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# Kübler-Ross's stages of dying and their limits

- Theory

Kübler-Ross described five emotional reactions in dying patients. They help name feelings but are not fixed steps everyone passes through.

Updated Nov 5, 2026

## Key points

- The five stages in classic order: denial, anger, bargaining, depression, acceptance.
- They were described in patients who were dying, not in bereaved relatives.
- The stages are not linear or universal: people skip, repeat or mix them, and many never reach acceptance.
- Research on bereavement does not support a fixed sequence; yearning and acceptance coexist from early on.
- Use the model to recognize emotions, never to judge whether a patient is ‘grieving correctly’.

## What it is

In 1969 the psychiatrist Elisabeth Kübler-Ross described five reactions in terminally ill patients facing their own death: denial, anger, bargaining, depression and acceptance. The model gave doctors a language for patients' emotions and helped launch the modern palliative care movement. It was never meant as a strict sequence, has little empirical support and was later stretched to every kind of loss.

## Step by step

- Denial: ‘This cannot be happening; the results must be wrong.’
- Anger: frustration directed at fate, family or the care team: ‘Why me?’
- Bargaining: trying to strike a deal: ‘If I can just reach my daughter's wedding…’
- Depression: sadness about losses already suffered and those to come.
- Acceptance: a calmer readiness, often with withdrawal and planning.

## Limits of the model

| Limit | What it means in practice |
| --- | --- |
| Not linear | A patient may accept the diagnosis and feel anger again weeks later |
| Not universal | Many people do not go through negative stages at all; resilience is common |
| Different population | Described in dying patients, then applied to grief, divorce and other losses |
| Little empirical support | Based on interviews, not on studies that tested a sequence |
| Risk of misuse | Labelling a patient ‘stuck in denial’ can replace listening |

## Clinical notes

- Anger directed at the team is often part of the reaction to bad news; answering it with empathy rather than defense keeps the alliance.
- Some denial can be protective; it needs to be addressed only when it blocks important decisions.

## Memory aid

DABDA: Denial, Anger, Bargaining, Depression, Acceptance; and remember: ‘a map, not a timetable’.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the five stages described by Kübler-Ross, in classic order?

Denial, anger, bargaining, depression and acceptance.

## In which population did Kübler-Ross describe the stages?

Terminally ill patients facing their own death, not bereaved relatives.

## What are the main limits of the Kübler-Ross model?

The stages are not linear or universal, the model has little empirical support, and it was extended to losses it was not described for.

## A dying patient says: ‘If I can just see my grandson born, I will accept anything.’ Which stage is this?

Bargaining.

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## Elsewhere in DurgiPedia

- [Interviewing in special situations: interpreters and breaking bad news](https://durgical.com/en/clinical-exam/interviewing-in-special-situations-interpreters-and-breaking-bad-news/)

## Connections

## Related 5

- [Normal grief, prolonged grief and depression](https://durgical.com/en/behavioral-science/normal-grief-prolonged-grief-and-depression/)
- [Breaking bad news: the SPIKES protocol](https://durgical.com/en/behavioral-science/breaking-bad-news-the-spikes-protocol/)
- [Defense mechanisms: what they are and how they are ranked](https://durgical.com/en/behavioral-science/defense-mechanisms-what-they-are-and-how-they-are-ranked/)
- [Coping and resilience](https://durgical.com/en/behavioral-science/coping-and-resilience/)
- [Normal psychological ageing vs dementia](https://durgical.com/en/behavioral-science/normal-psychological-ageing-vs-dementia/)

## Related conditions 1

- [Prolonged grief disorder](https://durgical.com/en/conditions/prolonged-grief-disorder/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment](https://pmc.ncbi.nlm.nih.gov/articles/PMC8475918/) (Focus, via PubMed Central (US National Library of Medicine), 2021); [Grief, Bereavement, and Coping With Loss (PDQ®)–Health Professional Version](https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-hp-pdq) (National Cancer Institute (NCI, NIH), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/kubler-ross-s-stages-of-dying-and-their-limits/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/kubler-ross-s-stages-of-dying-and-their-limits/