Understanding and Treatment of Patients with Persistent Somatic Complaints Through the Lens of Contemporary Attachment Theory

Abstract

This paper describes recent progress in our understanding of patients with persistent somatic complaints, based on a broad and integrative attachment approach. Attachment theory indeed provides a powerful lens through which to understand patients with persistent somatic complaints and the often extremely negative states in which they find themselves. It was Bowlby's genius to describe how the attachment system is activated in times of threat and distress and normatively serves to seek the proximity of others in an attempt to co-regulate stress. Yet, this primary attachment strategy typically increasingly fails when faced with the continuous distress associated with chronic somatic complaints. What often ensues is a negative vicious cycle characterised by an excessive reliance on secondary attachment strategies (either hyperactivation or deactivating the attachment system), problems with (embodied) mentalizing, and severe problems with epistemic trust, that is, trust in others as a reliable source of knowledge, including knowledge of the patient's physical and mental state. These issues are discussed in relation to Bowlby's original formulations and contemporary thinking about persistent somatic complaints and functional somatic disorders. We also summarise implications for clinical practice.