Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands.
Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands.
Eur J Psychotraumatol. 2023;14(2):2190544. doi: 10.1080/20008066.2023.2190544.
Prolonged grief disorder (PGD) has been included in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). Loss-related avoidance behavior perpetuates grief and effective interventions for prolonged grief symptoms target such avoidance behavior. Yet, behaviors characterized by approach of loss-related cues (i.e. rumination, yearning, proximity seeking) are also implicated in prolonged grief reactions. To solve this paradox, we will test the Approach Avoidance Processing Hypothesis, which holds that loss-related approach and avoidance behaviors co-occur in PGD, using latent class analyses (LCA). Two-hundred eighty-eight bereaved adults (92% female) completed questionnaires assessing loss-related approach behaviors (rumination, yearning, proximity seeking), loss-related avoidance behaviors (anxious avoidance, experiential avoidance) and ICD-11 and DSM-5-TR prolonged grief symptoms. LCA demonstrated the best fit for a three-class solution comprising a low approach/low avoidance class ( = 98, 34%), a high approach/low avoidance class ( = 79, 27%), and a high approach/high avoidance class ( = 111, 39%). The latter class showed significantly higher prolonged grief symptom levels and higher odds of probable PGD compared to the other classes. Co-occurrence of loss-related approach and avoidance appears characteristic to prolonged grief reactions. Distinguishing bereaved people with these behavioral patterns from those solely experiencing loss-related approach behaviors may improve the efficacy of PGD therapies.
持续性悲伤障碍（PGD）已被纳入《国际疾病分类》（ICD-11）和《精神障碍诊断与统计手册》第 5 版修订本（DSM-5-TR）。与丧失相关的回避行为会使悲伤持续存在，而针对持续性悲伤症状的有效干预措施则针对这种回避行为。然而，与丧失相关的线索（即沉思、渴望、寻求亲近）的接近行为也与持续性悲伤反应有关。为了解决这个矛盾，我们将使用潜在类别分析（LCA）检验与丧失相关的接近和回避行为在 PGD 中共存的接近回避处理假设。288 名丧亲的成年人（92%为女性）完成了评估与丧失相关的接近行为（沉思、渴望、寻求亲近）、与丧失相关的回避行为（焦虑回避、体验回避）以及 ICD-11 和 DSM-5-TR 持续性悲伤症状的问卷。LCA 表明，一个三类别解决方案的拟合度最佳，包括一个低接近/低回避类别（ = 98，34%）、一个高接近/低回避类别（ = 79，27%）和一个高接近/高回避类别（ = 111，39%）。最后一个类别表现出明显更高的持续性悲伤症状水平和更高的可能 PGD 几率。与丧失相关的接近和回避的共同发生似乎是持续性悲伤反应的特征。将具有这些行为模式的丧亲者与仅经历与丧失相关的接近行为的丧亲者区分开来，可能会提高 PGD 治疗的效果。
