Background

Childhood adversity is associated with somatization, including physical symptom burden and health anxiety. Attachment theory offers a developmental framework to understand adult somatization, as attachment phenomena are theoretically and empirically related to physiological regulation, affect regulation, and childhood adversity, all of which are relevant to somatization.

Objective

The purpose of this study was to identify the pathways by which childhood adversity and attachment insecurity influence physical symptom burden and health anxiety in adults.

Participants and setting

Three hundred and fifty-one family medicine patients from a teaching hospital in Toronto, Canada.

Methods

A cross-sectional survey study was conducted to assess adverse childhood experiences, attachment insecurity, health anxiety and physical symptom severity in primary care patients. Path Analysis using structural equation modeling (AMOS V.26, IBM, 2019) was used to test the model in which childhood adversity, attachment anxiety, attachment avoidance, symptom severity interact to influence health anxiety.

Results

The majority of the participants were white (66%), had completed post-secondary education (68%), and reported themselves to be in very good to excellent health (62%). Childhood adversity, attachment anxiety, attachment avoidance, health anxiety and symptom severity are all significantly correlated (ranges of r_s = 0.29 to 0.63). Childhood adversity has a significant indirect effect on health anxiety with attachment anxiety and symptom severity as serial mediators (β_indirect = 0.237, p = .001 and β_direct = 0.065, p = .244).

Conclusions

Overall, this model extends our understanding of the processes underlying adult somatization. Findings support that childhood adversity and attachment anxiety are predictors of symptom severity and health anxiety.

中文翻译：

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童年逆境和依恋焦虑可预测成人症状严重程度和健康焦虑

背景

童年逆境与躯体化有关，包括身体症状负担和健康焦虑。依恋理论为理解成人躯体化提供了一个发展框架，因为依恋现象在理论上和经验上都与生理调节、情感调节和童年逆境有关，所有这些都与躯体化有关。

客观的

本研究的目的是确定童年逆境和依恋不安全感影响成人身体症状负担和健康焦虑的途径。

参与者和设置

来自加拿大多伦多一家教学医院的 351 名家庭医学患者。

方法

进行了一项横断面调查研究，以评估初级保健患者的不良童年经历、依恋不安全感、健康焦虑和身体症状严重程度。使用结构方程模型的路径分析（AMOS V.26，IBM，2019）用于测试儿童逆境、依恋焦虑、依恋回避、症状严重程度相互作用以影响健康焦虑的模型。

结果

大多数参与者是白人（66%），完成了中学后教育（68%），并报告自己身体状况非常好（62%）。童年逆境、依恋焦虑、依恋回避、健康焦虑和症状严重程度均显着相关（r _s  = 0.29 至 0.63）。童年逆境对健康焦虑有显着的间接影响，依恋焦虑和症状严重程度作为连续介质（β_间接 = 0.237，p  = .001 和 β_直接 = 0.065，p  = .244）。

结论

总的来说，这个模型扩展了我们对成人躯体化过程的理解。研究结果支持童年逆境和依恋焦虑是症状严重程度和健康焦虑的预测因素。