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PERILOSS DISSOCIATION, SYMPTOM SEVERITY, AND TREATMENT RESPONSE IN COMPLICATED GRIEF

Authors


  • Conflict of interest: EB has received honoraria from Laboratoires Servier. NMS has research grants from American Foundation for Suicide Prevention, Forest Laboratories, NIMH, DOD, Glaxo SmithKline, NARSAD Sepracor and also has received honoraria for speaking/CME from MGH Psychiatry Academy. MKS has research grant from American Foundation for Suicide Prevention and NIMH. All other authors declare that they have no conflicts of interest.

Correspondence to: Eric Bui, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, One Bowdoin square, 6th floor, suite 650, Boston, MA02114.

E-mail: tebui@partners.org

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. periloss 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 were 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 (α = 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 < .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 < .05) and lower study discontinuation (P < .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.

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