms can escalate, especially if they are non-compliant with medications and treatment opportunities.
4. Traumatic brain injury: this kind of diagnosis comes with uncertainty in terms of the extent and nature of recovery. It can cause people to behave uncharacteristically and they may lose control of their emotions, behavior, and thoughts.
5. Immigrants: immigrating to a new country involves incredible risk. This person’s status may be unknown to loved ones for a long time. They may end up moving from place to place or not have the ability to communicate for extended periods of time. In some cases, their fate is never discovered.
6. Homelessness: people who experience homelessness often live in isolating and uncertain circumstances. They may choose not to communicate with loved ones or not be able to. Unpredictable access to healthcare, shelter, and food can compromise their safety, health, and well-being.
7. Drug & alcohol addiction: people with an addiction history often struggle through multiple relapses. This creates isolation and leads to uncharacteristic behaviors. They may be unable to communicate with loved ones or choose not to update their status due to instability and uncertainty.

Types of Ambiguous Loss

Ambiguous loss has been categorized into two types:

Type-One Ambiguous Loss

Type one ambiguous loss is the physical loss of a person. This can look like the loss of motor function of a loved one who may be struggling with Lupus, Multiple Sclerosis, cancer or any other kind of neurodegenerative or terminal disease. In this type of loss, the psychological presence of the person is alive and well, however the physical person may be totally dependent, which can be hard to witness.

Type-Two Ambiguous Loss

Type two ambiguous loss is the psychological loss of a person. This is a bit more commonly understood and seen as we relate this to people who have dementia. Any kind of diagnosis which impacts a person’s memory and personality is a psychological loss. This can include diagnoses of any type of dementia, brain cancer, other cancers that impact memory or cognition, brain injury, etc.

Symptoms of Ambiguous Loss

When it comes to ambiguous loss, some people may continue on with normal rituals and daily life, while others may suspend life and remain in a sort of limbo. The ongoing stress of ambiguous loss impacts people in numerous other ways, too.

Common symptoms of ambiguous loss include:

• Hopelessness
• Depression
• Confusion
• Anxiety
• Ongoing stress
• Despair
• Physical symptoms like headaches, digestive issues, loss of appetite, or overeating
• Inability to sleep
• Increased drug or alcohol use as a means of coping
• Increased body aches and tension
• Preoccupation with thoughts of a missing loved one

Why Is Ambiguous Loss So Hard to Get Over?

Ambiguous loss is so hard to handle because it does not look like how we anticipate loss to look like. It can be hard to get closure from this kind of loss because of the ambiguity—it is harder to get through the stages of grief and often, people feel stuck in one stage. This kind of loss often takes a long time and the grief begins far before the actual death of a loved one. We are witnessing a slow death of a loved one and see the milestones, such as the first fall, the first skipped meal, etc that all are indicators for health decline.

15 Ways to Cope With Ambiguous Loss

It’s important to find some balance between keeping a missing loved one in your heart and mind and getting through your day. As you await information, it can become increasingly challenging to meet the demands associated with living your daily life and managing your responsibilities and relationships.

Here are 15 tips on how to cope with ambiguous loss:

1. Acknowledge and identify what you’re feeling: it’s important to name your feelings. This is a new situation and you need time to learn how to cope, understand what is happening, and take better care of yourself.
2. Eat well, sleep well, and exercise often: these are the foundations for dealing with stress regardless of the source.
3. Prepare yourself for triggers: events like anniversaries, holidays, and birthdays can be triggers for painful emotions. If you know a trigger is coming, engage in increased self-care efforts. Ensure that you’re in a safe place and with people who can provide understanding and comfort.
4. Seek therapy: it may be difficult to talk with family members, especially if they’re experiencing similar challenges. A therapist with expertise in grief and loss can help you navigate your emotions and come to an understanding about the best ways to navigate pain and uncertainty.
5. Identify trusted resources: the National Council on Family Relations has created an extensive resource page specifically designed for those who struggle with ambiguous loss and grief⁴
6. Join a peer support group: support groups can help you to identify your feelings and feel less alone⁵
7. Find meaning through creativity: Expressing grief related emotions in creative ways helps begin the healing process. It is a safe way to express and explore feelings that can’t be verbalized. Examples include journaling, drawing, dancing, and gardening.
8. Look for new things to give you hope: Try to find hope even in the midst of tragedy. Allow yourself to feel the emotions of grief. Explore beloved memories that changed you in meaningful ways. Consider what you have learned about yourself as a result of living through this experience that may have surprised you and strengthened you in some way. Maintain hope that you can move forward and create positive pathways ahead.
9. Get involved in a cause you care about: Find a meaningful cause that you can get involved in that will honor the memory of the person that was lost. For example, if you lost a loved one to suicide, donate to or get involved in suicide prevention programs to help others who are at risk.
10. Validate your feelings: know that whatever you feel, it is valid. Give yourself permission to feel grief, anger, loss, etc.
11. Spend time with friends, family, and mentors: share your thoughts, feelings, and fears with whomever you perceive as being safe, comforting, and non-judgmental
12. Find comfort in religion/spirituality: spend time with people who share your religious or spiritual beliefs. Talk to your religious or spiritual guide if you have one.
13. Practice self-compassion: It’s important to be kind to yourself and allow yourself to feel the mixed and confusing emotions that come with ambiguous loss. It’s hard for us to really grasp this kind of loss as it challenges us to hold two beliefs at once, so self-compassion is key.
14. Aim for acceptance vs. closure: This kind of loss is very confusing, and aiming for closure may set you up to feel worse. Before that can be an option, you must focus on accepting that this type of loss is happening, and in that, you may find closure.
15. Use “Both/And” thinking: This is a perspective shift from “either/or” thinking, and allows you to have more than two options. This can feel comforting as neither of the two options available may be ideal.

When to Get Professional Help for Ambiguous Loss

If you feel overwhelmed by the loss of a missing loved one, it may be time to see a therapist. Self-isolation is another indication that professional help may be needed.

One type of therapy that may be useful for those experiencing ambiguous loss is family counseling. People grieve the loss of loved ones differently. In addition, the fact that a family member is missing alters the relationships and dynamics among remaining family members. This alteration and adjustment can be confusing and disruptive. It can create a cascade of angry and hurt feelings that disrupt communication.

Another option is to attend grief counseling. This deals specifically with the issue of loss, whether that’s the physical or emotional loss of a loved one, the loss of a pet, or a different kind of loss caused by major life changes.

How to Find a Therapist

If you’re looking for ways to find a therapist and you’re not sure where to begin, you could start your search through an online therapist directory. This allows you to sort by location, expertise, and insurance coverage.

Final Thoughts on Ambiguous Loss

Learning how to live your life when someone you love is not physically or psychologically present can feel impossible. The initial stages of ambiguous loss often create chaos, confusion, isolation, and fear. Reach out to friends, family, and mental health professionals as a lifeline to help you navigate one of life’s most challenging and confusing circumstances.⁶