An attachment-based model of complicated grief including the role of avoidance

  • Katherine Shear
  • Timothy Monk
  • Patricia Houck
  • Nadine Melhem
  • Ellen Frank
  • Charles Reynolds
  • Russell Sillowash



Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.


We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ).

Results of Avoidance Assessment

Mean (SD) GRAQ score was 25. 0 ± 12.5 with a range of 0–60. Cronbach’s alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief.


In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model.

Key words

complicated grief attachment avoidance behaviour 



This work was supported by grants from the National Institute of Mental Health: MH60783, AG020677, AG13396, P30MH30915, and P30MH52247.


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Copyright information

© Springer 2007

Authors and Affiliations

  • Katherine Shear
    • 1
  • Timothy Monk
    • 2
  • Patricia Houck
    • 2
  • Nadine Melhem
    • 2
  • Ellen Frank
    • 2
  • Charles Reynolds
    • 2
  • Russell Sillowash
    • 2
  1. 1.Columbia University School of Social WorkNew YorkUSA
  2. 2.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA

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