Insecure attachment style and cumulative traumatic life events in patients with somatoform pain disorder: A cross-sectional study

Abstract

ObjectiveCurrent models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls. MethodsWe compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors. ResultsInsecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32–94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84–6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06–3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance. ConclusionsThe high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD.