Children’s mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders

Abstract

Introduction: In line with literature, the quality of adult–infant interactions and mental representations of the caregivers play an essential role in influencing the children’s well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child’s attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children’s state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology.Methods: Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected.Results: In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales.Discussion: This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted.

The Child Attachment Interview: A Narrative Review

“…Security attachment was also found to be a protective factor against the onset of depression in the children of depressed mothers because of the ability of secure children to regulate emotions as well as to adopt successful coping strategies throughout periods of stress (Fox and Borelli, 2015 ). In general, a prevalence of insecurely attached children was found in clinical samples (Target et al, 2003 ; Shmueli-Goetz et al, 2008 ; Venta et al, 2014 ; Bizzi et al, 2015 ; Glazebrook et al, 2015 ; Jardin et al, 2015 ). Disorganized attachment was associated with child experiences of depressive symptoms and shyness, and with parent-reports of social anxiety, inattention, and thought problems (Borelli et al, 2010b ) as well as with disruptive behavior and Somatic Symptoms Disorders (SSDs; Bizzi et al, 2015 ).…”

“…In general, a prevalence of insecurely attached children was found in clinical samples (Target et al, 2003 ; Shmueli-Goetz et al, 2008 ; Venta et al, 2014 ; Bizzi et al, 2015 ; Glazebrook et al, 2015 ; Jardin et al, 2015 ). Disorganized attachment was associated with child experiences of depressive symptoms and shyness, and with parent-reports of social anxiety, inattention, and thought problems (Borelli et al, 2010b ) as well as with disruptive behavior and Somatic Symptoms Disorders (SSDs; Bizzi et al, 2015 ). A dismissing pattern was the most common finding in a very small sample of eight obese adolescent females who had taken on a caring role in their families, dismissing their own vulnerability and emotional needs and thus preserving self-reliance (Holland et al, 2012 ).…”

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence

“…However, the only studies showing a mediating effect of insecure attachment are limited to adult borderline PD (Baryshnikov et al, 2017;Godbout et al, 2019;Minzenberg, Poole, & Vinogradov, 2006), and they focus on attachment styles derived from self-report questionnaires of attachment which do not consider the unresolved attachment representation (Ravitz, Maunder, Hunter, Sthankiya, & Lancee, 2010). Given that the responsiveness and social proximity to attachment figures play a crucial role for affect regulation difficulties in individuals with personality pathology (Hengartner et al, 2015), impairments in their emotion regulation might become apparent in response to traumatic experiences, especially in those with an unresolved attachment pattern (Bizzi et al, 2015).…”

“…Unresolved attachment representation is associated with adverse outcomes after experiencing childhood maltreatment (Bizzi, Cavanna, Castellano, & Pace, 2015;Liotti, 2006). Individuals classified as unresolved are either confronted with threatened abandonment or potential danger from the attachment figure (George & West, 2011).…”

Attachment representations in children with disruptive behavior disorders: A special focus on insecurity in middle childhood

“…The use of CAI in clinical context to assess attachment representations in middle childhood concerns mainly heterogeneous clinical groups of children with several mental problems (Fox & Borelli, 2015;Scott et al, 2011;Shmueli-Goetz et al, 2008;Target et al, 2003), children that have experienced sexual abuse (Ensink et al, 2016) and specific clinical samples such as children with attention-deficit hyperactivity disorder (Rasmussen et al, 2019), somatic symptoms disorders (Bizzi, 2019) and DBD (Bizzi et al, 2015(Bizzi et al, , 2018, but focusing exclusively on the categorical approach based on attachment classifications (i.e. secure, insecure-dismissing, insecure-preoccupied and insecure-disorganised).…”