Children with somatic symptom disorders: is attachment investigation a key aspect for the diagnostic and intervention process?

Introduction: somatic symptom disorders (SSD) are characterized by multiple and variable physical symptoms without demonstrable pathophysiological processes. Literature has investigated the role of several psychological variables in SSD, with inconclusive data. Moreover, there is a paucity of studies on middle-childhood and early adolescence. The aim of this study is to evaluate the role of attachment as indicator of socio-emotional functioning in a sample of young patients with SSD. Specifically, we examined quality of attachment using different measures: 1) a narrative, evaluating the ‘state of mind’ of children; 2) a projective measure examining the ‘style’ of attachment; 3) a questionnaire, evaluating the ‘perception of security’ to parents. Methods: Sixty consecutive Italian patients aged from 8 to 15, previously diagnosed with SSD, were administered a battery of tools to investigate the attachment: Child Attachment Interview, Separation Anxiety Test, Security Scale or Inventory of Parent and Peer Attachment. Furthermore, they were administered WISC-IV to have a homogeneous sample on verbal comprehension index. Results: Insecure attachment was found in more than half of the patients with SSD. In addition, an over-representation of disorganized state of mind was found. The perception of security to parents was not high. Conclusions: these findings support the utility to further investigate the attachment for a better evaluation of the disorganization aspects surrounding the SSD in children and adolescents. The clinical implications for future research directions are discussed.