Background: People with intellectual disabilities are thought to have a reduced capacity for understanding death. Drawing on cognitive theory, researchers have suggested that those with profound intellectual and multiple disabilities mainly perceive loss as a mismatch between past and present experiences. However, very little research has considered how carers conceptualize bereavement in relation to this group. Method: Semi-structured interviews obtained responses from seven carers. Transcripts were examined using interpretative phenomenological analysis. Results: Two superordinate themes emerged: "difficulty articulating the experience of loss" and "making sense of bereavement through familiar patterns". Conclusions: Carers conceptualize bereavement primarily in cognitive terms, but also take account of relational factors mediating loss. Implications for training and further research are outlined.