Disorganized attachment and prolonged grief

Abstract

Objective: While the relationship between attachment anxiety and avoidance and the severity of prolonged grief disorder (PGD) has been well-studied, less is known about the relationship between disorganized attachment and PGD. We test the associations between disorganized attachment and the interaction between it and attachment avoidance and anxiety on PGD. Method: Participants (N = 258) who had lost a family member from 0.5 to 8.0 years before the survey completed the experiences in close relationships-revised, the adult disorganized attachment scale, and the PGD-13 scale. Results: The model explaining PGD symptoms through attachment, taking into account the level of disorganized attachment, explained variance in PGD significantly better than the model taking into account only the level of attachment anxiety and avoidance as predictors. Additionally, the relationships between attachment avoidance and PGD were positive, negative, or neither, depending on the configuration of the levels of disorganized attachment and attachment anxiety. Conclusion: Future research into the relationships between attachment and PGD should take into account disorganized attachment. Attachment-informed grief therapy focused on insecure styles of attachmentincluding the disorganized styleto the deceased person and other loved ones may prove a promising approach for bereaved persons who experience PGD.

Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder

“…Our results showed that being unprepared increased the relative probability of PGD by 22%. This aligns with previous studies that indicated that high levels of perceived preparedness for the death of a loved one might be a protective factor for better post-loss adjustment ( 29 ), whereas unpreparedness for or subjective unexpectedness of a death increases the risk for PGD ( 29 – 32 ). In case of terminally ill patients, health care providers can support family members and caregivers by facilitating the participation in the patients’ care and providing clear information on the impending death, as these actions have been found to promote preparedness for death ( 46 ).…”

“…Another study also found unexpected losses to be significantly related to greater PGD symptom severity. However, the association was weak and further studies are needed ( 32 ). Interestingly, in all of these studies, about half of the participants reported that the death of their loved one was unexpected, including those losses due to a disease which might be a further indicator that the subjective perception of the death is a better predictor than the objective cause of death.…”

A Latent Class Analysis on Symptoms of Prolonged Grief, Post-Traumatic Stress, and Depression Following the Loss of a Loved One

“…This accords also with prior findings that an objective measure of unexpectedness (measured as "number of days between forewarning of death and the actual death") was not associated with PGD symptoms (59), while a subjective measure of perceived unexpectedness was linked to elevated levels of PGD symptoms (60,61). Further recent research demonstrates that bereaved persons who experienced their loss as unexpected reported higher levels of PGD, even when other variables were controlled (62,63).…”

Family members’ long-term grief management: A prospective study of factors during ongoing palliative care and bereavement

“…Attachment anxiety relates to a person's appraisals of the availability and responsiveness of attachment figures in times of stress. These results are in line with previous findings (Sekowski and Prigerson 2022b) showing a positive correlation between prolonged grief disorder symptom severity and both attachment anxiety and attachment avoidance. Individuals high in attachment anxiety are overly dependent on interpersonal relationships to provide them with a sense of security and worry that resources will not be available in times of need (Weber Falk et al 2021).…”

“…According to the final model, older age in family members, younger age in patients, and family members being female were associated with a higher risk for prolonged grief symptom severity, and these findings are supported by previous research (Lundorff et al 2017;Mason et al 2020;Sekowski and Prigerson 2022b), although our result contradicts findings reported by others unable to find an association between gender and prolonged grief symptoms (Ghesquiere et al 2011;Nielsen et al 2017). In addition, family members' relationships with the patient were also included in the model, and such an association has been shown previously (Ghesquiere et al 2011).…”