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

Area of Science:

• Developmental Psychology
• Child Psychiatry
• Attachment Theory

Background:

• Somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) in children are associated with interpersonal and emotional regulation difficulties.
• Attachment security and mentalizing abilities, specifically reflective functioning (RF), are crucial for healthy socio-emotional development.
• Previous research suggests a link between attachment patterns and mental health conditions, but specific comparisons in pediatric populations are needed.

Purpose of the Study:

• To investigate whether children diagnosed with SSD and DBD exhibit higher rates of insecure or disorganized attachment compared to a healthy control group.
• To examine if children with SSD and DBD demonstrate impaired reflective functioning (RF) as a measure of mentalizing difficulties.
• To explore differences in RF between children with SSD and DBD, and within the SSD group regarding self versus others.

Main Methods:

• A clinical group of 85 children (8-15 years) with SSD (n=45) or DBD (n=40) and a control group of 46 healthy children participated.
• Attachment security and reflective functioning (RF) were assessed using the Child Attachment Interview, coded by trained raters.
• Statistical analyses were employed to compare attachment and RF scores between the clinical and control groups, and among diagnostic subgroups.

Main Results:

• Children in the clinical group displayed significantly lower RF and higher rates of insecure (over 80%) and disorganized attachment (over 40%) than controls.
• Reflective functioning (RF) was significantly lower in children with DBD compared to those with SSD.
• Within the SSD group, RF concerning self was significantly lower than RF concerning others, and RF was associated with attachment security.

Conclusions:

• School-aged children with SSD and DBD are more likely to have insecure and disorganized attachment styles.
• Impaired reflective functioning (RF) is evident in children with SSD and DBD, with distinct patterns observed between diagnostic groups.
• Findings support the theoretical link between RF and attachment, suggesting RF's utility in differentiating diagnostic subgroups and informing treatment strategies.