Exploring dissociative experiences in grief

Abstract

The first part of this thesis is a systematic review exploring the relationship between attachment insecurity and complicated grief in adults who have experienced the death of a loved one. A total of 21 cross-sectional and longitudinal studies (4946 participants), published between 2003 and 2019, met inclusion criteria and were selected for narrative review and quality assessment. There was consistent evidence found for an association between higher levels of attachment anxiety and symptoms of complicated grief across adults who represent a range of bereavement experiences. There was evidence found for association between higher levels of attachment avoidance and complicated grief, however this relationship demonstrated less consistency and suggests more complexity. The review poses implications for recognising individuals who may be at risk of intense psychological distress and complications in the grief process following the death of a loved one. The findings also suggest avenues for tailoring therapeutic intervention according to the attachment orientations for bereaved adults. Methodological limitations are discussed, with suggestions for future research.
Emerging evidence suggests that dissociation at the time of the death of a loved one (periloss dissociation), and persistent dissociation, are linked with higher levels of complicated grief, however the evidence base is limited by dearth and methodological flaws. Furthermore, factors that may moderate this proposed relationship have not yet been explored. The second part of the thesis therefore describes an empirical cross-sectional study which explored the potential moderating role of attachment insecurity on the relationship between periloss and persistent dissociation, and complicated grief among 237 adults who had experienced the death of a loved one. The findings indicate that periloss and persistent dissociation are both associated with increased symptoms of complicated grief. Attachment anxiety was positively associated with periloss and persistent dissociation, and complicated grief, however attachment avoidance was not associated with dissociation or grief. No moderating effect was found of attachment anxiety or avoidance, suggesting that the relationship between dissociation and complicated grief is not influenced by attachment insecurity. Methodological limitations and subsequent implications for interpretation of the findings of the study are explored. Implications of the findings and suggestions for future research are discussed.
Keywords: attachment; grief; bereavement; dissociation; coping; death

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