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Eur Arch Psychiatry Clin Neurosci. 2007 Dec;257(8):453-61.

An attachment-based model of complicated grief including the role of avoidance.

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Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA.



Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.


We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ). RESULTS OF AVOIDANCE ASSESSMENT: Mean (SD) GRAQ score was 25. 0 +/- 12.5 with a range of 0-60. Cronbach's alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief.


In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model.

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