Brief reportPanic-agoraphobic spectrum symptoms in complicated grief
Introduction
Complicated Grief (CG) is a debilitating syndrome consisting of persistent, intense grief-related symptoms that interfere with daily life and occur at least 6 months after the loss of a loved one. CG is associated with high rates of comorbid anxiety disorders (Simon et al., 2007, Shear and Skritskaya, 2012, Marques et al., in press), and includes some symptom overlap with posttraumatic stress disorder (Shear et al., 2011, Simon, 2012). There is some evidence that pre-existing anxiety may increase risk for CG following loss (Shear and Skritskaya, 2012), perhaps by promoting experiential avoidance or other maladaptive coping strategies. More research is needed to understand the presence and impact of a range of anxiety symptoms and traits on the presentation of CG.
Panic spectrum symptoms (PSS) are an array of lifetime clinical features associated with DSM-IV panic disorder. PSS are assessed along eight domains that include separation sensitivity, panic-like symptoms, stress sensitivity, medication and substance sensitivity, anxious expectation, agoraphobia, illness phobia and hypochondriasis, and reassurance orientation (Shear et al., 2002). PSS are associated with poorer quality of life and functioning in mood disorders (Benvenuti et al., 2010). However limited data are available on panic spectrum symptoms in CG.
To address this gap in the literature, we examined PSS in a sample of bereaved individuals with and without CG. We hypothesized that PSS would be significantly greater in those with CG compared to bereaved controls, and PSS would be associated with poorer quality of life among all participants.
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Participants
Participants were 72 adults enrolled in an ongoing ancillary study of baseline patient characteristics and predictors of treatment response at the Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program at the Massachusetts General Hospital. As part of the present study, they did not receive any treatment. Bereaved controls (n=44) were participants without any lifetime DSM-IV disorder who reported the loss of a loved one and had an Inventory of Complicated Grief (ICG;
Results
PAS-SR domains were moderately correlated (rs ranging from 0.53 to 0.76) and were therefore considered independent. Compared to bereaved controls, participants with CG reported significantly higher PSS on all subscales, and poorer quality of life (see Table 1). Logistic regression examining the relationship between CG status and PAS-SR, adjusting for variables that differed significantly by group (i.e., age, sex) among those without panic disorder (PD) diagnosis, revealed that CG status
Discussion
Greater lifetime PSS were present in individuals with CG compared to bereaved controls, and PSS appears to be independently associated with poorer quality of life in both CG and bereaved individuals in general. Our results with the PSS separation anxiety subscale are in line with prior research reporting an association of CG with separation anxiety (Dell'osso et al., 2011). Our findings, however, also highlight a significant relationship between CG and panic-like symptoms, stress sensitivity,
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Grief-related panic symptoms in complicated grief
2015, Journal of Affective DisordersCitation Excerpt :Simon et al. (2007) found that among 206 treatment-seeking individuals with CG, 63% met diagnostic criteria for a comorbid anxiety disorder, including 14% for PD. We also reported that individuals with CG exhibited higher levels of lifetime panic-spectrum symptoms, than otherwise healthy bereaved individuals, even after controlling for current PD diagnosis (Bui et al., 2013). Correspondingly, we found in a recent study that 18% of individuals with a primary diagnosis of PD, who lost a loved one at least six months prior, screened positive for CG compared to less than 1% in individuals without any current DSM-IV psychiatric disorders (Marques et al., 2013), and approximately 7% prevalence in the general population (Kersting et al., 2011).
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