Is there an association between insecure attachment and symptom severity in functional somatic disorders, and what is the role of mentalized affectivity?

Abstract

Conditions such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, functional neurological disorders and many types of chronic pain have no known organic cause. The increasing consensus that these presentations should be considered as complex interactions between biological, psychological and social factors, is best represented through the term ‘functional somatic disorders’ (FSD). FSD are common, cause significant disability and distress to sufferers and contribute to a considerable proportion of healthcare consultations. Developmental theories, and some empirical evidence, suggests a role for attachment, mentalization and emotional regulation in the development of FSD. Depression/anxiety are also associated with insecure attachment and reduced mentalizing and are commonly comorbid with FSD. There is limited existing research on this topic, especially regarding FSD in older adults.

Chapter one of this thesis presents a systematic review conducted to explore the question: is there an association between insecure attachment and severity of FSD symptoms in adults? PsychINFO, Embase and Medline electronic databases were searched for studies conducted with adults, using validated measures of attachment and FSD symptom severity, that reported a statistical relationship between attachment and symptom severity. Studies were excluded if they were not in the English language or were not peer-reviewed. A total of 12 studies, comprising 1,601 patients, with a mix of chronic pain, fibromyalgia, irritable bowel syndrome and general somatic disorder were selected for inclusion in the review. An association between insecure attachment and severity of FSD symptoms could not be established, due to the relatively small number of studies, mixed results and methodological issues. Future research should focus on clarifying terminology, improving measures, and studies designed to determine causal relationships and identify mechanisms of change.

Chapter two of this thesis presents the findings of a study to explore associations between FSD and attachment in older adults. A mediation model was tested to explore whether mentalized affectivity and depression/anxiety mediated the relationship between insecure attachment and FSD symptom severity. Recruitment was undertaken through social media advertising to people aged 45 years and older who identified as having either irritable bowel syndrome, chronic fatigue syndrome or fibromyalgia. Participants were asked to complete an online questionnaire which used validated measures of attachment security, mentalized affectivity, depression/anxiety and somatic symptoms.

A total of 852 completed responses were received. Severity of symptoms was found to be associated with measures of attachment, mentalized affectivity and depression/anxiety. Processing and expressing elements of mentalized affectivity, along with depression/anxiety, were found to mediate the relationship between anxious attachment and symptom severity. Future research should focus on clarifying causal links and the direction of effects. Clinicians should be aware of the potential for impaired mentalized affectivity, increased depression/anxiety and attachment difficulties in FSD presentations.