title: Periloss dissociation, symptom severity, and treatment response in complicated grief.
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.
authors.affiliation: Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. tebui@partners.org
authors.forename: Eric
authors.initials: E
authors.lastname: Bui
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Simon
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Robinaugh
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Leblanc
authors.forename: Yuanjia
authors.initials: Y
authors.lastname: Wang
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Skritskaya
authors.forename: Christine
authors.initials: C
authors.lastname: Mauro
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
mesh_terms: D000328:Adult; D003863:Depression / Q000628:therapy*; D004213:Dissociative Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006117:Grief; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome