Recent research indicates that adults experiencing complicated grief are also highly likely to haveseparation anxietyand worse depression symptoms, among other mental health challenges.

In a 2016 research study, Dr. Camilla Gesi and colleagues examined the relationship between complicated grief (CG) and separation anxiety disorder (SEPAD). The study involved a sample of adults seeking help for CG1。The researchers wanted to understand how common SEPAD is among people experiencing CG, and if those with both CG and SEPAD were more likely to suffer from other mental health problems, too.

What Is Complicated Grief?

复杂的悲伤,也称为创伤悲伤或长期悲伤障碍,可能发生在非常亲密的人之后。研究表明它会影响10%至20%的失去失去的人2, and it is associated with a negative impact on physical and mental health3


    • significant difficulty accepting the death
    • 憎恨
    • 积极回忆关于死者的困难
    • 愤怒
    • 自责
    • avoidance of reminders of the loss
    • social/identity disruption


Separation anxiety disorder is usually considered something seen only in children. But research shows that people can experience SEPAD over their lifespan, and it can even begin in adulthood in some cases4。有Sepad报告的人们激烈并造成与他们的实际或想象的分离的焦虑oved的或家庭环境,导致需要维持物理接近。Sepad被认为发生在约23%至40%的心理健康问题中5


在寻求CG的151位成年人的样本中,研究人员发现,近70%也有Sepad,这是比以前的研究更高的速率。经历合并的人(同时)CG和Sepad也更有可能在父母,配偶或儿童除外的丧失中报告CG症状。有趣的是,与单独使用Cg的人相比,在具有CoMorbid Sepad和CG的个体之间发生死亡(剧烈或非侵略性)的情况没有差异。

此外,患有合并Sepad和CG的个体更有可能报告与之一致的症状posttraumatic stress disorder(PTSD)和金宝博188滚球推荐在他们的寿命过程中。据报道,那些报告的人和Sepad还报告了更严重的CG,以及他们的工作,学校,休闲和家庭关系中的更大困难。

The group with comorbid CG and SEPAD also reported more peritraumatic dissociative symptoms, which include increased confusion, altered time perceptions, feelings of unreality, and feeling as if they were in a dream while awake. And this group reported more depression symptoms. The results of this study suggest that individuals who experience CG and SEPAD have a lot of distress — significantly more than those who suffer from CG alone.

A Theory May Explain the Relationship

The researchers in this study suggest that the high correlation between symptoms of CG and SEPAD may be explained by attachment theory. Its central assumption is that as humans, we have an innate motivation to form and maintain close emotional bonds to meet our emotional and instrumental needs. This process of seeking and forming attachments is hardwired in our neurobiological systems6

The British psychologist John Bowlby, a central figure in attachment theory, coined the term "internal working model," which is a mental representation of significant others derived from our history with them. This internal working model helps us develop expectations of caregivers and family, and it helps us predict how we will be treated by others.

When people are faced with a loss of a loved one, acute grief (as opposed to complicated grief) can disrupt the attachment system. The period of acute grief allows us to integrate the death of the loved one into our internal working model of the deceased and process the meaning of the loss. However, when we do not fully process or accept the death of a loved one, complicated grief can emerge7

The loss of a loved one can also trigger the onset of separation anxiety. Therefore, the findings in the study of high correlations between CG and SEPAD suggest that a common feature of both is separation distress. It is important to note that CG and SEPAD are still considered distinct disorders, but this research may indicate that the lived experiences of these two disorders may be similar, with the core emotions being fear and distress at the separation from loved ones.


This research is presented from only one point in time, so we can't conclude that CG caused SEPAD or that SEPAD caused CG. Also, we can't determine if people who had SEPAD as children might be more vulnerable to developing CG in adulthood when faced with the loss of a very close loved one.


Tara Shafer, M.A.
Sarah Krill Williston,M.ed.,Ph.D.
Carol S. Lee, Ph.D.



1. Gesi,C.,Carmassi,C.,Shear,K.,Shwartz,T.,Ghesquiere,A.,Khaler,J.,Dell'Osso,L.(2016)。复杂悲伤中成人分离焦虑症:频率和相关性的探索性研究。Comprehensive Psychiatry(72),6-12。

2.剪切,M.K.(2015)。临床实践。复杂的悲伤。新英格兰医学杂志icine(372), 153–160.

3. PRIGERSON,H.G.,Bierhals,A.J.,KASL,S.V.,Reynolds,C.f.III,Shear,M.K.,Day,N。等人。(1997)。创伤性悲伤是精神和身体发病率的危险因素。美国精神病学杂志(154), 616–623.

4. Pini,S,Abelli,M.,Shear,K.m.,Cardini,A.,Lari,L.,Gesi,C.等人。(2010)。成人分离焦虑在508例门诊患者样本中的频率和临床关联,情绪和焦虑症。188体育平台appActa Psychiatrica Scandanavia。2010 (122), 40–46.

5. Silove, D.M., Marnane, C.L., Wagner, R, Manicavasagar, V.L., & Rees, S. (2010). The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.BMC精神病学(10), 10–21.

6. Bowlby,J.附件和损失,第III卷:Loss, Sadness and Depression.(1980)。New York: Basic Books.

7. Shear, K., Monk, T., Houck, P., Melhem, N., Frank, E., Reynolds, C., et al. (2007). An attachment-based model of complicated grief including the role of avoidance.精神病临床神经科学的欧洲档案(257),453-461。

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