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The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss

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Abstract

Recent studies have supported the distinctiveness of complicated and prolonged forms of grief as a cluster of symptoms that is separate from other psychiatric disorders. The distinction between prolonged and normal reactions to loss remains unclear, however, with some believing that prolonged grief represents a qualitatively distinct clinical entity and others conceptualizing it as the extreme end of a continuum. Thus, in this study a taxometric methodology was used to examine the underlying structure of grief. Participants included 1,069 bereaved individuals who had lost a first-degree relative. Each participant completed the Dutch version of the Inventory of Complicated Grief–Revised, which was used to create indicators of prolonged grief. The mean above and mean below a cut (MAMBAC) and maximum eigenvalue (MAXEIG) tests supported a dimensional conceptualization, indicating that pathological reactions might be best defined by the severity of grief symptoms rather than the presence or absence of specific symptoms.

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Notes

  1. Prolonged grief disorder is currently being considered for inclusion in DSM-V and in the past has also been referred to as complicated grief or traumatic grief. To maintain consistency the term “prolonged grief disorder” or PGD is used throughout this paper.

  2. Other taxometric procedures, such as L-Mode (latent mode factor analysis; Waller and Meehl 1998) and MAXSLOPE (maximum slope; Grove 2004), were not implemented in this study because when they were used to analyze simulated datasets that mimicked the properties of the research data (e.g., in terms of sample size, indicator skew), but had known latent structures, ambiguous results were obtained.

  3. The proposed diagnostic criteria for PGD can be found in several recent publications (e.g., Prigerson and Maciejewski 2006; Prigerson et al. 2008). In this study, Separation Distress was represented using items 3, 5, and 22. Cognitive, Emotional, and Behavioral Symptoms were represented by items 4, 7, 9, 10, 13, 14, 17, 19, 21, 23, and 24. Impairment was represented by items 28 and 29.

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Holland, J.M., Neimeyer, R.A., Boelen, P.A. et al. The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss. J Psychopathol Behav Assess 31, 190–201 (2009). https://doi.org/10.1007/s10862-008-9113-1

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