Ambiguous loss

Joel Dean, Founder of Joyful
Last updated October 30, 2026

Two types: gone but not for sure, here but not here

Boss's first research was with families of pilots declared missing in action in Vietnam, and later with families living with Alzheimer's disease.¹ She is professor emeritus of family social science at the University of Minnesota, and from that work she described two types.¹

Physically gone, still present in your mind

Someone is absent, but there's no proof the loss is permanent, so they stay present in your thoughts. Families describe this as "gone, but not for sure."¹

Physically here, psychologically gone

Someone is still with you, but illness, injury, addiction or another change has taken part of who they were. Families call this "here, but not here."¹

The two types can overlap in the same family, and either can be catastrophic or more everyday.²

Stuck between hope and despair

Boss describes ambiguous loss as freezing grief and blocking the usual ways of coping.² Without a clear loss, people can feel stuck between hope and despair.¹

Other people may not know what to say, because nothing official has happened.

Four more things show up in her work:

• Confusion about your role. Are you still a wife, a son, a caregiver, a widow? Boss's questions ask who is "in" the family now and who is "out."²
• Mixed feelings: love and resentment, hope and the wish for it to end. Boss's guidance is to treat these feelings, and the guilt that comes with them, as normal, while not acting on harmful ones.²
• Exhaustion. Boss lists helplessness, hopelessness and exhaustion among the effects.²
• Dropped rituals. Birthdays and holidays can stop, because nobody knows how to hold them now.¹

Boss's six guidelines, and what gets in the way

Because an ambiguous loss may never be clarified, Boss sets the goal as resilience: learning to live well despite "not knowing."¹ She proposed six guidelines for this, and her training slides say they are circular, with no fixed order to move through.^1,2

Under each one, she lists what helps and what hinders.²

1. Finding meaning. Helps: naming the problem, holding two ideas at once, seeing suffering as part of life. Hinders: the wish for revenge, and secrets.
2. Tempering mastery. Helps: noticing where your need to fix things comes from, and placing the blame on the situation instead of on yourself. Hinders: blaming yourself for not fixing what can't be fixed.
3. Reconstructing identity. Helps: redefining who your family is now and who does which role. Hinders: stigma, and holding onto one fixed identity.
4. Normalizing ambivalence. Helps: noticing mixed feelings and treating negative feelings and guilt as normal, but not harmful actions.
5. Revising attachment. Helps: "both/and" thinking, such as holding that she is here and she is gone; family meetings and peer support groups. Hinders: expecting closure on the relationship.
6. Discovering hope. Helps: building tolerance for not knowing, imagining new options, laughing at the absurd, and remaking family rituals. Hinders: insisting on an end point.

Widely used, lightly tested

Treat the six guidelines as a well-used map. We didn't find large trials testing them against other approaches.

Boss's 1999 book Ambiguous Loss has been translated into several languages, and researchers have applied the theory to dementia, missing persons, migration and other losses.¹ The guidelines come from clinical work: Boss and a colleague write that they have been found useful with families who can't get answers.³

Some of her ideas are still open. She proposes that the lasting grief from ambiguous loss looks like the grief from a hard death, and she says herself that this idea is controversial and untested.¹ Symptoms from ambiguous loss can also be mistaken for depression or other disorders, which is one reason to see a clinician who knows about this kind of loss.³

One assumption of the theory is that people can't cope with a problem until they know what it is.¹ Boss writes that families feel relieved when they're told their distress isn't their fault, and are then more likely to accept support.¹

Five things to try this month

1. Name it out loud. "This is an ambiguous loss" is a true sentence, and Boss treats naming the problem as the first step.²
2. Write one both/and sentence. Put both truths in one line, joined by "and", like the examples above.
3. Rework one ritual. Choose one birthday or holiday and decide how to hold it this year. Boss suggests rituals as a good place to start.²
4. Hand over one role. Write down the tasks the person used to do, and choose one to share with someone else.
5. Find people in the same situation. Boss's guidance includes peer support groups.² Dementia caregiver groups, families of the missing and support groups for families living with addiction exist for this.

When it turns into depression, anxiety or substance use

Boss lists depression, anxiety and substance misuse among the outcomes of ongoing ambiguous loss.² If you notice any of these, or you feel hopeless, that's the point to bring in a professional, and a family therapist who knows Boss's work can help a whole family talk about it together.

If you're caring for someone with dementia, a hospice or palliative team may offer counseling once your person is eligible.⁴ Joyful is an AI journaling companion, not therapy or a grief counselor.

Questions people ask

What is an example of ambiguous loss?

A parent with dementia who no longer recognizes you is one. Boss's list also has quieter ones: a child leaving home, a partner moving into a care home, someone lost to homesickness or to an obsession with work.¹

Is a breakup an ambiguous loss?

Divorce is on Boss's list, since the person is gone from your home but often still present in your life.¹ A breakup can share those features. The coping with divorce page covers that loss.

Is ambiguous loss the same as anticipatory grief?

No. Anticipatory grief looks ahead to a death that is coming. Ambiguous loss is a loss that stays unclear, with no ending. Someone caring for a parent with dementia can feel both.