Periloss Dissociation, Symptom Severity, and Treatment Response in Complicated Grief

Abstract

Background Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e. Peri-Loss Dissociation (PLD)) in CG. The present study aimed to examine the psychometric properties of the PLD-adapted peritraumatic dissociative experiences questionnaire and its association with symptom severity, treatment response, and drop-out rate. Methods PLD data collected as part of a randomized controlled trial of two loss-focused psychotherapy approaches for CG was examined. Treatment-seeking individuals with primary CG (n=193) were assessed for PLD at the initial visit, 95 of whom were randomized and completed at least one treatment session. Results The PLD-adapted peritraumatic dissociative experiences questionnaire was found to be internally consistent (alpha = 0.91) with good convergent and divergent validity. After controlling for age, gender, time since loss and current comorbid psychiatric diagnosis, self-reported PLD was associated with greater CG symptom severity (p<0.01). However, contrary to our hypotheses, after controlling for age, baseline symptoms severity, psychiatric comorbidity and treatment arm, PLD was predictive of better treatment response (p<0.05) and lower study discontinuation (p<0.01). Conclusions PLD may be useful in identifying individuals at risk for CG and those who might respond to psychotherapy. Additional research should investigate the relationship of PLD with treatment outcome for different treatment approaches, and whether PLD prospectively predicts the development of CG.

The Mediating Role of Integration of Loss in the Relationship Between Dissociation and Prolonged Grief Disorder

“…Our findings suggest that, to the contrary, it is the tendency to dissociate that limits the awareness of the loss and contributes to psychopathology via the impairment of the integration of the memory of the loss. Our findings are in line with former studies of dissociation and PGD that focused on PLD–the dissociation that takes place during or right after the loss–and found that higher levels of dissociation were related to an increase in PGD symptoms (Bui et al., ; Boelen, ; Boelen et al., ).…”

“…A few studies examining dissociation in the grief process have found that the loss of a close significant other in childhood was related to dissociation symptoms years later (Irwin, a,b), and recent studies examining periloss dissociation (PLD) (dissociation experienced during or right after the loss) have found a link between PLD symptoms and PGD symptoms (Boelen, Keijsers, & van den Hout, ; Bui et al., ). In addition, dissociation has been found to mediate the associations between those losses that are characterized by violence and unexpectedness, and PGD (Boelen, ).…”

Panic-agoraphobic spectrum symptoms in complicated grief

“…Bereaved controls ( n = 44) were participants without any lifetime DSM-IV disorder who reported the loss of a loved one and had an Inventory of Complicated Grief (ICG; Prigerson et al, 1995) score < 25. CG participants ( n = 28) were individuals with an ICG score ≥ 30 (Bui et al, 2013) who reported grief as their primary problem and sought treatment for CG more than 6 months after the loss (see Table 1 for participant characteristics).…”

Grief in the time of COVID-19: An editorial

“…Firstly, screening of grievers at risk for developing PGD during this period is warranted. The COVID-19 pandemic is associated with specific risk factors for PGD, related to the disease itself, as well as to the measures taken to combat the spread of the virus (Mayland et al, 2020) including: immediate psychological response to the death (Bui et al, 2013) (e.g., being directly responsible for the contamination of the deceased, impaired communication between doctors and family); separation at the time of death and the absence of usual funeral rites (Mutabaruka et al, 2012) (e.g., inability "to say a last goodbye", absence of funeral rites and practices); and cooccurring environmental stressors and lack of perceived social support (Shear, 2015) (e.g., loss of employment, professional and financial insecurity, increased work burden, social isolation due to confinement measures, and uncertainty about the future). Efforts should thus be devoted to identify those at risk for developing PGD as well as PGD itself, including in primary care settings, and through health literacy promotions (e.g., by the media).…”