A newly conceptualised mental health condition, Prolonged Ruptured Attachment Syndrome (PRAS), is emerging as a critical framework for understanding the psychological impact of unresolved attachments. Introduced by Martin Seager and colleagues, PRAS provides insights into the distress caused by indeterminate ruptures in significant relationships, such as those experienced by refugees, alienated parents, and families of missing persons. The findings were published in Psychreg Journal of Psychology.
PRAS is distinct from traditional grief or trauma models. It describes a state where attachments are neither completely severed nor fully intact, leaving individuals unable to process their emotions or find closure. Unlike conventional models that allow for adaptation over time, PRAS emphasises the persistent nature of these unresolved ties, which can hinder emotional recovery. As Seager explains: “Our hope has been to fill a gap diagnostically that sits somewhere between trauma and grief. Many people present with a syndrome that has elements of both but, unlike grief and trauma, cannot be resolved because the source of the pain is ongoing without closure.”
Central to the concept of PRAS is the role of attachment. Human well-being relies on secure and stable relationships, and disruptions to these bonds can have profound psychological consequences. PRAS extends beyond temporary separations or permanent losses, focusing on cases where there is prolonged uncertainty. This includes situations such as family separations, disrupted caregiving relationships, and ambiguous losses like those involving missing persons. Seager notes, “The concept of an open psychological wound resonated very much with our work as clinicians. We agreed that there was a need for a new concept and terminology that reflected this drawn-out and often tortuous mental state of unresolved separation.”
The psychological effects of PRAS are multifaceted. Individuals may experience elements of trauma and grief, combined with feelings of helplessness, fear, and anxiety. This persistent distress arises from the lack of control and closure associated with unresolved attachments. The condition underscores how fundamental connections are to human resilience, shaping emotional well-being across biological, psychological, and social dimensions. Highlighting its broader relevance, Seager said: “It soon became apparent that this whole idea of a missing person who was not dead but unreachable applied to so many other areas of life, not just parental alienation or COVID. It began to be clear that this was a universal phenomenon.”
PRAS has significant implications for mental health practice. Recognising this condition allows clinicians to address the unique challenges it poses. The framework highlights the importance of tailoring interventions to account for the enduring nature of these disruptions. For instance, practitioners can support individuals by helping them navigate the complexities of prolonged uncertainty and develop strategies to manage associated stress and anxiety. Seager emphasised the need for clinicians to recalibrate their expectations: “We hope that the concept will help clinicians hold and bear the emotional pain of their clients more effectively without colluding with an inevitable pressure to expect some kind of quick fix or recovery.”
The development of a clinical scale for PRAS is underway, aiming to provide measurable criteria for assessing its impact. Preliminary dimensions include the intensity of the attachment, the duration and indeterminacy of the rupture, and the availability of compensatory support systems. This scale offers a structured approach to understanding PRAS, facilitating targeted interventions and improved outcomes. “A fuller development of a validated scale for PRAS would help both in terms of clinical assessment and in improving the quality of research measures in capturing this significant aspect of human distress,” Seager added.
PRAS also raises awareness of the broader societal implications of ruptured attachments. From healthcare systems with inconsistent caregiving practices to policies affecting refugees and separated families, these disruptions can perpetuate emotional suffering. Reflecting on potential applications, Seager remarked: “Another obvious application of the PRAS concept has occurred to us since writing the original paper: the whole area of dementia. The common experience of those living with dementia and those caring for them is that of a precious identity that is there physically but psychologically absent.”
The PRAS framework may offer insights into the prevention of suicide. According to Seager: “The nature of the entrapment posed by a ruptured attachment can feel more unbearable than a simple loss or a traumatic event that has caused a serious wound but is in the past. By conceptualising PRAS more clearly, we may be able to help those at risk of suicide and those that care for them to find a more bearable way of living through rather than terminating their ordeals.”
