Boelen, P. A. (2015). Peritraumatic Distress and Dissociation in Prolonged Grief and Post-Traumatic Stress Following Violent and Unexpected Deaths. Journal of Trauma and Dissociation, 16, 541-550. DOI: 10.1080/15299732.2015.1027841


This study examined associations between the violence of a loss and the suddenness of a loss and symptom-levels of Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) after the death of a loved-one. A further aim was to investigate if peritraumatic distress (i.e., fear, helplessness, and horror) and peritraumatic dissociation mediate the emotional impact of violent losses and unexpected losses. We obtained self-reported data from 265 individuals, bereaved in the previous three years by losses due to violent causes (17%) or illness (83%). Outcomes showed that participants who experienced violent losses (due to homicide, suicide, or accident) reported more PGD-symptoms and PTSD-symptoms compared to those confronted with illness-loss. In this latter group, greater perceived unexpectedness was positively associated with PGD-severity and PTSD-severity. Multiple mediation analyses showed that the impact of violent loss and unexpectedness of the loss on PGD-severity and PTSD-severity was fully mediated by peritraumatic distress and dissociation; peritraumatic helplessness and peritraumatic dissociation (but not peritraumatic fear and horror) emerged as unique mediators. Findings suggest that both violent and unexpected losses exacerbate post-loss psychopathology which is at least partially due to such losses yielding more intense acute helplessness and dissociative responses.