Objective: Individuals with mental illnesses severe enough to require psychiatric hospitalization often have significant trauma histories, have developed maladaptive attachment styles, and experience comorbid somatic distress. Gaining an understanding about the interaction of such factors may lead to prioritizing interventions that target factors that mediate the relationship between trauma and adverse somatic distress. Prior research has examined various mediation models, but results have been mixed and conducted only on outpatient samples.

Method: Participants (47.7% female) in a large sample (N = 2702) with a mean age of 34.62 (SD = 14.7) were enrolled in a specialist inpatient program and completed self-report measures pertaining to demographics, attachment insecurity, lifetime trauma exposure, and somatic distress within 72 hours of admission. The dimensions of attachment insecurity (i.e., attachment anxiety and attachment avoidance) were tested as parallel mediators in the relationship between lifetime trauma exposure and somatic distress.

Results: The mediation analyses revealed that attachment anxiety and avoidance partially mediated the relationship between lifetime trauma exposure and somatic distress.

Conclusions: These results are the first to date to implicate both attachment anxiety and avoidance as mediators between trauma exposure and somatic distress in a high acuity sample. Although the results do not imply causality, they do call attention to social-cognitive factors related to somatic distress and highlight the importance of considering attachment styles as a possible contributor to comorbid physical symptoms in patients with trauma exposure.

目标：患有严重到需要精神病住院治疗的精神疾病的个体通常有明显的创伤史，已经发展出适应不良的依恋方式，并经历过共病的躯体痛苦。了解这些因素的相互作用可能会导致优先考虑针对调节创伤和不良躯体痛苦之间关系的因素的干预措施。先前的研究已经检查了各种中介模型，但结果喜忧参半，并且仅在门诊样本上进行。

方法：平均年龄为 34.62 ( SD  = 14.7)的大样本 ( N = 2702 ) 中的参与者（47.7% 女性）参加了专科住院计划，并完成了与人口统计学、依恋不安全感、终生创伤有关的自我报告措施入院后 72 小时内暴露和躯体不适。依恋不安全的维度（即依恋焦虑和依恋回避）被测试为终生创伤暴露与躯体痛苦之间关系的平行中介。

结果：中介分析显示，依恋焦虑和回避在一定程度上调节了终生创伤暴露与躯体痛苦之间的关系。

结论：这些结果是迄今为止第一个将依恋焦虑和回避作为高敏锐度样本中创伤暴露和躯体痛苦之间的中介因素的结果。尽管结果并不暗示因果关系，但它们确实引起了对与躯体痛苦相关的社会认知因素的关注，并强调了将依恋方式视为可能导致创伤暴露患者身体症状的可能因素的重要性。