An Attachment-Based Model of the Relationship Between Childhood Adversity and Somatization in Children and Adults

Psychosom Med. 2017 Jun;79(5):506-513. doi: 10.1097/PSY.0000000000000437.


Objective: An attachment model was used to understand how maternal sensitivity and adverse childhood experiences are related to somatization.

Methods: We examined maternal sensitivity at 6 and 18 months and somatization at 5 years in 292 children in a longitudinal cohort study. We next examined attachment insecurity and somatization (health anxiety, physical symptoms) in four adult cohorts: healthy primary care patients (AC1, n = 67), ulcerative colitis in remission (AC2, n = 100), hospital workers (AC3, n = 157), and paramedics (AC4, n = 188). Recall of childhood adversity was measured in AC3 and AC4. Attachment insecurity was tested as a possible mediator between childhood adversity and somatization in AC3 and AC4.

Results: In children, there was a significant negative relationship between maternal sensitivity at 18 months and somatization at age 5 years (B = -3.52, standard error = 1.16, t = -3.02, p = .003), whereas maternal sensitivity at 6 months had no significant relationship. In adults, there were consistent, significant relationships between attachment insecurity and somatization, with the strongest findings for attachment anxiety and health anxiety (AC1, β = 0.51; AC2, β = 0.43). There was a significant indirect effect of childhood adversity on physical symptoms mediated by attachment anxiety in AC3 and AC4.

Conclusions: Deficits in maternal sensitivity at 18 months of age are related to the emergence of somatization by age 5 years. Adult attachment insecurity is related to somatization. Insecure attachment may partially mediate the relationship between early adversity and somatization.

MeSH terms

  • Adult
  • Adult Survivors of Child Adverse Events / psychology*
  • Aged
  • Aged, 80 and over
  • Child, Preschool
  • Humans
  • Infant
  • Longitudinal Studies
  • Middle Aged
  • Models, Psychological
  • Mother-Child Relations / psychology*
  • Object Attachment*
  • Somatoform Disorders / etiology*
  • Young Adult