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Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders

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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

  1. 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.

References

  1. Madigan S, Brumariu LE, Villani V et al (2016) Representational and questionnaire measures of attachment: a meta-analysis of relations to child internalizing and externalizing problems. Psychol Bull 142:367–399. https://doi.org/10.1037/bul0000029

    Article  PubMed  Google Scholar 

  2. Ensink K, Bégin M, Normandin L, Fonagy P (2016) Maternal and child reflective functioning in the context of child sexual abuse: pathways to depression and externalising difficulties. Eur J Psychotraumatol 7:30611. https://doi.org/10.3402/ejpt.v7.30611

    Article  PubMed  Google Scholar 

  3. Bosmans G, Kerns KA (2015) Attachment in middle childhood: progress and prospects. New Dir Child Adolesc Dev 2015:1–14. https://doi.org/10.1002/cad.20100

    Article  PubMed  Google Scholar 

  4. Ensink K, Normandin L, Target M et al (2015) Mentalization in children and mothers in the context of trauma: an initial study of the validity of the Child Reflective Functioning Scale. Br J Dev Psychol 33:203–217. https://doi.org/10.1111/bjdp.12074

    Article  PubMed  Google Scholar 

  5. Schulte IE, Petermann F (2011) Somatoform disorders: 30 years of debate about criteria! What about children and adolescents? J Psychosom Res 70:218–228. https://doi.org/10.1016/j.jpsychores.2010.08.005

    Article  PubMed  Google Scholar 

  6. Kurlansik SL, Maffei MS (2016) Somatic symptom disorder. Am Fam Physician 93:49–54

    PubMed  Google Scholar 

  7. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  8. Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ (1999) Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry 38:1093–1101. https://doi.org/10.1097/00004583-199909000-00012

    Article  CAS  PubMed  Google Scholar 

  9. Kugler BB, Bloom M, Kaercher LB et al (2012) Somatic symptoms in traumatized children and adolescents. Child Psychiatry Hum Dev 43:661–673. https://doi.org/10.1007/s10578-012-0289-y

    Article  PubMed  Google Scholar 

  10. Mattila AK, Kronholm E, Jula A et al (2008) Alexithymia and somatization in general population. Psychosom Med 70:716–722. https://doi.org/10.1097/PSY.0b013e31816ffc39

    Article  PubMed  Google Scholar 

  11. Kolko DJ, Dorn LD, Bukstein OG et al (2009) Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up. J Abnorm Child Psychol 37:591–609. https://doi.org/10.1007/s10802-009-9303-7

    Article  PubMed  PubMed Central  Google Scholar 

  12. Batum P, Yagmurlu B (2007) What counts in externalizing behaviors? The contributions of emotion and behavior regulation. Curr Psychol 25:272–294. https://doi.org/10.1007/BF02915236

    Article  Google Scholar 

  13. White R, Renk K (2012) Externalizing behavior problems during adolescence: an ecological perspective. J Child Fam Stud 21:158–171. https://doi.org/10.1007/s10826-011-9459-y

    Article  Google Scholar 

  14. Groh AM, Roisman GI, van Ijzendoorn MH et al (2012) The significance of insecure and disorganized attachment for children’s internalizing symptoms: a meta-analytic study. Child Dev 83:591–610. https://doi.org/10.1111/j.1467-8624.2011.01711.x

    Article  PubMed  Google Scholar 

  15. Marvin RS, Britner PA (1999) Normative development: the ontogeny of attachment. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory research and clinical application. Guilford Press, New York, pp 44–67

    Google Scholar 

  16. Ensink K, Borelli JL, Normandin L, Target M, Fonagy P (2018) Childhood sexual abuse and attachment insecurity: independent and interactive associations with children’s psychological adjustment (in press)

  17. Shmueli-Goetz Y, Target M, Fonagy P, Datta A (2008) The Child Attachment Interview: a psychometric study of reliability and discriminant validity. Dev Psychol 44:939–956. https://doi.org/10.1037/0012-1649.44.4.939

    Article  PubMed  Google Scholar 

  18. Sroufe LA (2005) Attachment and development: a prospective, longitudinal study from birth to adulthood. Attach Hum Dev 7:349–367. https://doi.org/10.1080/14616730500365928

    Article  PubMed  Google Scholar 

  19. Kobac R, Zajac K, Madsen SD (2016) Attachment disruption, reparative processes, and psychopathology: theoretical and clinical implications. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 3rd edn. Guilford Press, New York, pp 25–39

    Google Scholar 

  20. Duschinsky R (2015) The emergence of the disorganized/disoriented (D) attachment classification, 1979–1982. Hist Psychol 18:32–46. https://doi.org/10.1037/a0038524

    Article  PubMed  PubMed Central  Google Scholar 

  21. Colle L, Del Giudice M (2011) Patterns of attachment and emotional competence in middle childhood. Soc Dev 20:51–72. https://doi.org/10.1111/j.1467-9507.2010.00576.x

    Article  Google Scholar 

  22. Cyr C, Euser EM, Bakermans-Kranenburg MJ, Van Ijzendoorn MH (2010) Attachment security and disorganization in maltreating and high-risk families: a series of meta-analyses. Dev Psychopathol 22:87–108. https://doi.org/10.1017/S0954579409990289

    Article  PubMed  Google Scholar 

  23. Hesse E, Main M (2000) Disorganized infant, child, and adult attachment: collapse in behavioral and attentional strategies. J Am Psychoanal Assoc 48:1097–1127. https://doi.org/10.1177/00030651000480041101

    Article  CAS  PubMed  Google Scholar 

  24. Lyons-Ruth K (1996) Attachment relationships among children with aggressive behavior problems: the role of disorganized early attachment patterns. J Consult Clin Psychol 64:64–73

    Article  CAS  PubMed  Google Scholar 

  25. Brazelton TB (1984) Neonatal behavioral assessment scale. Spastics International Medical Publications, London

    Google Scholar 

  26. Padrón E, Carlson EA, Sroufe LA (2014) Frightened versus not frightened disorganized infant attachment: newborn characteristics and maternal caregiving. Am J Orthopsychiatry 84:201–208. https://doi.org/10.1037/h0099390

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ainsworth MDS, Blehar MC, Waters E, Wall S (1978) Patterns of attachment: a psychological study of the strange situation. Erlbaum, Oxford

    Google Scholar 

  28. Granqvist P, Sroufe LA, Dozier M et al (2017) Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers. Attach Hum Dev 19:534–558. https://doi.org/10.1080/14616734.2017.1354040

    Article  PubMed  PubMed Central  Google Scholar 

  29. Duschinsky R, Solomon J (2017) Infant disorganized attachment: clarifying levels of analysis. Clin Child Psychol Psychiatry 22:524–538. https://doi.org/10.1177/1359104516685602

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bizzi F, Cavanna D, Castellano R, Pace CS (2015) Children’s mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders. Front Psychol 6:1125. https://doi.org/10.3389/fpsyg.2015.01125

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brumariu LE, Kerns KA (2010) Parent-child attachment and internalizing symptoms in childhood and adolescence: a review of empirical findings and future directions. Dev Psychopathol 22:177–203. https://doi.org/10.1017/S0954579409990344

    Article  PubMed  Google Scholar 

  32. George C, Kaplan N, Main M (1985) Adult Attachment Interview. University of California Department of Psychology, Berkeley (unpublished manuscript)

  33. Moss E, Lecompte V (2015) Attachment and socioemotional problems in middle childhood. New Dir Child Adolesc Dev 2015:63–76. https://doi.org/10.1002/cad.20095

    Article  PubMed  Google Scholar 

  34. Nunes SAN, Faraco AMX, Vieira ML (2013) Attachment and parental practices as predictors of behavioral disorders in boys and girls. Paid (Ribeirão Preto) 23:369–378. https://doi.org/10.1590/1982-43272356201311

    Article  Google Scholar 

  35. Boldt LJ, Kochanska G, Yoon JE, Koenig Nordling J (2014) Children’s attachment to both parents from toddler age to middle childhood: links to adaptive and maladaptive outcomes. Attach Hum Dev 16:211–229. https://doi.org/10.1080/14616734.2014.889181

    Article  PubMed  PubMed Central  Google Scholar 

  36. Borelli JL, David DH, Crowley MJ, Mayes LC (2010) Links between disorganized attachment classification and clinical symptoms in school-aged children. J Child Fam Stud 19:243–256. https://doi.org/10.1007/s10826-009-9292-8

    Article  Google Scholar 

  37. Brumariu LE, Kerns KA, Seibert A (2012) Mother-child attachment, emotion regulation, and anxiety symptoms in middle childhood. Pers Relatsh 19:569–585. https://doi.org/10.1111/j.1475-6811.2011.01379.x

    Article  Google Scholar 

  38. Bizzi F (2018) The quality of attachment in children with Somatic Symptom Disorders and related disorders. Psicol Clin dello Svilupp (in press)

  39. Kozlowska K, Williams LM (2009) Self-protective organization in children with conversion and somatoform disorders. J Psychosom Res 67:223–233. https://doi.org/10.1016/j.jpsychores.2009.03.016

    Article  PubMed  Google Scholar 

  40. Kozlowska K, Scher S, Williams LM (2011) Patterns of emotional-cognitive functioning in pediatric conversion patients: implications for the conceptualization of conversion disorders. Psychosom Med 73:775–788. https://doi.org/10.1097/PSY.0b013e3182361e12

    Article  PubMed  Google Scholar 

  41. Ensink K, Bégin M, Normandin L et al (2017) Mentalization and dissociation in the context of trauma: implications for child psychopathology. J Trauma Dissociation 18:11–30. https://doi.org/10.1080/15299732.2016.1172536

    Article  PubMed  Google Scholar 

  42. Ha C, Sharp C, Goodyer I (2011) The role of child and parental mentalizing for the development of conduct problems over time. Eur Child Adolesc Psychiatry 20:291–300. https://doi.org/10.1007/s00787-011-0174-4

    Article  PubMed  Google Scholar 

  43. Borelli JL, Palmer A, Vanwoerden S, Sharp C (2017) Convergence in reports of adolescents’ psychopathology: a focus on disorganized attachment and reflective functioning. J Clin Child Adolesc Psychol. https://doi.org/10.1080/15374416.2017.1399400

    Article  PubMed  Google Scholar 

  44. Madigan S, Atkinson L, Laurin K, Benoit D (2013) Attachment and internalizing behavior in early childhood: a meta-analysis. Dev Psychol 49:672–689. https://doi.org/10.1037/a0028793

    Article  PubMed  Google Scholar 

  45. Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH et al (2010) The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta-analytic study. Child Dev 81:435–456. https://doi.org/10.1111/j.1467-8624.2009.01405.x

    Article  PubMed  Google Scholar 

  46. Pasco Fearon RM, Belsky J (2011) Infant-mother attachment and the growth of externalizing problems across the primary-school years. J Child Psychol Psychiatry 52:782–791. https://doi.org/10.1111/j.1469-7610.2010.02350.x

    Article  CAS  PubMed  Google Scholar 

  47. Lecompte V, Moss E (2014) Disorganized and controlling patterns of attachment, role reversal, and caregiving helplessness: links to adolescents’ externalizing problems. Am J Orthopsychiatry 84:581–589. https://doi.org/10.1037/ort0000017

    Article  PubMed  Google Scholar 

  48. Allen JG, Fonagy P, Bateman AW (2008) Mentalizing in clinical Practice. American Psychiatric Publishing, Washington DC

    Google Scholar 

  49. Fonagy P, Allison E (2012) What is mentalization? The concept and its foundations in developmental research. In: Midgley N, Vrouva I (eds) Minding the child: mentalization-based interventions with children, young people and their families. Routledge, London, pp 11–34

    Google Scholar 

  50. Fonagy P, Gergely G, Jurist EL, Target M (2002) Affect regulation mentalization and the development of the self. Karnac, London

    Google Scholar 

  51. Fonagy P, Bateman A (2016) Adversity, attachment, and mentalizing. Compr Psych 64:59–66. https://doi.org/10.1016/j.comppsych2015.11.006

    Article  Google Scholar 

  52. Fonagy P, Target M (1996) Playing with reality I. Int J Psycho-anal 77:217

    Google Scholar 

  53. Gergely G, Nádasdy Z, Csibra G, Bíró S (1995) Taking the intentional stance at 12 months of age. Cognition 56:165–193

    Article  CAS  Google Scholar 

  54. Gergely G (2000) Reapproaching Mahler: new perspectives on normal autism, symbiosis, splitting and libidinal object constancy from cognitive developmental theory. J Am Psychoanal Assoc 48:1197–1228. https://doi.org/10.1177/00030651000480040801

    Article  CAS  PubMed  Google Scholar 

  55. Ensink K, Berthelot N, Bernazzani O et al (2014) Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale. Front Psychol 5:1471. https://doi.org/10.3389/fpsyg.2014.01471

    Article  PubMed  PubMed Central  Google Scholar 

  56. Katznelson H (2014) Reflective functioning: a review. Clin Psychol Rev 34:107–117. https://doi.org/10.1016/j.cpr.2013.12.003

    Article  PubMed  Google Scholar 

  57. Sharp C, Fonagy P (2008) The parent’s capacity to treat the child as a psychological agent: constructs, measures and implications for developmental psychopathology. Soc Dev 17:737–754. https://doi.org/10.1111/j.1467-9507.2007.00457.x

    Article  Google Scholar 

  58. Sharp C, Venta A (2012) Mentalizing problems in children and adolescents. In: Midgley NVI (ed) Minding the child: mentalization-based interventions with children, young people and their families. Routledge, London, pp 35–53

    Google Scholar 

  59. Bo S, Kongerslev M (2017) Self-reported patterns of impairments in mentalization, attachment, and psychopathology among clinically referred adolescents with and without borderline personality pathology. Borderline Pers Disord Emot Dysregul 4:4. https://doi.org/10.1186/s40479-017-0055-7

    Article  Google Scholar 

  60. Bo S, Sharp C, Fonagy P, Kongerslev M (2017) Hypermentalizing, attachment, and epistemic trust in adolescent BPD: clinical illustrations. Pers Disord 8:172–182. https://doi.org/10.1037/per0000161

    Article  Google Scholar 

  61. Girard É, Terradas MM, Matte-Gagné C (2014) Empathie, biais de mentalisation, comportements pro-sociaux et troubles de comportement chez les enfants d’âge scolaire. Enfance en difficulté 3:77. https://doi.org/10.7202/1028013ar

    Article  Google Scholar 

  62. Sharp C (2008) Theory of mind and conduct problems in children: deficits in reading the “emotions of the eyes. Cogn Emot 22:1149–1158. https://doi.org/10.1080/02699930701667586

    Article  Google Scholar 

  63. Venta A, Sharp C (2015) Mentalizing mediates the relation between attachment and peer problems among inpatient adolescents. J Infant Child Adolesc Psychother 14:323–340. https://doi.org/10.1080/15289168.2015.1071997

    Article  Google Scholar 

  64. Möller C, Falkenström F, Holmqvist Larsson M, Holmqvist R (2014) Mentalizing in young offenders. Psychoanal Psychol 31:84–99. https://doi.org/10.1037/a0035555

    Article  Google Scholar 

  65. Taubner S, White LO, Zimmermann J et al (2013) Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. J Abnorm Child Psychol 41:929–938. https://doi.org/10.1007/s10802-013-9736-x

    Article  PubMed  Google Scholar 

  66. Taubner S, Curth C (2013) Mentalization mediates the relation between early traumatic experiences and aggressive behavior in adolescence. Psihologija 46:177–192. https://doi.org/10.2298/PSI1302177T

    Article  Google Scholar 

  67. Stonnington CM, Locke DEC, Hsu C-H et al (2013) Somatization is associated with deficits in affective Theory of Mind. J Psychosom Res 74:479–485. https://doi.org/10.1016/j.jpsychores.2013.04.004

    Article  PubMed  Google Scholar 

  68. Subic-Wrana C, Beutel ME, Knebel A, Lane RD (2010) Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosom Med 72:404–411. https://doi.org/10.1097/PSY.0b013e3181d35e83

    Article  PubMed  Google Scholar 

  69. Waldinger RJ, Schulz MS, Barsky AJ, Ahern DK (2006) Mapping the road from childhood trauma to adult somatization: the role of attachment. Psychosom Med 68:129–135. https://doi.org/10.1097/01.psy.0000195834.37094.a4

    Article  PubMed  Google Scholar 

  70. Liu L, Cohen S, Schulz MS, Waldinger RJ (2011) Sources of somatization: exploring the roles of insecurity in relationships and styles of anger experience and expression. Soc Sci Med 73:1436–1443. https://doi.org/10.1016/j.socscimed.2011.07.034

    Article  PubMed  PubMed Central  Google Scholar 

  71. McWilliams LA (2017) Adult attachment insecurity is positively associated with medically unexplained chronic pain. Eur J Pain 21:1378–1383. https://doi.org/10.1002/ejp.1036

    Article  CAS  PubMed  Google Scholar 

  72. Madigan S, Moran G, Schuengel C et al (2007) Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: links to toddler behavior problems. J Child Psychol Psychiatry 48:1042–1050. https://doi.org/10.1111/j.1469-7610.2007.01805.x

    Article  PubMed  Google Scholar 

  73. O’Connor EE, Collins BA, Supplee L (2012) Behavior problems in late childhood: the roles of early maternal attachment and teacher–child relationship trajectories. Attach Hum Dev 14:265–288. https://doi.org/10.1080/14616734.2012.672280

    Article  PubMed  Google Scholar 

  74. Wang F, Willoughby M, Mills-Koonce R, Cox MJ (2016) Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool ages. Attach Hum Dev 18:534–553. https://doi.org/10.1080/14616734.2016.1243139

    Article  PubMed  Google Scholar 

  75. Boldt LJ, Kochanska G, Jonas K (2017) Infant attachment moderates paths from early negativity to preadolescent outcomes for children and parents. Child Dev 88:584–596. https://doi.org/10.1111/cdev.12607

    Article  PubMed  Google Scholar 

  76. Luyten P, van Houdenhove B, Lemma A et al (2012) A mentalization-based approach to the understanding and treatment of functional somatic disorders. Psychoanal Psychother 26:121–140. https://doi.org/10.1080/02668734.2012.678061

    Article  Google Scholar 

  77. Achenbach T, Rescorla L (2001) Manual for the ASEBA school-age forms and profiles. University of Vermont Research Center for Children Youth and Families, Burlington

    Google Scholar 

  78. Ensink K, Target M, Duval J, Oandasan C (2015) Child reflective functioning scale scoring manual: for application to the Child Attachment Interview. Anna Freud Centre, University College London, London (unpublished manuscript)

  79. Venta A, Shmueli-Goetz Y, Sharp C (2014) Assessing attachment in adolescence: a psychometric study of the child attachment interview. Psychol Assess 26:238–255. https://doi.org/10.1037/a0034712

    Article  PubMed  Google Scholar 

  80. Cavanna D, Bizzi F, San Martini P, Castellano (2018) Child Attachment Interview: a psychometric Study of an Italian Sample. Psicol Clin dello Svilupp 22:111–137

    Google Scholar 

  81. Bizzi F, Shmueli-Goetz Y, Castellano R, Cavanna D (2018) A multi assessment approach to attachment in middle childhood and early adolescence in two clinical groups. Test Psychometrics Met Appl Psychol 25(3):409–427. https://doi.org/10.4473/TPM25.3.6

    Article  Google Scholar 

  82. Target M, Fonagy P, Shmueli-Goetz Y (2003) Attachment representations in school-age children: the development of the child attachment interview (CAI). J Child Psychother 29:171–186. https://doi.org/10.1080/0075417031000138433

    Article  Google Scholar 

  83. Fonagy P, Target M, Steele H, Steele M (1998) Reflective-functioning manual version 5.0: for application to Adult Attachment Interviews. University College London, London (unpublished manuscript)

  84. Ensink K (2004) Assessing theory of mind affective understanding and reflective functioning in primary school age children. Doctoral dissertation, University College London

  85. Cohen J (1988) The effect size. Statistical power analysis for the behavioral sciences. Lawrence Earlbaum Associates, Hillsdale

    Google Scholar 

  86. Marty P (1991) Mentalisation et Psychosomatique. Synthélabo, Paris

    Google Scholar 

  87. Suchman NE, DeCoste CL, McMahon TJ et al (2017) Mothering from the inside out: results of a second randomized clinical trial testing a mentalization-based intervention for mothers in addiction treatment. Dev Psychopathol 29:617–636. https://doi.org/10.1017/S0954579417000220

    Article  PubMed  PubMed Central  Google Scholar 

  88. Slade A, Sadler LS, Mayes LC (2005) Minding the baby: enhancing parental reflective functioning in a nursing/mental health home visiting program. In: Berlin LJ, Ziv Y, Amaya-Jackson L (eds) Duke series in child development and public policy Enhancing early attachments: theory, research, intervention, and policy. Guilford Press, New York, pp 152–177

    Google Scholar 

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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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Authors and Affiliations

  1. Department of Educational Science, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy

    Fabiola Bizzi, Simone Charpentier Mora & Donatella Cavanna

  2. Department of School of Psychology, University of Laval, Quebec, Canada

    Karin Ensink

  3. Department of Psychology and Social Behavior, University of California, Irvine, CA, USA

    Jessica L. Borelli

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  1. Fabiola Bizzi
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  2. Karin Ensink
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  3. Jessica L. Borelli
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Correspondence to Fabiola Bizzi.

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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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