Investigating the Relationship between Childhood Trauma and Attachment Styles with Prolonged Grief Symptoms
-
Fatemeh Serjouie
,
Amir Sam Kianimoghadam
,
Hoda Doosalivand
,
Zeinab Farjampanah
,
Abbas Masjedi-Arani
Abstract
Objective: Childhood trauma and attachment styles are critical factors influencing prolonged grief symptoms in bereaved adults. This study investigates the relationship between childhood trauma, attachment styles, and prolonged grief symptoms considering the mediating role of mentalization, shame, and guilt in bereaved adults.
Method: The present research is a cross-sectional descriptive study with a correlational design utilizing path analysis. The statistical population of this study includes bereaved individuals, selected by the convenience sampling method. A total of 311 participants completed to the PG-13-R, CTQ, RAAS, RFQ, and SSGS questionnaires. SPSS 24 and PLS 3 were employed for data analysis using path analysis modeling. PLS-SEM, a variance-based approach suitable for non-normal and complex models with multiple mediators, was used for path analysis modeling.
Results: The study results demonstrated a significant direct relationship of childhood trauma (β = 0.29, P = 0.006) and attachment styles (β = 0.23, P = 0.020) with prolonged grief symptoms. The critical finding in this research concerns the mediating variables. According to the results, shame significantly mediated the overall model (β = 0.10, P = 0.042), specifically between between attachment styles and prolonged grief symptoms (β = 0.10, P = 0.044), while mentalization and guilt were not significant mediators. In total, 60% of the variance in prolonged grief symptoms can be explained by predictive variables (R² = 0.609), including childhood trauma, attachment style, mentalization, shame, and guilt.
Conclusion: These findings emphasize the role of shame in the prolonged grief symptoms among adults with childhood trauma histories and insecure attachments. Therefore, the findings suggest that interventions targeting shame could be effective in reducing prolonged grief symptoms.
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2. Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O'Connor M. Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. J Affect Disord. 2017;212:138-49.
3. Rheingold AA, Williams JL, Bottomley JS. Prevalence and Co-Occurrence of Psychiatric Conditions Among Bereaved Adults. JAMA Netw Open. 2024;7(6):e2415325.
4. Nikkhah P, Niusha B, Haghighat-Manesh E. Developing a Model of Prolonged Grief Based on Adverse Childhood Experiences with the Mediating Role of Perceived Social Support among Survivors of the COVID-19 Pandemic. Mental Health and Lifestyle Journal. 2025;3(4):1-13.
5. Ahn J, Lee SW, Kim K, Jin B, Chung US. The Relationship Between Childhood Trauma Experience and Complicated Grief: The Importance of Psychological Support for Individuals Coping With Pet Loss in Korea. J Korean Med Sci. 2023;38(37):e305.
6. Chen MA, Lewis MR, Chirinos DA, Murdock KW, Fagundes C. Differential psychological reactions to grief: The role of childhood adversity for depression symptoms among bereaved and non-bereaved adults. Death Stud. 2020;44(12):778-86.
7. Kokou-Kpolou CK, Moukouta CS, Masson J, Bernoussi A, Cénat JM, Bacqué M-F. Correlates of grief-related disorders and mental health outcomes among adult refugees exposed to trauma and bereavement: A systematic review and future research directions. J Affect Disord. 2020;267:171-84.
8. Janshen A, Boelen PA, Schut HAW, Eisma MC. Do insecure attachment styles predict prolonged grief symptoms? Significant null findings. Death Stud. 2024;48(10):1076-84.
9. Mikulincer M, Shaver PR. An attachment perspective on loss and grief. Curr Opin Psychol. 2022;45:101283.
10. Gegieckaite G, Kazlauskas E. Do emotion regulation difficulties mediate the association between neuroticism, insecure attachment, and prolonged grief? Death Stud. 2022;46(4):911-9.
11. Eisma MC, Bernemann K, Aehlig L, Janshen A, Doering BK. Adult attachment and prolonged grief: A systematic review and meta-analysis. Pers Individ Dif. 2023;214:112315.
12. Poznyak E, Morosan L, Perroud N, Speranza M, Badoud D, Debbané M. Roles of age, gender and psychological difficulties in adolescent mentalizing. J Adolesc. 2019;74:120-9.
13. Bateman AW, Fonagy P. Handbook of mentalizing in mental health practice: American Psychiatric Pub; 2019.
14. Doba K, Saloppé X, Choukri F, Nandrino JL. Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies. Child Abuse Negl. 2022;132:105815.
15. Berthelot N, Lemieux R, Garon-Bissonnette J, Lacharité C, Muzik M. The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents. Child Abuse Negl. 2019;95:104065.
16. Ensink K, Bégin M, Normandin L, Godbout N, Fonagy P. Mentalization and dissociation in the context of trauma: Implications for child psychopathology. J Trauma Dissociation. 2017;18(1):11-30.
17. Condino V, Giovanardi G, Vagni M, Lingiardi V, Pajardi D, Colli A. Attachment, Trauma, and Mentalization in Intimate Partner Violence: A Preliminary Investigation. J Interpers Violence. 2022;37(11-12):Np9249-np76.
18. Riazi SS, Manouchehri M. The mediating role of mentalization and integrative self-knowledge in the relationship between childhood trauma and fear of intimacy. Front Psychol. 2024;15:1384573.
19. Parada-Fernández P, Herrero-Fernández D, Oliva-Macías M, Rohwer H. Analysis of the mediating effect of mentalization on the relationship between attachment styles and emotion dysregulation. Scand J Psychol. 2021;62(3):312-20.
20. Popov Ș. The relationship between attachment styles, psychological disorders, and mentalization capacity. Psihologie, Revistă ştiinţifico-practică. 2024;44(1):52-63.
21. Levi-Belz Y, Lev-Ari L. Thinking for healing: The role of mentalization deficits as moderator in the link between complicated grief and suicide ideation among suicide-loss survivors. Death Stud. 2023;47(3):360-9.
22. Lombardo L, Veneziani G, Giraldi E, Morelli E, Durante S, Aceto P, et al. How attachment style, mentalization and preparedness for death are associated with pre-loss grief symptoms' severity: A network analysis study in caregivers of terminally ill cancer patients. Death Stud. 2024;48(6):537-49.
23. Kim S, Thibodeau R, Jorgensen RS. Shame, guilt, and depressive symptoms: a meta-analytic review. Psychol Bull. 2011;137(1):68-96.
24. Farahani H, Azadfallah P, Watson P, Qaderi K, Pasha A, Dirmina F, et al. Predicting the Social-Emotional Competence Based on Childhood Trauma, Internalized Shame, Disability/Shame Scheme, Cognitive Flexibility, Distress Tolerance and Alexithymia in an Iranian Sample Using Bayesian Regression. J Child Adolesc Trauma. 2023;16(2):351-63.
25. Farahani H, Watson P, Movasagh L, Blagojević M, Bagheri-Sheykhangafshe F, Allahyari A, et al. Explainable multilayer perceptron classification model for detecting the internalized shame-based on childhood trauma, social-emotional competence, cognitive flexibility, distress tolerance, alexithymia, and age. Shame and Ageing in a Transforming World: Springer; 2024. p. 21-50.
26. Cândea DM, Szentagotai-Tătar A. Shame-proneness, guilt-proneness and anxiety symptoms: A meta-analysis. J Anxiety Disord. 2018;58:78-106.
27. Calderon C. The relationship between attachment style and narcissism: mediating effects of shame: Alliant International University; 2021.
28. Levi-Belz Y, Hamdan S. Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure. Eur J Psychotraumatol. 2023;14(1):2182820.
29. Szőcs H, Sandheden L, Horváth Z, Vizin G. The mediating role of state shame, guilt, and pride in the relationship between self-compassion and prolonged grief. Eur Psychiatry. 2022;65(S1):S179-S80.
30. Hansen J, Khvorost A, Zimonjic M, Schoosleitner C. How (why) could this have happened? The influence of construal level on shame versus guilt and related action tendencies. Cogn Emot. 2025:1-17.
31. Tangney JP, Stuewig J, Mashek DJ. Moral emotions and moral behavior. Annu Rev Psychol. 2007;58:345-72.
32. Norman S. Trauma-Informed Guilt Reduction Therapy: Overview of the Treatment and Research. Curr Treat Options Psychiatry. 2022;9(3):115-25.
33. Kip A, Diele J, Holling H, Morina N. The relationship of trauma-related guilt with PTSD symptoms in adult trauma survivors: a meta-analysis. Psychol Med. 2022;52(12):2201-11.
34. Bateman AW, Fonagy P. Handbook of mentalizing in mental health practice: American Psychiatric Pub; 2019.
35. Almasi M, Dinarvand N. The role of Attachment Styles, Mentalization and shame and guilt in predicting the quality of patient care among nurses. Quarterly Journal of Nursing Management. 2023;11(4):14-25.
36. Hashemi S, Dortaj F, Sadipour E, Asadzadeh H. Structural model of shame and guilt feelings based on parenting styles: The mediating role of attachment styles. 2018.
37. Remondi C, Casu G, Pozzi C, Greco F, Gremigni P, Brugnera A. A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles. Int J Environ Res Public Health. 2023;20(4).
38. NECULAU-COJOCARU A, KARNER-HUȚULEAC A, COBZEANU A. THE LINK BETWEEN ATTACHMENT STYLES AND SHAME PRONENESS: THE ROLE OF CULTURAL FACTORS. A SYSTEMATIC REVIEW. STUDII ŞI CERCETĂRI. 2025;71(2).
39. Bottomley JS, Campbell KW, Feigelman W, Schamber EL, Rheingold AA. Prospective relations between stigma, guilt, shame, posttraumatic stress and prolonged grief symptoms among overdose and suicide loss survivors. J Affect Disord. 2025;379:223-31.
40. Li J, Stroebe M, Chan CL, Chow AY. Guilt in bereavement: a review and conceptual framework. Death Stud. 2014;38(1-5):165-71.
41. Ensink K, Bégin M, Martin-Gagnon G, Biberdzic M, Berthelot N, Normandin L, et al. Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood. Front Psychol. 2023;14:919736.
42. Arabadzhiev Z, Paunova R. Complexity of mentalization. Front Psychol. 2024;15:1353804.
43. Santoro G, Costanzo A, Franceschini C, Lenzo V, Musetti A, Schimmenti A. Insecure Minds through the Looking Glass: The Mediating Role of Mentalization in the Relationships between Adult Attachment Styles and Problematic Social Media Use. Int J Environ Res Public Health. 2024;21(3):255.
44. Smits ML, de Vos J, Rüfenacht E, Nijssens L, Shaverin L, Nolte T, et al. Breaking the cycle with trauma-focused mentalization-based treatment: theory and practice of a trauma-focused group intervention. Front Psychol. 2024;15:1426092.
45. Levi-Belz Y. Interpersonal facilitators of complicated grief and depression in the aftermath of suicide loss: The mediated roles of suicide-related shame and guilt. Suicide Life Threat Behav. 2023;53(4):680-91.
46. Saboori F, Pishghadam R, Hosseini Fatemi A, Ghonsooli B. Culture and identity: Linking Iranian identity components and cultural dimensions. Issues in Language Teaching. 2015;4(1):49-78.
47. Gouveia A. On the concept, taxonomy, and transculturality of disordered grief. Front Psychol. 2023;14:1165421.
48. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169-90.
49. Ebrahimi H, Dejkam M, Seghatoleslam T. Childhood traumas and suicide attempt in adulthood. Iranian journal of psychiatry and clinical psychology. 2014.
50. Collins NL, Read SJ. Adult attachment, working models, and relationship quality in dating couples. J Pers Soc Psychol. 1990;58(4):644-63.
51. Hajializadeh K, Ahadi H, Jomehri F, Rahgozar M. Psychosocial predictors of barriers to cervical cancer screening among Iranian women: the role of attachment style and social demographic factors. J Prev Med Hyg. 2013;54(4):218-22.
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| Keywords | ||
| Bereavement Guilt Mentalization Prolonged Grief Disorder Shame | ||
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How to Cite
1.
Serjouie F, Kianimoghadam AS, Doosalivand H, Farjampanah Z, Masjedi-Arani A. Investigating the Relationship between Childhood Trauma and Attachment Styles with Prolonged Grief Symptoms. Iran J Psychiatry. 2026;:1-13.
