Abstract
Research has shown that prolonged grief disorder (PGD) is a disorder distinct from other disorders including major depression and posttraumatic stress disorder (PTSD). This study aimed to extend this research by examining the distinctiveness of symptoms of PGD relative to symptoms of adult separation anxiety disorder, also taking into account depression. Data were available from 205 bereaved individuals who completed measures tapping these symptoms together with a complementary measure of mental and physical health. Findings showed that symptoms of PGD, depression, and adult separation anxiety disorder were better conceptualized as distinct dimensions instead of a unitary dimension of distress. Correlations between the three symptom clusters were moderate to large. Cause of loss was the single variable that was associated with all three symptom clusters with loss due to violent cause giving rise to more severe symptoms. All three symptom clusters were associated with lower concurrent mental and physical health.
1. Introduction
The death of a loved one can precipitate the development of mood and anxiety disorders and prolonged grief disorder (PGD). PGD is a syndrome that includes disruptive yearning, trouble accepting the death, detachment, bitterness, difficulties moving on without the lost person, and a sense of meaninglessness present to the point of impairment beyond 6 months after the loss (Prigerson et al., 2009). PGD is not yet included in DSM-IV. However, there is considerable evidence that PGD meets the criteria for a mental/psychiatric disorder as put forth by Stein et al. (2010) and is therefore under consideration for inclusion in the fifth edition of DSM-V (Boelen and Prigerson, 2012).
There is evidence that PGD is distinct from its “near neighbours” including major depression and posttraumatic stress disorder (PTSD; Boelen et al., 2010). Moreover, PGD symptoms have been found to predict health impairments over and above these neighbour syndromes attesting to the incremental validity of PGD (Bonanno et al., 2007). Of interest, no studies have yet explored the distinctiveness and correlates of PGD, relative to symptoms of adult separation anxiety disorder. Adult separation anxiety is characterized by exaggerated fears about separations from, and harm befalling, close attachment figures. It parallels childhood separation anxiety disorder although onset can occur after 18 years of age ( Manicavasagar et al., 2010). It is conceivable that at least in some bereaved individuals separation from the deceased loved one elicits fear of additional bond ruptures that is central to separation anxiety disorder. Furthermore, childhood separation anxiety is a risk factor for both PGD ( Vanderwerker et al., 2006) and adult separation anxiety disorder ( Manicavasagar et al., 2000) and may pose a risk for the co-occurrence of both syndromes in adulthood.
Several studies have explored the linkage of PGD with adult separation anxiety. For instance, Dell’Osso et al. (2011) found that bereaved individuals meeting criteria for PGD had significantly higher levels of adult separation anxiety than bereaved control subjects not meeting criteria for PGD. In a further study Dell’Osso et al. (2012) rated levels of adult separation anxiety disorder in outpatients with a diagnosis of posttraumatic stress disorder (PTSD), PGD, or both PTSD and PGD. Outcomes showed that patients meeting criteria for both conditions had significantly higher separation anxiety scores than patients with either complicated grief or PTSD alone. Silove et al. (2010) assessed PGD and adult separation anxiety among war-affected Bosnian refugees and found no significant association between the severity of these conditions (see also Momartin et al., 2004).
To our knowledge, no studies have yet explored the distinctiveness of symptoms of PGD and adult separation anxiety disorder. Examining the distinctiveness of these conditions is timely given upcoming revisions of the DSM (Boelen and Prigerson, 2012) and can inform theorizing and research about underlying mechanisms, assessment, and treatment of post-loss psychopathology. The current study was designed to do so, also taking into account depressive symptoms. Specifically, the key aim of this study (i) was to test the prediction that symptoms of PGD, depression, and adult separation anxiety disorder are better conceptualized as distinct factors instead of a unitary dimension of distress. On the condition that this was indeed so, further aims of this study were to examine (ii) correlations between the symptom clusters and (iii) the degree to which symptom clusters varied as a function of demographic (e.g., age and gender) and loss-related (e.g., time since loss) variables. To enhance knowledge about the relative importance of PGD, depression, and adult separation anxiety in psychological functioning, we examined (iv) the degree to which symptom clusters were associated with concurrent mental and physical health. Finally, we examined (v) prevalence rates of PGD and adult separation anxiety disorder “caseness” and differences in mental and physical health between cases and non-cases.
