Abstract
Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8–15 years) spanning two groups—a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children’s RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.
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Notes
Note that in this paper, we use the attachment terms employed in the assessment of attachment in middle childhood on the Child Attachment Interview [17]—secure, dismissing, preoccupied, and disorganized. Note that in infancy, attachment classifications obtained from the Strange Situation Procedure are categorized in the following way: secure, avoidant, ambivalent/resistant, disorganized. And in adulthood they are categorized as autonomous, dismissing, preoccupied, and unresolved on the Adult Attachment Interview. For the sake of promoting clear communication, here we are consistent in our use of the former terms, but readers should note that the category names and the methods of coding behavior differ as a function of measurement tool and developmental stage.
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Acknowledgements
We wish to express our special gratitude toward participants for their involvement in the study. We are also grateful to the experts of mental health of Gaslini (Prof. E. Veneselli, Dr. L. Sciarretta, M. Savoini) and interns for their help with data collection.
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Bizzi, F., Ensink, K., Borelli, J.L. et al. Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders. Eur Child Adolesc Psychiatry 28, 705–717 (2019). https://doi.org/10.1007/s00787-018-1238-5
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DOI: https://doi.org/10.1007/s00787-018-1238-5