Pangs of pain in prolonged grief: Nature, prevalence, and predictive value

People with prolonged grief disorder (PGD), a disorder of persistent and disabling grief recently included in the ICD-11 and DSM-5-TR, often experience intrusive images related to the loss. These intrusive experiences can not only entail visual images but may also encompass broader psychological phenomena, including sensory experiences, thoughts, and intense emotions. These experiences can be referred to as “pangs of pain” and represent sudden, sharp, and brief psychological experiences, often triggered by cues connected with the loss (e.g., photos, places, people). From an associative memory network perspective, we postulate that intrusive, sudden pangs of pain in PGD are, at least to some extent, the result of severe, acute threats to fundamental needs or violations of core certainties (see summary). This study aims to increase our understanding of pangs of pain in PGD. We investigate which themes exist within pangs of pain, how pangs of pain can be characterized, and how they are related to PGD symptom severity and other symptoms of bereavement-related psychopathology at three to six months post-loss and nine months later. We also examine responses to pangs of pain and their relation to PGD symptoms, as well as relationships among characteristics and frequency of pangs of pain, intensity of avoidance behaviors, endorsement of negative cognitions, and PGD symptoms (see study protocol for a detailed description of research questions, hypotheses, and methods).