Primary headache (PH) is a common somatic disorder in childhood with a strong impact in terms of quality of life. There are several risk factors related to the development of this disorder including environmental factors as attachment bonds. However, studies in this direction are relatively few and have often used self-report or semi-projective measures looking at the only maternal attachment. Moreover, several studies have shown a link between somatoform pains and mentalizing abilities, but the relation between mentalizing and PH in childhood is unexplored. Therefore, this study aims at exploring attachment bonds, focusing on both maternal and paternal representations and mentalizing abilities in early adolescents with and without PH within a cross-sectional case-controlled design. A sample of 94 early adolescents aged 10–14 years (47 with PH and 47 without PH as a comparison group) completed the Child Attachment Interview to assess attachment representations to caregivers. Mentalizing abilities were assessed applying to the interviews in the Child and Adolescent Reflective Functioning Scale. PH adolescents showed a greater percentage of insecure-preoccupied attachment to both parents, with higher level of preoccupied anger especially to father than the comparison group (p values from 0.000 to 0.014, effect size values from.31 to.45), while no differences emerged about mentalizing (p values from.264 to 0.312). The over-representation of insecure–preoccupied attachment to both parents suggests a key role of parent–child interaction in early adolescents with PH, while the role of mentalizing abilities remains controversial and further studies are needed to address this issue. Clinical implications are discussed.

中文翻译：

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早期青少年原发性头痛对照顾者的依恋表征和心理化能力

原发性头痛 (PH) 是儿童期常见的躯体疾病，对生活质量有很大影响。有几个与这种疾病的发展相关的风险因素，包括作为依恋关系的环境因素。然而，这方面的研究相对较少，并且经常使用自我报告或半投射措施来观察唯一的母性依恋。此外，一些研究表明躯体形式的疼痛与心智化能力之间存在联系，但尚未探索儿童期心智化与 PH 之间的关系。因此，本研究旨在探索依恋纽带，在横断面病例对照设计中，重点关注有和没有 PH 的早期青少年的母亲和父亲的表征和心理化能力。儿童依恋访谈以评估对照顾者的依恋陈述。心理能力评估适用于儿童和青少年反思功能量表中的访谈。与对照组相比，PH 青少年对父母双方的不安全全神贯注的依恋比例更高，尤其是对父亲的全神贯注愤怒程度更高（p值从 0.000 到 0.014，效应值从 0.31 到 .45），但没有差异出现了关于心理化（p值从 .264 到 0.312）。对父母双方不安全的全神贯注依恋的过度表现表明亲子互动在早期 PH 青少年中发挥着关键作用，而心智化能力的作用仍存在争议，需要进一步研究来解决这个问题。讨论了临床意义。