Attachment insecurities and identification of at-risk individuals following the death of a loved one

Article

Attachment insecuritiesand identification ofat-risk individualsfollowing the deathof a loved one

Angelique M. Jerga1, Phillip R. Shaver2, andRoss B. Wilkinson1

AbstractWe examined variables that might identify at-risk individuals following the death of asignificant other. Previous research indicates attachment anxiety is associated withmore intense grief, while avoidant individuals seem to cope with loss as well as secureindividuals. Participants in this study (368 adults aged 17–49) completed an online surveymeasuring general and relationship-specific attachment insecurities, relationship charac-teristics, loss circumstances, and typical and prolonged grief symptoms. Generalattachment anxiety and avoidance were related to prolonged grief symptoms but notto typical symptoms. Relationship-specific anxiety was positively related to grief symp-toms, while specific avoidance was negatively related. The results support the distinc-tion between general and specific attachment insecurities and between normative andprolonged grief reactions.

Keywordsadjustment, attachment, bereavement, coping, death, grief, loss, prolonged grief

1 Australian National University, Australia2 University of California, Davis, USA

Corresponding author:

Angelique M. Jerga, Department of Psychology, College of Medicine, Biology and Environment, Building 39,

The Australian National University, Canberra, ACT, 0200, Australia

Email: [email protected]

Journal of Social andPersonal Relationships

28(7) 891–914ª The Author(s) 2011

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For most people love is the most profound source of pleasure in our lives, while the loss of

those whom we love is the most profound source of pain. Hence, love and loss are two sides

of the same coin. We cannot have one without risking the other. (Parkes, 2006, p. 1)

The loss of a loved one is a potentially traumatic experience that everyone is likely to face at

some point. Although the majority of bereaved people recover following a loss (e.g.,

Bonanno, 2004; Bonanno, Moskowitz, Papa, & Folkman, 2005; Bonanno et al., 2002),

Raphael and Minkov (1999) estimated that approximately 9% of bereaved individuals

experience chronic grief. Little is known, however, about how to identify individuals who

are at risk for chronic grief after losing a loved one. Stroebe and Schut (2001) listed the

following kinds of risk factors that affect bereavement outcomes: (a) the bereavement sit-

uation; (b) the person; and (c) the interpersonal context. Attachment insecurities are among

the personal risk factors associated with bereavement outcomes, but they have not yet been

thoroughly researched (see Shaver & Fraley, 2008, for a review).

One of the newest and most promising models of bereavement is the Dual-Process

Model of Coping with Bereavement (Stroebe & Schut, 1999; Stroebe, Schut, & Stroebe,

2005). This model, which includes both painful thoughts about a loss (‘‘loss orienta-

tion’’) and future-oriented thoughts about accepting the loss, adjusting, and building a

reorganized life (‘‘restoration orientation’’), incorporates elements of attachment theory

and makes predictions about how people with different attachment patterns are likely to

differ in their grief reactions (Stroebe et al., 2005). A few studies have supported the pro-

posed inclusion of aspects of attachment theory in bereavement models by finding that

attachment insecurity is a risk factor for more intense grief reactions (Field & Sundin,

2001; Fraley & Bonanno, 2004; van Doorn, Kasl, Berry, Jacobs, & Prigerson, 1998;

Waskowic & Chartier, 2003; Wayment & Vierthaler, 2002). It seems likely that attach-

ment theory can provide a useful framework for understanding different patterns of grief

following losses of various kinds.

Attachment theory

Since its inception, Bowlby’s (1973, 1980, 1982) attachment theory has been focused

on separation and loss. Bowlby’s (1944) early work on maternal separation and

loss provided the basis for his three-volume work, Attachment and Loss (Vol. I,

Attachment, first published in 1969 and revised and republished in 1982; Vol. II,

Separation, 1973; Vol. III, Loss, 1980). As early as 1948, Bowlby and his colleague

James Robertson identified three phases that children go through following separation

from a parent: protest, despair, and detachment. Bowlby and Parkes (1970) later

became aware of similarities between the responses of children to separation from

a parent and the responses of adults who lost an important relationship or relationship

partner. They modified the phases of grief to include an initial phase of numbness, and

eventually Bowlby (1980) reformulated ‘‘detachment’’ as ‘‘reorganization.’’ This

change fit better with the emphasis in attachment theory on ‘‘internal working mod-

els’’ of self, partners, and relationships; it also fits better with subsequent research on

‘‘continuing [mental] bonds’’ with deceased attachment figures (summarized by

Field, 2008, and Shaver & Fraley, 2008).

892 Journal of Social and Personal Relationships 28(7)



In all three volumes of the Attachment and Loss series, Bowlby discussed individual

differences in attachment to caregivers and, later, to adult relationship partners. In these

discussions, Bowlby often contrasted anxious attachment with what was eventually

called avoidant attachment (e.g., Ainsworth, Blehar, Waters, & Wall, 1978; Mikulincer

& Shaver, 2007). These were the two main kinds of insecurity that Ainsworth et al.

(1978) identified with their famous Strange Situation laboratory assessment procedure

for infant–parent dyads, and they are the two main kinds of insecurity operationalized by

personality and social psychologists in studies of adolescent and adult attachment (e.g.,

Brennan, Clark, & Shaver, 1998; Fraley & Shaver, 2000). People who score relatively

high on measures of anxious attachment are anxious about separations, abandonment,

lack of love and support, and deficiencies in themselves. People who score relatively

high on measures of avoidant attachment are wary of intimacy and dependency, and are

likely to suppress rather than express emotions and other signs of need or vulnerability.

Bowlby (1980) described two disordered variants of grieving: chronic mourning and

the prolonged absence of conscious grieving (also called absent, delayed, inhibited, or

suppressed grief). He described adults who show a prolonged absence of conscious

grieving in ways that correspond with current conceptions of avoidant attachment,

describing them as ‘‘normatively self-sufficient people, proud of their independence and

self-control, scornful of sentiment; tears they regard as weakness’’ (p. 153), while people

with chronic grief were described in ways that correspond with attachment anxiety.

Bowlby (1980) described how people who fail to mourn loss may go on to feel deeply

dissatisfied with their lives, experiencing emptiness in personal relationships, as well

as depersonalization and a sense of unreality.

The Dual-Process Model

According to the Dual-Process Model (DPM; Stroebe & Schut, 1999; Stroebe et al.,

2005), most bereaved individuals oscillate between painful thoughts about their loss,

reminiscent of the psychoanalytic notion of ‘‘working through’’ a loss and consistent

with Bowlby’s ideas about anxious attachment, and thoughts about adjusting, changing,

and getting on with life, reminiscent of Bowlby’s ideas about secure and avoidant attach-

ment. The DPM interprets difficulties in the grieving process as either a lack of oscillation

or a disturbance in the oscillation process.

Stroebe and Schut (1999) related three kinds of grief complications – chronic, absent/

delayed or inhibited, and traumatic grief – to different coping strategies. In addition,

Stroebe et al. (2005) predicted that people with a ‘‘preoccupied’’ attachment style (low

on avoidance and high on anxiety; Bartholomew & Horowitz, 1991) would be most

likely to experience chronic grief, a state in which they remained focused on – and highly

preoccupied with – a loss orientation. Stroebe et al. predicted that people with a dis-

missing attachment style (low on anxiety and high on avoidance; Bartholomew &

Horowitz, 1991) would be most likely to experience delayed or inhibited grief, a con-

dition in which they focused mainly on the tasks of restoration and moving on while

avoiding processing the loss (i.e., avoiding loss-oriented reminders and stressors). They

predicted that people with a disorganized attachment style (high on both anxiety and

avoidance; Bartholomew & Horowitz, 1991) would be more likely to experience a

Jerga et al. 893



disturbance of the oscillation process, experiencing both intense and persistent periods of

confrontation with the loss, on the one hand, and an inability to confront or reorganize

thoughts and feelings about it, on the other.

Empirical evidence

There is some evidence that a person’s attachment ‘‘style,’’ or characteristic pattern of

cognition, emotion, emotion-regulation, and behavior in close relationships, has an effect

on experiences and behavior following the loss of a close relationship (Field & Sundin,

2001; Fraley & Bonanno, 2004; Wayment & Vierthaler, 2002). People with a secure

attachment style tend to fare better after the loss of a loved one than people with an inse-

cure attachment style. However, there can be different reactions as a function of the dif-

ferent kinds of insecurity – anxiety and avoidance.

Studies investigating attachment and bereavement have often found an association

between attachment anxiety and grief symptoms, but little or no association between

avoidant attachment and symptoms (Field & Sundin, 2001; Fraley & Bonanno, 2004;

Wayment & Vierthaler, 2002). Fraley and Bonanno (2004), for example, investigated

attachment insecurities and intensity of grief and found that participants with a pre-

occupied or fearful attachment style (i.e., the two styles characterized by high attachment

anxiety) experienced more intense grief over time, while those with a secure or dis-

missing attachment style (i.e., those who scored relatively low on attachment anxiety)

were more resilient. This latter finding (i.e., little difference between secure and dis-

missing individuals) contradicts widely held beliefs that people with a dismissingly

avoidant attachment style are likely to experience grief complications in the form of a

delayed grief response (e.g., Belitsky & Jacobs, 1986; Parkes, 1965; Rando, 1992;

Worden, 1982). Other studies support these findings, with attachment anxiety being

positively related to grief symptoms, and avoidant attachment having little or no rela-

tionship with grief symptoms (Field & Sundin, 2001; Wayment & Vierthaler, 2002).

Studies investigating attachment styles and romantic dissolution, another important kind

of loss, have yielded similar findings (Davis, Shaver, & Vernon, 2003; Sprecher,

Felmlee, Metts, Fehr, & Vanni, 1998). Two studies have even revealed a significant

negative association between avoidant attachment and post-breakup distress (Feeney &

Noller, 1992; Simpson, 1990). In fact, Feeney and Noller (1992) found that avoidant

individuals reported being ‘‘quite’’ relieved after their relationship ended.

Wijngaards-de Meij et al. (2007) are the only investigators who found a positive asso-

ciation between avoidant attachment and grief symptoms following loss. They con-

ducted a study of bereaved parents and showed that both anxious and avoidant

attachment were related to grief and depression symptoms following the death of their

child. This study, however, concerns the loss of a caregiving relationship rather than

an attachment relationship, as defined in attachment theory, and therefore is a loss of

a different kind than examined in most other studies (e.g., loss of a parent, grandparent,

romantic partner, or friend).

In summary, in studies of losses of attachment figures, a positive association between

attachment anxiety and grief symptoms has been observed, whereas no association and

sometimes even a negative association has been found between avoidant attachment and




grief symptoms, whether following a loss caused by death or one caused by the dis-

solution of a romantic relationship. These findings contradict common beliefs of

bereavement theorists and clinicians (e.g., Belitsky & Jacobs, 1986; Parkes, 1965;

Rando, 1992; Worden, 1982), who expect avoidant defenses applied early in the

bereavement process to portend a later, delayed grief response. Traditional bereavement

theory postulates that failure to work through a loss, including the emotional pain of the

loss, may result in a delayed grief reaction.

With this background in mind, we designed a study to examine relations between

attachment insecurities and adjustment to loss, but with the special goal of understanding

more about the divergence between theoretical notions of delayed or inhibited grief and

the lack of empirical support for it. There are a few reasons why avoidant attachment

may have been unrelated to grief symptoms in previous bereavement research (Field &

Sundin, 2001; Fraley & Bonanno, 2004; Wayment & Vierthaler, 2002).

Firstly, previous research did not assess grief symptoms in line with current concep-

tions of prolonged or complicated grief. Prigerson (e.g., Prigerson et al., 2009) has pio-

neered the creation of a diagnostic category, complicated grief, which is now called

Prolonged Grief Disorder (PGD). It has been proposed for inclusion in the DSM V, and is

best represented by the Prolonged Grief Inventory (PG-13; Prigerson et al., 2009). The

eight symptoms of grief assessed by Fraley and Bonanno (2004) covered only four of the

11 symptoms in the PG-13 (yearning, trouble accepting the loss, life as empty and mean-

ingless, and interpersonal difficulties), leaving aside over 60% of the items in the PG-13

(intense sorrow, avoiding reminders, shock, role confusion, bitterness, trouble moving

on, emotional numbness). Wayment and Vierthaler (2002) and Field and Sundin (2001)

used the 13-item Texas Revised Inventory of Grief (TRIG; Faschingbauer, Zisook, &

DeVaul, 1987), which included the contents of only one item from the PG-13 (trouble

accepting the loss). Previous studies on attachment and loss, while assessing grief symp-

toms, have failed to assess symptoms of prolonged or complicated grief. It may be that

avoidant attachment is related only to more complicated or prolonged grief symptoms,

which indicate the difficulties some people have in reinvesting in the world after a loss.

Secondly, previous research has been inconsistent with respect to the con-

ceptualization and measurement of attachment patterns. For example, Fraley and

Bonanno (2004) and Wayment and Vierthaler (2002) assessed attachment generally,

whereas Field and Sundin (2001) assessed attachment specific to the relationship with

the deceased. While general (or global) and specific attachment insecurities are related

conceptually, they are not interchangeable and should be assessed and discussed sepa-

rately. A variety of attachment measures have been used in previous research, with

Fraley and Bonanno (2004) using the Relationship Styles Questionnaire (RSQ; Griffin &

Bartholomew, 1994) to create the two attachment dimensions of avoidance and anxiety,

whereas Wayment and Vierthaler (2002) used the Attachment Style Questionnaire

(ASQ; Feeney, Noller, & Hanrahan, 1994) to derive three attachment styles: secure,

anxious-ambivalent, and avoidant. Field and Sundin (2001) used the Compulsive

Care-Seeking scale from the Reciprocal Attachment Questionnaire (RAQ; West &

Sheldon-Keller, 1994) to indicate attachment anxiety, even though it loaded only .49

on the anxiety factor in Brennan, Clark, and Shaver’s (1998) factor analytic study of

attachment items.

Jerga et al. 895



Thirdly, participants in previous attachment and loss studies were aware, when they

agreed to participate, that the study was designed to investigate grief and bereavement

(e.g., Fraley & Bonanno, 2004, disseminated information about the study to recently

bereaved people, and Wayment & Vierthaler, 2002, recruited bereaved people through

hospices), making it evident that the investigators were interested in loss. This may

have biased the sample, causing people to choose whether or not to participate based on

whether they were struggling to integrate the loss or were using an avoidant strategy to

keep from thinking about it. Bowlby (1980) mentioned that we may know less about

people who are ‘‘independent of affectional ties’’ (i.e., avoidant) than about other kinds

of people because ‘‘individuals disposed to assert emotional self-sufficiency are pre-

cisely those who are least likely to volunteer to participate in studies of the problem’’

(p. 211).

Fourthly, previous research has not always controlled for the closeness of the rela-

tionship with the deceased or the strength of the attachment relationship. It is possible

that people high on attachment-related avoidance report losses of a less significant nature

than those reported by other study participants. If so, the lack of a relationship between

avoidant attachment and grief symptoms might be partly a function of the kind of rela-

tionship that was lost rather than a result of avoidant coping following the loss.

Finally, previous studies have often involved small participant samples and may not

have had sufficient statistical power to detect an effect between avoidant attachment and

grief symptoms.

The present study is an attempt to address these problems and improve upon past

research by: measuring both manifestations of typical grief and symptoms of prolonged

grief; assessing attachment both generally and with respect to the particular relationship

that was lost; using measures of the two major dimensions of attachment insecurity,

anxiety and avoidance; disguising the nature of the study in the beginning to avoid

sampling biases; controlling for relationship closeness and degree of attachment; and

involving a large sample.

Hypotheses

A number of hypotheses were proposed with regard to relations between attachment and

prolonged versus typical grief. Firstly, consistent with the literature on general attach-

ment styles (i.e., not specific to a particular relationship), we expected that general

attachment anxiety would be associated with both typical and prolonged grief symptoms.

Also consistent with previous findings, general avoidant attachment was expected not to

be related to typical grief symptoms. However, based on our argument that generalized

avoidant working models would lead to a failure to resolve a loss over the longer term,

we expected that there would be an association between general avoidant attachment and

prolonged grief symptoms.

With regard to relationship-specific attachment insecurities, previous research has

shown that relationships characterized by anxious attachment (i.e., involving conflict,

ambivalence, or dependency) are associated with more intense grief symptoms and pro-

blematic adjustment to loss. Thus, we expected relationship-specific attachment anxiety

to be associated with manifestations of both typical grief and prolonged grief symptoms.




In the case of avoidant attachment, previous studies have failed to find an association

between relationship-specific avoidance and manifestations of grief, and we expected

to replicate this finding. In contrast to the predictions for general avoidant attachment,

however, because relationship-specific avoidant attachment may indicate a weaker emo-

tional bond with the lost relationship partner, we expected either no association between

relationship-specific avoidance and grief symptoms or a negative association, if

relationship-specific avoidance went with lower relationship strength.

In addition, we expected that stronger bonds, greater relationship conflict, greater

care experienced in the relationship, and the traumatic nature of the loss would be

associated with both typical and prolonged grief symptoms. Given the likely healing

effects of time on grief, we expected that time since loss would be associated with less

intense typical and prolonged grief symptoms. No predictions were made concerning

participant age or gender.

Method

Participants and design

Three hundred seventy-two undergraduate students from the University of California,

Davis (250 women and 122 men), aged 17–49 years (M ¼ 19.6, SD ¼ 2.59), completed

an online survey for class credit, and within the survey there were questions about a sig-

nificant death loss. More students than we are discussing here completed the online sur-

vey, reporting no loss or a non-death loss, but here we discuss only the data for students

who reported a death loss. Students were not aware in advance that the study was focused

on interpersonal losses. They were informed through the consent form that they would be

asked questions about their relationships, coping strategies, and current functioning.

They were also warned that they would be asked personal questions about their life and

that there was a chance that they might feel some sadness during or after completing the

survey. Students were told they could withdraw from the study at any time without pen-

alty and that there were alternate ways of obtaining research credit, including other

research studies or writing a short paper. Students who reported a loss were provided

with a debriefing statement at the end of the online questionnaire and were encouraged

to contact the researchers if they had any questions about or problems with the study. The

study was approved in advance by the Ethics Committee at the Australian National

University and the Institutional Review Board at the University of California, Davis.

Procedures and measures

Participants completed the online survey without time pressure. To begin, they answered

demographic questions and questions relating to general attachment insecurities (anxiety

and avoidance). They then answered questions about past losses and designated their

most significant loss (if no loss was reported, they moved on to the end of the survey).

The remainder of the survey dealt with this loss. Participants completed a narrative

writing task in which they described their ‘‘deepest thoughts and feelings’’ about the loss

and then answered questions about their relationship with the deceased and any recent

grief symptoms related to this loss.

Jerga et al. 897



Demographics. Questions were asked about the participant’s gender, age, ethnicity, first

spoken language, religion, and relationship status.

General attachment. General attachment insecurities, measured along the two dimensions

of anxious and avoidant attachment, were assessed with the Experiences in Close

Relationships Scale (ECR; Brennan, Clark & Shaver, 1998). Instructions focused on how

the participant generally feels and behaves in close relationships. Attachment anxiety

and avoidance were each assessed with 18 questions answered on a seven-point Likert

scale ranging from 1 (strongly disagree) to 7 (strongly agree). In past studies both scales

have been internally reliable, as indicated by high alpha coefficients, and they were again

reliable in the present study, as reported in the Results section. The item scores were

averaged to obtain each scale score, yielding means that could range from 1 to 7.

Past losses. This measure was created by the authors and includes questions regarding

past losses, including death and non-death losses. Participants answered specific ques-

tions about their most significant loss, including how the loss occurred, the circum-

stances surrounding the loss (including how traumatic it was, how prepared the

participant was, and how expected the loss was), age at the time of the loss, time since

the loss, length of the relationship with the deceased, and whether the participant had

received counseling in relation to the loss. Although participants could have chosen

either a death or a non-death loss to report as their most significant loss, here we pres-

ent only data related to a death loss.

Traumatic loss. The traumatic nature of the loss was assessed by asking, ‘‘Were the cir-

cumstances surrounding the loss traumatic?’’ The question was answered on a five-point

scale ranging from 1 (not at all) to 5 (a great deal).

Next, participants completed a narrative writing task in which they wrote con-

tinuously for five minutes about their deepest thoughts and feelings about the loss. They

then completed the following measures with reference to that particular loss.

Specific attachment. Specific attachment insecurities, both anxiety and avoidance, were

assessed with the short form of the ECR (ECR-Short Form; Wei, Russell, Mallinckrodt,

& Vogel, 2007). Instructions focused on the past relationship with the deceased. Attach-

ment anxiety and avoidance were each assessed by six items rated on a seven-point

Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The item scores

were averaged to obtain each scale score, yielding means that could range from 1 to 7.

Attachment strength. To measure the strength of the attachment to the deceased, eight

items were adapted from the Attachment Network Questionnaire (ANQ; Doherty &

Feeney, 2004). Instructions were based on the relationship with the deceased. Two items

were included for each of four attachment functions: safe haven (e.g., I would turn to this

person if I felt upset or down), secure base (e.g., I felt that I could always count on this

person, no matter what), proximity seeking (e.g., I enjoyed spending time with this

person), and separation protest (e.g., I did not like to be away from this person). Ratings

were made on a seven-point Likert scale ranging from 1 (strongly disagree) to




7 (strongly agree), and the scores were averaged to obtain a scale score, yielding a mean

that could range from 1 to 7.

Relationship quality. Two scales were used from the Relationship Rating Form (RRF;

Davis, 2001) to assess aspects of the relationship to the deceased: care and conflict. The

care scale includes 11 items and comprises three subscales: giving the utmost (e.g.,

Could you count on this person to give the utmost on your behalf?), championing (e.g.,

Could you count on this person to support you in an argument or dispute with others?),

and assistance (e.g., Could you count on this person to come to your aid when you

needed help?). The conflict scale includes three items (e.g., I would fight and argue with

this person). Items on the RRF are usually answered on a nine-point Likert scale. To

maintain response-scale consistency with the other relationship measures, the rating

scale was changed in the present study to a seven-point Likert scale ranging from

1 (strongly disagree) to 7 (strongly agree). The item scores were averaged to obtain each

scale score, yielding means that could range from 1 to 7.

Prolonged grief symptoms. Prolonged grief symptoms were measured with the PG-13

(Prigerson et al., 2009), which was designed to assess symptoms of prolonged grief and

to screen for people with PGD. Neimeyer and Hogan (2001) explained how the Inven-

tory of Complicated Grief (ICG; Prigerson et al., 1995), an earlier version of the PG-13,

‘‘was designed to distinguish between ‘normal’ grief and its more ‘pathological’ forms’’

(p. 98). Eleven questions assess the severity of prolonged grief symptoms (rated on a

five-point Likert scale), and two questions assess whether the symptoms have been

present for longer than six months and whether the person has experienced a significant

reduction in functioning (based on a yes/no response scale). The questionnaire was used

in the present study to assess the severity of prolonged grief symptoms (and not to screen

for PGD) and was therefore based on the 11 questions assessing the severity of grief

symptoms. The first two questions asked about separation distress (e.g., How often have

you felt yourself longing or yearning for the person you lost?), and the other nine ques-

tions asked about cognitive symptoms (e.g., How often have you tried to avoid reminders

that the person you lost is gone?), emotional symptoms (e.g., Do you feel emotionally

numb since your loss?), and behavioral symptoms (e.g., Do you feel that moving on

(e.g., making new friends, pursuing new interests) would be difficult for you now?). The

11 items were averaged, resulting in a mean score that could range from 1 to 5.

Manifestations of more typical grief. Manifestations of normal, or typical, grief were

measured with the Core Bereavement Items (CBI; Burnett, Middleton, Raphael, &

Martinek, 1997). This scale was designed to measure core bereavement phenomena as

experienced by a community sample of people reporting different types of losses. The

items in the scale are considered to be central to the construct of grief as conceptualized

in Western society and to represent manifestations of normal grief that are commonly

experienced by bereaved individuals and generally decline significantly over time. This

is distinguished from a more ‘‘complicated’’ or ‘‘prolonged’’ grief response, which is

better assessed using the PG-13, as previously mentioned. In a chapter describing a

variety of grief scales, Neimeyer and Hogan (2001) said that the CBI is best suited to

Jerga et al. 899



the study of ‘‘normal’’ grief responses, rather than more complicated grief trajectories (p.

98). The CBI includes 17 items that can be assembled into three subscales: images and

thoughts (e.g., Do you experience images of the events surrounding the loss?), acute

separation (e.g., Do you find yourself pining for/yearning for the person you lost?), and

grief (e.g., Do reminders such as photos, situations, music, places, etc, cause you to feel

longing for the person you lost?). The first subscale includes seven items, whereas the

second and third subscales each include five items. Items on the CBI are usually

answered on a four-point Likert scale. To maintain response-scale consistency with the

prolonged grief measure, the rating scale was changed in the present study to a five-point

Likert scale ranging from 1 (not at all) to 5 (all the time). The 17 items were averaged,

resulting in a mean score that could range from 1 to 5.

Results

A total of 372 people provided information about a death loss in the online survey. The

data were screened for missing values, violations of univariate and multivariate nor-

mality, outliers, homoscedasticity, and multicollinearity. Univariate outliers were

detected using a criterion of jzj > 3.29. Once detected, their influence was reduced by

altering the associated raw score so that it was less deviant than before. That is, scores

were manually adjusted so there was less difference between them and the closest score

that did not violate the criterion of jzj > 3.29 (see Tabachnick & Fidell, 2001). Altered

scores were only used for the regression analyses. Four multivariate outliers were

detected using the Mahalanobis distance measure in SPSS software and were deleted.

Multicollinearity and singularity were not present in the regression analyses. Homo-

scedasticity was observed in the bivariate scatterplots, but due to the large sample size it

was not considered problematic for the regression analyses.

The average age of members of the final sample of 368 (247 women, 121 men) was 19.6

years (SD ¼ 2.6). Most participants reported English as their first language (67.1%) and

were Christian (47.6%) or Agnostic (14.1%), followed by a group that chose no specific

religion (11.1%), Buddhists (9.8%), other (7.9%), Atheist (5.7%), and Jewish (3.8%). About

half of the participants (49.7%) were in a romantic relationship at the time of the study;

20.9% were in a relationship that had lasted for up to 12 months, and 28.8% had been in a

relationship for longer than a year. Of the death losses reported, the majority of the deceased

were grandparents (54.1%), followed by friends (13.0%), parents (12.8%), other relatives

(12.2%), other losses (4.3%), siblings (1.9%), and romantic partners (1.6%).

Due to the large correlation of .80 between the two grief measures, a decision was

made to factor analyze all 28 grief items to see if the two scales actually measured

distinct constructs, as intended. All 28 items were entered into an analysis using principal

axis factoring. The data were initially assessed to see if they were suitable for factor

analysis, and they were according to a Kaiser–Meyer–Olkin value of .959, a statistically

significant value for the Bartlett Test of Sphericity (Bartlett, 1954), and many coeffi-

cients greater than .30 in the correlation matrix. Cattell’s (1966) scree test indicated a

two-factor solution, as did Horn’s parallel analysis (Horn, 1965). Both a two- and a

three-factor solution, based on direct oblimin rotation, were computed. The two-factor

solution was the most interpretable and fit the data best. Items were chosen that best




discriminated between the two factors. Loadings had to exceed .50 and cross-loadings

had to be lower than .32. Based on these criteria, six items from the CBI scale were

removed (CBI6, CBI11, CBI12, CBI14, CBI15, CBI17). Besides not meeting our cri-

teria, all of these six items had mean values that were lower than the overall mean value

for the CBI, indicating that they were not strongly endorsed by participants. The removal

of these items left 22 items, with 11 items on each of the two scales. The remaining 22

items were re-analyzed, using principal axis factoring and direct oblimin rotation (see

Table 1 for the final solution). Factor 1 included mostly items from the CBI, with only

two items from the Prolonged Grief Scale. All of the items assess typical grief symptoms,

such as thinking about the deceased, missing the deceased, being reminded of the

deceased, and longing and yearning for the deceased. Factor 2 included mostly items

from the PG-13, with only two coming from the CBI. The two items from the CBI had

the lowest means of the remaining CBI items, indicating that they were not frequently

endorsed by participants. The items on Factor 2 concern difficulties reinvesting in the

world, such as difficulty trusting people, feeling that life is empty, and feeling emotion-

ally numb. The first factor, which we will call, for present purposes, typical grief symp-

toms, accounted for 48.10% of the item variance. The second factor, which we will call

prolonged grief symptoms, accounted for 7.64% of variance. Unit-weighted scores were

computed for the two factor-based scales. The reliability of the first scale, typical grief

symptoms, was .94 and the reliability for the second scale, prolonged grief symptoms,

was .91. The first scale was correlated .96 with the CBI (Burnett et al., 1997), and the

second scale was correlated .97 with the PG-13 (Prigerson et al., 2009), supporting the

naming of these two scales. The correlation between the two scales was .70.

The correlations among the variables used in the regression analyses are presented in

Table 2. The scale reliabilities are reported in parentheses along the diagonal of the table

and range from .69 to .94. The means and standard deviations are presented in the last

two rows of the table.

The two general attachment dimensions were significantly correlated (r ¼ .37), as

were the two specific attachment dimensions (r ¼ .43). General and specific attachment

dimensions were all significantly correlated with each other (see Table 2). With respect

to typical grief symptoms, neither general attachment anxiety nor specific attachment

anxiety was related to typical grief symptoms, contrary to expectations. As predicted,

general avoidant attachment was not significantly related to typical grief symptoms.

However, specific attachment avoidance was negatively associated with typical grief

symptoms (r ¼ –.21). In addition, the following variables were significantly correlated

with typical grief symptoms as expected: attachment strength, relationship conflict and

care, the traumatic nature of the loss, and prolonged grief symptoms. Time since loss

was, as expected, negatively correlated with typical grief symptoms.

With respect to prolonged grief symptoms, as hypothesized, both general and specific

attachment anxiety, and general but not specific avoidant attachment, were associated

with more intense prolonged grief symptoms. Other variables were significantly corre-

lated with prolonged grief symptoms, as predicted, including attachment strength,

relationship care, relationship conflict, the traumatic nature of the loss, and typical grief

symptoms. Time since loss was, as expected, significantly and negatively correlated with

symptoms of prolonged grief.

Jerga et al. 901



All four attachment dimensions were significantly correlated with relationship

conflict (in the lost relationship), with specific attachment anxiety correlating most

highly (r ¼ .58). All four attachment dimensions were also significantly, negatively

correlated with relationship care (the degree of care in the relationship with the

deceased), with specific avoidant attachment correlating most strongly in the negative

Table 1. Pattern matrix for final two-factor solution with 22 items

Factor 1 Factor 2

CBI4: Do you think about X? .933 –.161CBI8: Do you find yourself missing X? .905 –.156CBI9: Are you reminded by familiar objects (photos,

possessions, rooms etc) of X?.802 –.053

CBI2: Do thoughts of X come into your mindwhether you wish it or not?

.684 .201

PG1: In the past month, how often have you feltyourself longing or yearning for the person youlost?

.680 .147

CBI16: Do reminders of X such as photos, situations,music, places, etc, cause you to feel sadness?

.666 .123

CBI1: Do you experience images of the events sur-rounding the loss of X?

.658 .170

CBI13: Do reminders of X such as photos, situations,music, places, etc, cause you to feel longing for X?

.646 .177

CBI10: Do you find yourself pining or yearning for X? .594 .276CBI7: Do you find yourself thinking of reunion with

X?.590 .052

PG2: In the past month, how often have you hadintense feelings of emotional pain, sorrow, orpangs of grief related to the lost relationship?

.544 .300

PG11: Do you feel emotionally numb since your loss? –.063 .829PG8: Has it been hard for you to trust others since

your loss?–.177 .828

PG12: Do you feel that life is unfulfilling, empty, ormeaningless since your loss?

–.054 .793

PG9: Do you feel bitter over your loss? .125 .663PG4: In the past month, how often have you tried to

avoid reminders that the person you lost is gone?.064 .660

PG10: Do you feel that moving on (e.g., making newfriends, pursuing new interests) would be difficultfor you now?

.012 .659

PG6: Do you feel confused about your role in life orfeel like you don’t know who you are (i.e., feelingthat a part of yourself has died)?

.123 .593

PG5: In the past month, how often have you feltstunned, shocked, or dazed by your loss?

.226 .571

CBI5: Do images of X make you feel distressed? .177 .550CBI3: Do thoughts of X make you feel distressed? .215 .539PG7: Have you had trouble accepting the loss? .210 .528




Tab

le2.

Des

crip

tive

stat

istics

and

corr

elat

ions

among

vari

able

sin

the

regr

essi

on

anal

yses

12

34

56

78

910

11

12

13

1.A

ge–

.05

.21**

.09

.07

.06

–.0

7.0

7.0

7.1

2*

.11*

–.0

2.0

52.G

ender

––.0

7–.1

0*

.07

.08

.10

.04

–.1

2*

.12*

–.0

3–.0

4–.0

23.T

ime

since

loss

–.0

1.0

5.0

2–.1

4**

–.0

3.0

9–.1

0.0

0–.2

4**

–.1

6**

4.T

raum

atic

loss

––.0

3–.0

1–.2

9**

.01

.38**

.05

.35**

.36**

.24**

5.G

ener

alav

oid

ance

(.93)

.37**

.22**

.21**

–.1

3*

.17**

–.1

5**

.06

.28**

6.G

ener

alan

xie

ty(.94)

.21**

.26**

–.0

2.1

1*

–.1

1*

.07

.23**

7.Sp

ecifi

cav

oid

ance

(.82)

.43**

–.7

7**

.31**

–.5

9**

–.2

1**

–.0

28.Sp

ecifi

can

xie

ty(.69)

–.1

9**

.58**

–.2

3**

.09

.32**

9.A

ttac

hm

ent

stre

ngt

h(.91)

–.1

5**

.76**

.38**

.21**

10.C

onfli

ct(.85)

–.0

8.2

3**

.41**

11.C

are

(.92)

.41**

.21**

12.T

ypic

algr

ief

(.94)

.70**

13.Pro

longe

dgr

ief

(.91)

Mea

n19.6

2–

4.7

03.8

23.1

73.3

52.6

42.1

65.2

61.8

95.1

82.2

01.6

0SD

2.5

9–

3.8

51.2

21.1

51.1

41.1

91.0

21.3

41.3

01.3

1.8

6.7

0

*p<

.05,**

p<

.01,N¼

368

dea

thlo

sses

.Par

enth

esiz

edco

effic

ients

along

the

dia

gonal

indic

ate

the

relia

bili

tyofea

chsc

ale.

903



direction (r ¼ –.59). General avoidant attachment, specific avoidant attachment, and

specific attachment anxiety were all significantly negatively correlated with attachment

strength (the strength of the attachment relationship with the deceased), with specific

avoidant attachment correlating most negatively (r ¼ –.77).

Prediction of typical grief

A hierarchical regression analysis was conducted to see whether general and specific

attachment insecurities were related to typical grief symptoms after controlling for the

other major predictors (see Table 3). The final model was significant F (11, 356) ¼18.94, p < .01, and accounted for 36.9% of the variance in typical grief symptoms. In the

first step, age, gender, time since loss, and the traumatic nature of the loss were entered

as predictors, resulting in R2 ¼ .19, F (4, 363) ¼ 21.46, p < .01. The traumatic nature of

the loss was a significant positive predictor of typical grief symptoms (b¼ .36, p < .001)

and time since loss was a significant negative predictor (b ¼ –.25, p < .001). Age and

gender did not significantly predict typical grief symptoms.

In step 2, general attachment anxiety and avoidance were entered as predictors, with

the result that R2 ¼ .20, F (6, 361) ¼ 15.09, p < .05, and an additional 1% of the

variance was explained, which was a non-significant contribution to the model. Neither

avoidance (b ¼ .06, p ¼ .245) nor anxiety (b ¼ .06, p ¼ .253) made a unique and sig-

nificant contribution to the model.

In step 3, specific attachment anxiety and avoidance were added to the model, R2¼ .25,

F (8, 359) ¼ 14.96, p < .01, and this resulted in a significant increment in variance

explained (R2D ¼ .05; see Table 3). Specific attachment anxiety was associated with

typical grief symptoms (b¼ .16, p < .01) and specific avoidant attachment was negatively

associated with these symptoms (b ¼ –.26, p < .001).

In step 4, attachment strength was added to the model, yielding R2 ¼ .31, F (9, 358) ¼17. 46, p < .01, and a further significant increase in explained variance (R2D ¼ .055;

see Table 3). Strength was positively associated with typical grief symptoms (b ¼ .40, p <

Table 3. Multiple regression analysis predicting typical grief

Betastep 1

Betastep 2

Betastep 3

Betastep 4

Betastep 5 F D

Age .01 .00 –.03 –.03 –.08 21.46**Gender –.02 –.03 –.03 –.01 –.05Time since loss –.25** –.25** –.28** –.27** –.23**Traumatic loss .36** .36** .29** .23** .19**General avoidance .06 .08 .09 .08 2.09General anxiety .06 .06 .02 .06Specific avoidance –.26** .06 .01 11.86**Specific anxiety .16** .11* .02Attach. strength .40** .19* 28.34**Conflict .23** 18.10**Care .25**

R2 ¼ 0.191** R2 D¼ 0.009 R2 D¼ 0.050** R2 D¼ 0.055** R2 D¼ 0.064** R2 ¼ 0.369**

*p < .05, **p < .01, N ¼ 368 death losses.




.001), and its inclusion in the regression model reduced the beta coefficient for specific

avoidant attachment to non-significance, suggesting that the significant negative association

between specific avoidant attachment and typical grief symptoms was due to the weaker

strength of avoidant individuals’ attachment bond with the lost person.

In step 5, with relationship conflict and care added to the model, R2¼ .37, F (11, 356)

¼ 18.94, p < .01, and there was a further significant increment in variance explained

(R2D ¼ .064; see Table 3). Relationship conflict and care were both significant pre-

dictors of typical grief symptoms (b ¼ .23, p < .001 and b ¼ .25, p < .001, respectively),

and the beta coefficient for specific attachment anxiety was no longer significant, sug-

gesting that conflict and care may have mediated the association between specific

attachment anxiety and typical grief symptoms.

In the final regression model, the following variables were positively associated with

typical symptoms: traumatic nature of the loss, attachment strength, and relationship

conflict and care. Time since loss was negatively associated with symptoms, and specific

attachment insecurities were no longer significantly related to symptoms.

Prediction of prolonged grief

A hierarchical regression analysis was conducted to see whether general and specific

attachment insecurities were uniquely related to prolonged grief symptoms after controlling

for the other major predictors (see Table 4). The final regression model was significant,

F (11, 356)¼ 19.43, p < .01, and accounted for 37.5% of the variance. In step 1, age, gender,

time since loss, and the traumatic nature of the loss were added to the model, R2 ¼ .09,

F (4, 363)¼ 8.62, p < .01. The traumatic nature of the loss was a significant predictor of these

symptoms (b ¼ .24, p < .001) and time since loss was inversely related to symptoms (b ¼–.17, p < .01). Age and gender did not have significant beta coefficients.

In step 2, with the global attachment dimensions entered, R2 ¼ .19, F (6, 361) ¼14.20, p < .01, and both general avoidant attachment (b ¼ .24, p < .001) and general

Table 4. Multiple regression analysis predicting prolonged grief

Betastep 1

Betastep 2

Betastep 3

Betastep 4

Betastep 5 F D

Age .04 .03 –.01 –.01 –.06 8.62**Gender –.01 –.04 –.04 –.03 –.07Time since loss –.17** –.19** –.20** –.19** –.15**Traumatic loss .24** .24** .19** .15** .11*General avoidance .24** .23** .23** .22** 23.25**General anxiety .15** .12* .08 .12*Specific avoidance –.20** .02 –.03 19.33**Specific anxiety .32** .28** .13*Attach. strength .27** .15 13.22**Conflict .32** 22.67**Care .16*

R2 ¼ 0.087** R2 D¼ 0.104** R2 D¼ 0.079** R2 D¼ 0.026** R2 D¼ 0.080** R2 ¼ 0.375**

*p < .05, **p < .01, N ¼ 368 death losses.

Jerga et al. 905



attachment anxiety (b ¼ .15, p < .01) were significantly related to prolonged symptoms,

accounting for 10.4% of the variance (see Table 4).

In step 3, specific attachment anxiety and avoidance were entered, and R2¼ .27,

F (8, 359) ¼ 16.56, p < .01, with an additional 7.9% of the variance in symptoms being

accounted for (see Table 4). Specific attachment anxiety significantly predicted pro-

longed symptoms (b ¼ .32, p < .001) and specific avoidant attachment was negatively

associated with them (b ¼ –.20, p < .001).

In step 4, attachment strength was added as a predictor, and R2 ¼ .30, F (9, 358) ¼16.69, p < .01, resulting in a significant increment in R2 (R2D ¼ .026, see Table 4).

Attachment strength was positively associated with prolonged symptoms (b ¼ .27, p <

.001), and its inclusion in the model reduced the beta coefficient for specific avoidant

attachment to non-significance (similar to step 4 of the regression analysis predicting typ-

ical grief symptoms). This suggests, again, that the negative association between specific

avoidance and grief symptoms was mediated by strength of attachment.

In step 5, relationship conflict and care were entered, and R2 ¼ .38, F (11, 356) ¼19.43, p < .01, with there being a significant increment in variance explained (R2D¼ .08,

see Table 4). Relationship conflict and care were both positively associated with pro-

longed grief symptoms (b ¼ .32, p < .001 and b ¼ .16, p < .05, respectively). The beta

coefficient for specific attachment anxiety, although still significant, was reduced from

.28 to .13, suggesting that conflict and care within the relationship partially mediated the

association between relationship-specific attachment anxiety and prolonged symptoms.

In the final regression model the following variables were significant predictors of pro-

longed grief symptoms: traumatic nature of the loss, general attachment anxiety and

avoidance, specific attachment anxiety, and relationship conflict and care. Time since loss

was negatively associated with prolonged symptoms. Relationship-specific avoidant attach-

ment and attachment strength were unrelated to prolonged grief symptoms in the final model.

We were interested in testing whether the attachment variables would remain sig-

nificant predictors of prolonged grief symptoms once normal manifestations of grief,

represented by typical grief symptoms, entered the model. The three attachment vari-

ables remained significant predictors of prolonged grief symptoms, as did relationship

conflict, but relationship care, time since loss, and traumatic nature of the loss became

non-significant. Thus, attachment and relationship conflict contributed to a person’s

moving beyond typical grief symptoms to prolonged adjustment difficulties.

We were also interested in determining whether there were any significant interac-

tions between the general attachment scores and the specific attachment scores, for both

grief outcome variables. Interactions were tested with and without the control variables

(age, gender, time since loss, and traumatic nature of the loss) and none were found to be

significant. Thus, only the main effects will be discussed.

Discussion

The main purpose of this study was to examine associations between general and specific

attachment insecurities, on the one hand, and experiences of grief following a death loss,

on the other. General attachment anxiety, reflecting general working models of

relationships characterized by conflict and ambivalence, was expected to be associated




with both ‘‘normal,’’ or typical, manifestations of grief and prolonged grief, the latter

state having been associated in the past with failure to resolve feelings and issues related

to the deceased. This hypothesis was partially supported, in that general attachment

anxiety was correlated with a measure of prolonged grief symptoms (closely related to

Prigerson et al.’s, 2009, measure of these symptoms) and predicted these symptoms in a

regression analysis, even after measures of specific relationship factors were statistically

controlled. General attachment anxiety was not significantly correlated with our measure

of more typical, or normative, grief symptoms and did not predict these symptoms in a

regression analysis. These findings suggest that people who are generally anxious in

close relationships are vulnerable to prolonged grief symptoms, even though they do not

necessarily experience more intense normative grief symptoms.

Turning to avoidant attachment, we expected that general avoidant attachment would

predict prolonged grief symptoms but not typical grief symptoms. This hypothesis was

confirmed by a significant correlation between general avoidant attachment and pro-

longed grief symptoms, but not typical or normative grief symptoms. The hypothesis was

also supported in all steps of a regression analysis. This finding suggests that people who

are generally avoidant in close relationships experience long-term difficulties adjusting

to the loss of a loved one, even though they do not necessarily experience more intense

typical grief symptoms, a lack of relationship that had been found in previous studies.

In relation to specific attachment insecurities in the relationship with the deceased,

attachment anxiety was expected to be related to both typical and prolonged grief

symptoms. Specific avoidance, however, was expected to be unrelated, or possibly

negatively related, to either kind of symptoms. The first of these hypotheses was largely

supported. Specific attachment anxiety was correlated with prolonged grief symptoms,

and significantly predicted prolonged grief symptoms in every step of a regression

analysis. Specific attachment anxiety was not significantly correlated with typical grief

symptoms, and although it was a significant predictor in steps 3 and 4 of a five-step

regression analysis, it became non-significant in the fifth step when relationship conflict

and care were statistically controlled. These results indicate that people who were more

anxiously attached to the deceased individual experienced more intense grief after the

person’s death, but this may have happened because they had experienced more conflict

with the person and received more care from him or her. This kind of ambivalence (want-

ing care but provoking conflict) is characteristic of people who score high on attachment

anxiety (Mikulincer, Shaver, Bar-On, & Ein-Dor, 2010).

Our predictions regarding relationship-specific avoidance were also largely sup-

ported. Relationship-specific avoidance was not significantly correlated with prolonged

grief symptoms, but it was negatively correlated with typical grief symptoms. It was also

unrelated to both prolonged and typical grief when other relationship variables were

included in a regression analysis. Specific avoidance was negatively related to both pro-

longed and typical grief symptoms when it was entered into the regression analyses, but

when attachment strength was included in the model predicting either typical or pro-

longed grief symptoms, the association with avoidance became non-significant. These

results fit with previous studies of attachment insecurities and romantic dissolution,

which have found a negative association between avoidant attachment and post-

breakup distress (Feeney & Noller, 1992; Simpson, 1990). Our results suggest that the

Jerga et al. 907



specific bond to the deceased may not have been as strong for more avoidant individuals,

leaving less to grieve about in comparison with people who were emotionally close to the

people they lost. The strong negative correlation between specific avoidant attachment

and attachment strength to the deceased (r ¼ –.77) clearly supports this idea.

Our results also support the predictions made regarding the remaining relationship

factors. Attachment strength, relationship conflict, and relationship care were correlated

with manifestations of typical grief and prolonged grief symptoms and were significant

predictors of these variables in regression analyses (with the exception of attachment

strength in the final step of the prolonged grief model). These results indicate that the

greater the strength of the attachment bond with the deceased, the greater the degree of

care in the relationship with the deceased, and the greater the degree of conflict in the

relationship with the deceased, the greater was the grief experienced after the loss. As

expected, time since loss was negatively correlated with both typical and prolonged grief

symptoms and was inversely related to both outcome variables in the regression anal-

yses, confirming, as expected, that grief declines in intensity over time. The loss being

traumatic was correlated with both kinds of grief symptoms and was a significant pre-

dictor of both, even when attachment variables and relationship quality were statistically

controlled. Age and gender were unrelated to grief symptoms of either kind.

We were interested in distinguishing, to the extent possible, general attachment

insecurities from relationship-specific attachment insecurities. The two have often been

confused or conflated in previous research on attachment and loss. By measuring the two

kinds of attachment insecurity separately and measuring both typical and prolonged grief

symptoms, we hoped to shed light on previous studies that have not found an association

between avoidant attachment and grief symptoms.

Two important findings emerged when examining the different outcomes of general

and specific attachment insecurities. First, there was a difference between general and

specific avoidant attachment when predicting prolonged grief symptoms. General

avoidant attachment was positively associated with prolonged grief symptoms, but

specific avoidant attachment was not, and in fact specific avoidant attachment was

negatively related to these grief symptoms even after controlling for general attachment

in a regression analysis. Second, the association between general avoidant attachment

and grief symptoms was present only in the case of prolonged or complicated grief

symptoms, and not with respect to normative or typical grief. These two findings help to

explain why previous studies have failed to find a significant association between

avoidant attachment and reactions to loss (Field & Sundin, 2001; Fraley & Bonanno,

2004; Wayment & Vierthaler, 2002). In relation to the first point, Field and Sundin

(2001) investigated the association between specific avoidant attachment to the deceased

and grief symptoms, based on the assumption that the specific attachment to the

deceased spouse was an expression of the bereaved individual’s general attachment

style. As shown in the present study, however, global and specific avoidant attachment

are not related in the same way to grief symptoms. In relation to the second point,

previous investigators have measured grief in different ways. As mentioned in our

Introduction, Fraley and Bonanno (2004) included four of the 11 prolonged grief

symptoms in their study, while Wayment and Vierthaler (2002) and Field and Sundin

(2001) included only one of the 11 prolonged grief symptoms. It is possible that




previous studies have assessed mainly manifestations of normal grief, inadvertently

resulting in a failure to find an association between avoidant attachment and experi-

ences of prolonged grief.

Wijngaards-de Meij et al. (2007), although assessing a caregiving rather than an

attachment relationship with the deceased, were the only previous investigators who

found a relation between avoidant attachment and grief symptoms. Interestingly, they

used the ICG (Prigerson et al., 1995) – an early version of the PG-13 used in our study.

Previous research may have underestimated the importance of distinguishing between

normal and prolonged grief symptoms. Other factors that may have affected previous

findings include small sample sizes, the transparent nature of the studies in the eyes

of participants, failing to assess strength of the attachment to the deceased individual,

and assessing grief symptoms closely following the loss.

Turning to attachment anxiety, both general and specific attachment anxiety were

associated with prolonged grief symptoms, making it less critical that previous studies

failed to differentiate between the two types or levels of attachment. General attachment

anxiety did not predict manifestations of normal grief, however, and specific attachment

anxiety predicted these symptoms only in the initial steps of a regression analysis, sug-

gesting that the apparent main effects were mediated by care and conflict. The finding that

general attachment anxiety was unrelated to normal grief symptoms seems inconsistent

with previous research findings on attachment and loss (Fraley & Bonanno, 2004; Way-

ment & Vierthaler, 2002). This inconsistency may be related to the different samples, with

the other studies using much older samples and where a number of people reported the loss

of a spouse, a loss reported by less than 2% of people in the current study.

So, why are general attachment anxiety and avoidance related to prolonged grief

symptoms but not to more normative manifestations of grief? When describing the

effects of disordered mourning, Bowlby (1980) wrote about the impact on relationships

as well as one’s ability to organize one’s life.

Disordered variants of mourning lead to many forms of physical ill health as well as of

mental ill health. Psychologically they result in a bereaved person’s capacity to make and

to maintain love relationships becoming more or less seriously impaired or, if already

impaired, being left more impaired than it was before. Often they affect also a bereaved per-

son’s ability to organize the rest of his life. (p. 137)

Normative manifestations of grief include missing and yearning for the deceased, but

do not usually include a person’s level of functioning in daily life. The symptoms of

prolonged grief assessed in the present study included difficulties experiencing emo-

tions, forming and maintaining close relationships, and reinvesting in the world and

organizing one’s life. It is possible that the items in the prolonged grief measure are able

to detect the impact of loss on avoidant people’s lives to an extent that other measures do

not. Bowlby (1980) discussed these research difficulties:

First, it is in the nature of the condition that, to an external eye, their mourning should often

appear to be progressing uneventfully. As a result, in all studies except those using the most

sophisticated of methods, it is easy to overlook such people and to group them with those

whose mourning is progressing in a genuinely favourable way. (p. 211)

Jerga et al. 909



Another goal of our study, beyond examining attachment and loss, was to identify

factors that helped to predict and explain prolonged grief symptoms. Around 9% of

people are likely to exhibit a chronic grief response, and it is important to understand

who is at risk for this disabling experience. Attachment insecurities accounted for over

10% of the variance in prolonged grief symptoms, and the nature of the specific

attachment relationship accounted for an additional 8% of the variance. Other rela-

tionship variables (relationship strength, care, and conflict) accounted for an additional

11% of the variance, and circumstances surrounding the loss accounted for 9% of the

variance. Attachment insecurities, both general and specific to the relationship,

accounted for over 18% of the variance. It may be useful to consider attachment issues

and other variables when identifying people who may be at risk for psychological

problems following the loss of a loved one.

Limitations and future research

Although we consider our results to be both enlightening and clinically useful, several

limitations should be considered. First, and perhaps most importantly, we cannot be sure

that a person’s attachment orientation after a loss is the same as it was before the loss. It

is possible that people who experienced a difficult loss became more avoidant or anxious

as a result. With respect to specific attachment insecurities, it is possible that a person’s

view of his or her relationship with the deceased was affected by the loss, resulting in

either idealization or minimization of its importance. In addition, if the relationship

ended long before our study, it is possible that a person’s description of it was affected by

memory errors or biases.

Another possible limitation of our study is the heterogeneous nature of the losses.

Because of our participants’ youth, most of their losses were of parents and grandparents.

Loss of a romantic partner, the kind of loss most often studied previously, was rare in our

sample. The type of loss may help to explain why general attachment anxiety did not

have as strong an association with manifestations of normal grief as had been reported in

several previous studies.

The relative youth of our sample is also a limitation of the study. Most of the par-

ticipants were between the ages of 18 and 25, with an average age of 19.6 years, and all

were university students living in the United States. The sample is not representative of

the general population, even of the United States, which may limit the generalizability of

the results.

Future research can benefit from separately assessing general and specific attachment

insecurities and from using a variety of measures to assess adjustment to a loss. Given the

multiple factors associated with grief, many probably having relatively small effect

sizes, it is important that future research in this area employs adequately large samples.

Moreover, methods will need to be employed that allow for the investigation of different

kinds of relationship losses. Finally, to enable the detection of delayed grief symptoms,

future research should extend the length of time considered following a loss and include

measures of prolonged grief symptoms that are indicative of problematic adjustment to

the loss.




Conclusions

Although previous research has generally supported the view that people with an

avoidant attachment style cope well with loss, the present study questions this view by

finding that general avoidant attachment is significantly related to prolonged grief

symptoms. Although theorists have written about avoidant attachment as a precursor of

delayed or inhibited grief responses, previous research seemed not to support this

clinically based understanding. Our results suggest that the hypothesis should continue to

be entertained, and that it deserves to be studied with adequately complex measures and

research designs.

Conflict of interest statement

The author(s) declared no conflicts of interest with respect to the authorship and/or publication of

this article.

Funding

This research received no specific grant from any funding agency in the public, commercial, or

not-for-profit sectors.

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Attachment insecurities and identification of at-risk individuals following the death of a loved one

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