Emotional maltreatment and early-adult somatization. The role of romantic attachment in a female group

Author/s Maria Elena Brianda, Chiara Sacchi, Pietro De Carli, Alessandra Simonelli
Publishing Year 2018 Issue 2018/1
Language Italian Pages 21 P. 81-101 File size 330 KB
DOI 10.3280/PDS2018-001005
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Emotional maltreatment is proved to be related to, or even predictive of, several psycho-logical and physical later impairments. Somatization has a higher incidence among individuals with a history of maltreatment, and among females. Studies highlighted the importance to investigate the role of mediating factors between childhood maltreatment and adult symp-tomatology. Although little is known about the specific case of somatic unexplained symp-toms, its relation with childhood maltreatment seems to be influenced by the role of romantic attachment. The main objective of our study is to check the effect of emotional maltreatment on early-adult somatization through the mediation of avoidance and anxiety levels of romantic attachment in a female group. Participants were 346 female students (mean age = 23.17) who completed a self-report protocol composed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Ex-periences in Close Relationships Scale-Revised (ECR-R) and the Symptom Check-List (SCL-90). A structural equation modelling has been applied in order to test the mediation of romantic attachment (ECR-R) in the relation between emotional maltreatment (CTQ-SF) and somatic symptoms (SCL-90). The total model fit resulted adequate and it proved that romantic attachment mediates the relation between emotional maltreatment and adult somatization (b = 0.15, SE = 0.05, z = 2.76, p = 0.006, 95% CI [0.04, 0.25]). Our results stress the importance to consider the relational level within intervention pro-grams for female victims of adverse childhood experiences. Addressing the treatment of these individuals towards the adult relational functioning might prevent negative effects of maltreatment and thus reduce public health costs.

Keywords: Emotional maltreatment, somatization, romantic attachment.

  1. Afari N., Ahumada S.M., Wright L.J., Mostoufi S., Golnari G., Reis V. and Cuneo J.G. (2014). Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosomatic Medicine, 76 (1): 2-11. DOI: 10.1097/PSY.000000000000001
  2. Anda R., Tietjen G., Schulman E., Felitti V. and Croft J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache, 50 (9): 1473-1481.
  3. Autorità Garante per l’Infanzia e l’Adolescenza – CISMAI – Fondazione Terre desHommes Italia (2015). Indagine nazionale sul maltrattamento dei bambini e degli adolescenti in Italia: Risultati e Prospettive.
  4. Chaffin M., Silovsky J.F., Funderburk B., Valle L.A., Brestan E.V., Balachova T., Jackson S., Lensgraf J. and Bonner B.L. (2004). Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72 (3): 500-510. DOI: 10.1037/0022-006X.72.3.50
  5. Cicchetti D. (2011). Allostatic Load. Development and Psychopathology, 23: 723-724. DOI: 10.1017/S095457941100027
  6. Cicchetti D. and Toth S.L. (2005). Child maltreatment. Annual Review of Clinical Psychology, 1: 409-438.
  7. D’Andrea W., Ford J., Stolbach B., Spinazzola J. and Van der Kolk B.A. (2012). Under-standing interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82 (2): 187-200.
  8. Derogatis L.R., Lipman R.S. and Covi L. (1973). The SCL–90: An outpatient psychiatric rating scale. Preliminary report. Psychopharmacology Bulletin, 9 (1): 13-28.
  9. Dong M., Giles W.H., Felitti V.J., Dube S.R., Williams J.E., Chapman D.P. and Anda R.F. (2004). Insights into Causal Pathways for Ischemic Heart Disease. Circulation, 110 (13): 1761-1766. DOI: 10.1161/01.CIR.0000143074.54995.7
  10. Elwood L.S. and Williams N.L. (2007). PTSD? Related Cognitions and Romantic Attachment Style as Moderators of Psychological Symptoms in Victims of Interpersonal Trauma. Journal of Social and Clinical Psychology, 26 (10): 1189-1209.
  11. Felitti V.J. and Anda R.F. (2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. In: Lanius R.A., Vermetten E. and Pain C., editors, The impact of early life trauma on health and disease: The hidden epidemic. New York, NY: Cambridge University Press, pp. 77-87.
  12. Felitti V.J., Anda R.F., Nordenberg D., Williamson D.F., Spitz A.M., Edwards V., Koss M.P. and Marks J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4): 245-258. DOI: 10.1016/S0749-3797(98)00017-
  13. Fraley R.C., Waller N.G. and Brennan K.A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78 (2): 350-365. DOI: 10.1037/0022-3514.78.2.35
  14. Gatta M., Balottin L., Mannarini S., Chesani G., Del Col L., Spoto A. and Battistella P.A. (2016). Familial factors relating to alexithymic traits in adolescents with psychiatric dis-orders. Clinical Psychologist.
  15. Gilbert L.K., Breiding M.J., Merrick M.T., Thompson W.W., Ford D.C., Dhingra S.S. and Parks S.E. (2015). Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010. American Journal of Preventive Medicine, 48 (3): 345-349.
  16. Hazan C. and Shaver P.R. (1987). Romantic Love Conceptualized as an Attachment Process. Journal of Personality and Social Psychology, 52 (3): 511-524. DOI: 10.1037/0022-3514.52.3.51
  17. Hornor G. (2012). Emotional maltreatment. Journal of Pediatric Health Care, 26 (6): 436-442.
  18. Kanuri N., Cassell B., Bruce S.E., White K.S., Gott B.M., Gyawali C.P. and Sayuk G.S. (2016). The impact of abuse and mood on bowel symptoms and health‐related quality of life in irritable bowel syndrome (IBS). Neurogastroenterology & Motility, 28 (10): 1508-1517.
  19. Kirmayer L.J., Groleau D., Looper K.J. and Dao M.D. (2004). Explaining medically unexplained symptoms. The Canadian Journal of Psychiatry, 49 (10): 663-672. DOI: 10.1177/07067437040490100
  20. Molnar B.E., Buka S.L. and Kessler R.C. (2001). Child Sexual Abuse and Subsequent Psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health, 91 (5): 753-760. DOI: 10.2105/AJPH.91.5.75
  21. Moss E., Dubois-Comtois K., Cyr C., Tarabulsy G.M., St-Laurent D. and Bernier A. (2011). Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial. Development and Psychopathology, 23 (1): 195-210. DOI: 10.1017/S095457941000073
  22. Ogrodniczuk J.S., Joyce A.S. and Abbass A.A. (2014). Childhood maltreatment and somatic complaints among adult psychiatric outpatients: Exploring the mediating role of Alexithymia. Psychotherapy and Psychosomatics, 83 (5): 322-324. DOI: 10.1159/00036376
  23. Olde E., van der Hart O., Kleber R.J., van Son M.J., Wijnen H.A. and Pop V.J. (2005). Peritraumatic dissociation and emotions as predictors of PTSD symptoms following child-birth. Journal of Trauma & Dissociation, 6 (3): 125-142.
  24. Paivio S.C. and Cramer K.M. (2004). Factor structure and reliability of the Childhood Trauma Questionnaire in a Canadian undergraduate student sample. Child Abuse & Neglect, 28 (8): 889-904.
  25. Petrone L., Manca M., Pedon A. and Ricci S. (2012). Maltrattamento o maltrattamenti? dati preliminari dell’adattamento italiano del Childhood Trauma Questionnaire Short-Form. International Journal of Developmental and Educational Psychology, 1 (1): 199-204.
  26. Mikulincer M. and Shaver P. (2016). Adult Attachment and Emotion Regulation. In: Cassidy J. and Shaver P.R., editors, Handbook of attachment – Third edition: Theory, Research, and Clinical Applications. New York, NY: Guilford Press, pp. 507-533.
  27. McCall-Hosenfeld J.S., Winter M., Heeren T. and Liebschutz J.M. (2014). The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma. Journal of Psychosomatic Research, 77 (3): 196-204.
  28. Maunder R.G., Hunter J.J., Atkinson L., Steiner M., Wazana A., Fleming A., Moss E., Gaudreau H., Meaney M., and Levitan R.D. (2017). An attachment-based model of the relationship between childhood adversity and somatization in children and adults. Psychosomatic Medicine, 79 (5): 496-505. DOI: 10.1097/PSY.000000000000043
  29. Mandelli L., Petrelli C. and Serretti A. (2015). The role of specific early trauma in adult depression: a meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, 30 (6): 665-680.
  30. Lyons-Ruth K. and Jacobviz D. (2016). Attachment Disorganization from Infancy to Adult-hood: Neurobiological Correlates, Parenting Contexts, and Pathways to Disorder. In: Cassidy J. and Shaver P.R., editors, Handbook of attachment – Third edition: Theory, Research, and Clinical Applications. New York, NY: Guilford Press, pp. 667-695.
  31. Liotti G. (2005). Trauma e dissociazione alla luce della teoria dell’attaccamento. Infanzia e Adolescenza, 4 (3): 130-44.
  32. Li M., D’Arcy C. and Meng X. (2016). Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychological Medicine, 46 (04): 717-730. DOI: 10.1017/S003329171500274
  33. Larkin H., Felitti V.J. and Anda R.F. (2014). Social Work and Adverse Childhood Experiences Research: Implications for Practice and Health Policy. Social Work in Public Health, 29 (1): 1-16. DOI: 10.1080/19371918.2011.61943
  34. Calvo V. (2008) Il questionario ECR–R: Aspetti di validazione della versione italiana dello strumento [The ECR-R questionnaire: Aspects of validation of the Italian version of the instrument]. In: Atti del X Congresso Nazionale AIP: Sezione Clinica-Dinamica, Padova, pp. 275-279.
  35. Busuito A., Huth-Bocks A. and Puro E. (2014). Romantic attachment as a moderator of the association between childhood abuse and posttraumatic stress disorder symptoms. Journal of Family Violence, 29 (5): 567-577.
  36. Busonera A., San Martini P., Zavattini G.C. and Santona A. (2014). Psychometric Properties of an Italian Version of the Experiences in Close Relationships-Revised (ECR-R) Scale. Psychological Reports, 114 (3): 785-801.
  37. Brown T.A. (2015). Confirmatory factor analysis for applied research. New York, NY: Guilford Publications.
  38. Brown R.J., Schrag A. and Trimble M.R. (2005). Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. American Journal of Psychiatry, 162 (5): 899-905.
  39. Brown D.W., Anda R.F., Felitti V.J., Edwards V.J., Malarcher A.M., Croft J.B. and Giles W.H. (2010). Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study. BMC Public Health, 10 (1): 1-12. DOI: 10.1186/1471-2458-10-2
  40. Bohn D., Bernardy K., Wolfe F. and Häuser W. (2013). The association among childhood maltreatment, somatic symptom intensity, depression, and somatoform dissociative symptoms in patients with fibromyalgia syndrome: a single-center cohort study. Journal of Trauma & Dissociation, 14 (3): 342-358. DOI: 10.1080/15299732.2012.73693
  41. Bleiberg K.L. and Markowitz J.C. (2005). A pilot study of interpersonal psychotherapy for posttraumatic stress disorder. American Journal of Psychiatry, 162 (1): 181-183.
  42. Bifulco A., Kwon J., Jacobs C., Moran P.M., Bunn A. and Beer N. (2006). Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology, 41 (10): 796-805.
  43. Bhandari R., Bakermans-Kranenburg M.J., van der Veen R., Parsons C.E., Young K.S., Grewen K.M., Stein A., Kringelbach M.L. and van IJzendoorn M.H. (2014). Salivary oxytocin mediates the association between emotional maltreatment and responses to emotional infant faces. Physiology & Behavior, 131: 123-128.
  44. Bernstein D.P., Stein J.A., Newcomb M.D., Walker E., Pogge D., Ahluvalia T., Stokes J., Handelsman L., Medrano M., Desmond D. and Zule W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27 (2): 169-190. DOI: 10.1016/S0145-2134(02)00541-
  45. Bernstein D.P. and Fink L. (1998). Childhood trauma questionnaire: A retrospective self-report: Manual. Orlando: Psychological Corporation.
  46. Bellis M.A., Lowey H., Leckenby N., Hughes K. and Harrison D. (2013). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36 (1): 81-91.
  47. Bateman A.W. and Fonagy P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment. New York: Oxford University Press.
  48. Bateman A.W. and Fonagy P. (2012). Handbook of Mentalizing in Mental Health Practice. Washington: American Psychiatric Pyblishing.
  49. Baer J.C. and Martinez C.D. (2006). Child maltreatment and insecure attachment: a meta-analysis. Journal of Reproductive and Infant Psychology, 24 (3): 187-197. DOI: 10.1080/0264683060082123
  50. Prino L.E. e Scarzello D. (2015). Il parenting stress nei primi anni di vita del bambino: il ruolo dell’alessitimia e dell’autoefficacia emotiva genitoriale. Psicologia della Salute, 3: 45-64. DOI: 10.3280/PDS2015-003003
  51. Teicher M.H. and Samson J.A. (2013). Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry, 170 (10): 1114-1133.
  52. Tietjen G.E. (2016). Childhood maltreatment and headache disorders. Current Pain and Headache Reports, 20 (4): 1-9.
  53. Tietjen G.E., Buse D.C., Fanning K.M., Serrano D., Reed M.L. and Lipton R.B. (2015). Re-called maltreatment, migraine, and tension-type headache: results of the AMPP study. Neurology, 84 (2): 132-140. DOI: 10.1212/WNL.000000000000112
  54. Toth S.L., Gravener-Davis J.A., Guild D.J. and Cicchetti D. (2013). Relational interventions for child maltreatment: Past, present, and future perspectives. Development and Psychopathology, 25 (4pt2): 1601-1617. DOI: 10.1017/S095457941300079
  55. Van der Kolk B.A. (2005). Developmental trauma disorder. Psychiatric Annals, 35: 401-408.
  56. Van der Kolk B.A. (2008). Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Praxis der Kinderpsychologie und Kinderpsychiatrie, 58 (8): 572-586.
  57. van Schie C.C., van Harmelen A.L., Hauber K., Boon A., Crone E.A. and Elzinga B.M. (2017). The neural correlates of childhood maltreatment and the ability to understand mental states of others. European Journal of Psychotraumatology, 8 (1): 1-11. DOI: 10.1080/20008198.2016.127278
  58. Waldinger R.J., Schulz M.S., Barsky A.J. and Ahern D.K. (2006). Mapping the Road from Childhood Trauma to Adult Somatization: The Role of Attachment. Psychosomatic Medicine, 68 (1): 129-135.
  59. Weissman M.M., Markowitz J.C. and Klerman G. (2008). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books.
  60. Cassidy J. (1994). Emotion regulation: influences of attachment relationships. Monographs of the Society for Research in Child Development, 59 (2-3): 228-249.
  61. Kline R.B. (2015). Principles and practice of structural equation modeling. New York, NY: Guilford Press.
  62. Prunas A., Sarno I., Preti E., Madeddu F. and Perugini M. (2012), Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample. European Psychiatry, 27 (8): 591-597.
  63. Riggs S.A. (2010). Childhood Emotional Abuse and the Attachment System Across the Life Cycle: What Theory and Research Tell Us. Journal of Aggression, Maltreatment & Trauma, 19 (1): 5-51. DOI: 10.1080/1092677090347596
  64. Roche D.N., Runtz M.G. and Hunter M.A. (1999). Adult Attachment A Mediator Between Child Sexual Abuse and Later Psychological Adjustment. Journal of Interpersonal Violence, 14 (2): 184-207. DOI: 10.1177/08862609901400200
  65. Roelofs K., Keijsers G.P.J., Hoogduin K.A.L., Näring G.W.B. and Moene F.C. (2002). Childhood Abuse in Patients with Conversion Disorder. American Journal of Psychiatry, 159 (11): 1908-1913.
  66. Rosseel Y. (2012). lavaan: An R Package for Structural Equation Modeling. Journal of Statistical Software, 48 (2): 1-33.
  67. Sacchi C., Vieno A. and Simonelli A. (2017). Italian Validation of the Childhood Trauma Questionnaire-Short Form on a College Group. Psychological Trauma: THEORY, Re-search, Practice, and Policy (advance online publication).
  68. Salmon P., Skaife K. and Rhodes J. (2003). Abuse, dissociation, and somatization in irritable bowel syndrome: towards an explanatory model. Journal of Behavioral Medicine, 26 (1): 1-18. DOI: 10.1023/A:102171830463
  69. Santoro P., Canale N., Laugelli E., Michieletto N., Vieno A., Simonelli A. e Santinello M. (2016). Lo psicologo di base: primi risultati dalla sperimentazione in Veneto. Psicologia della Salute, 3: 103-115. DOI: 10.3280/PDS2016-00300
  70. Scott K.M., Smith D.R. and Ellis P.M. (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry, 67 (7): 712-719.
  71. Sethi D., editor (2013). European report on preventing child maltreatment. Copenhagen, Denmark: World Health Organization, Regional Office for Europe.
  72. Shields A. and Cicchetti D. (2001). Parental maltreatment and emotion dysregulation as risk factors for bullying and victimization in middle childhood. Journal of Clinical Child Psychology, 30 (3): 349-363. DOI: 10.1207/S15374424JCCP3003_
  73. Simonelli A. and Sacchi C. (2016). Childhood Traumatic Experiences and Post-Traumatic Stress Disorder in Female Adults: Which is the Role Played by Stress Disorder in Female Adults: Which is the Role Played by Romantic Attachment? In: El-Baalbaki G. and Fortin C., editors, A Multidimensional Approach to Post-Traumatic Stress Disorder – from Theory to Practice. Rijeka: InTech, pp. 109-129.
  74. Simpson J.A., Collins A., Farrell A.K. and Lee Raby K. (2015). Attachment and Relation-ships Across Time: An Organizational-Developmental Perspective. In: Zayas V. and Hazan C., editors, Bases of Adult Attachment: Linking Brain, Mind and Behavior. New York, NY: Springer, pp. 61-78.
  75. Simpson J.A. and Rholes W.S. (2017). Adult attachment, stress, and romantic relationships. Current Opinion in Psychology, 13: 19-24.
  76. Sitko K., Bentall R.P., Shevlin M. and Sellwood W. (2014). Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatry Research, 217 (3): 202-209.
  77. Spiegel D.R., Shaukat A.M., Mccroskey A.L., Chatterjee A., Ahmadi T., Simmelink D., Oldfield E.C., Pryor C.R., Faschan M. and Raulli O. (2016). Conceptualizing a subtype of patients with chronic pain: the necessity of obtaining a history of sexual abuse. The International Journal of Psychiatry in Medicine, 51 (1): 84-103. DOI: 10.1177/009121741562126
  78. Spinhoven P., Elzinga B.M., Hovens J.G., Roelofs K., Zitman F.G., van Oppen P. and Penninx B.W. (2010). The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders. Journal of Affective Disorders, 126 (1): 103-112.
  79. Spinhoven P., Elzinga B.M., Van Hemert A.M., de Rooij M. and Penninx B.W. (2016). Childhood maltreatment, maladaptive personality types and level and course of psycho-logical distress: A six-year longitudinal study. Journal of Affective Disorders, 191: 100-108.
  80. Spitzer C., Barnow S., Gau K., Freyberger H.J. and Grabe H.J. (2008). Childhood maltreatment in patients with somatization disorder. Australian and New Zealand Journal of Psychiatry, 42 (4): 335-341. DOI: 10.1080/0004867070188153
  81. Steinbrecher N., Koerber S., Frieser D. and Hiller W. (2011). The prevalence of medically unexplained symptoms in primary care. Psychosomatics, 52 (3): 263-271.
  82. Stuart S. and Noyes R. (1999). Attachment and Interpersonal Communication in Somatization. Psychosomatics, 40 (1): 34-43. DOI: 10.1016/S0033-3182(99)71269-
  83. Subic-Wrana C. (2010). Emotion regulation and Mentalization in Somatoform Disorders. In: Nyklíček I., VingerhoetsA. and Zeelenberg M., editors, Emotion regulation and Well-being. New York, NY: Springer Science & Business Media, pp. 245-260.
  84. Tasca G.A., Ritchie K., Zachariades F., Proulx G., Trinneer A., Balfour L., Demidenko N., Hayden G., Wong A. and Bissada H. (2013). Attachment insecurity mediates the relationship between childhood trauma and eating disorder psychopathology in a clinical sample: a structural equation model. Child Abuse & Neglect, 37 (11): 926-933.
  85. Taylor G.J., Bagby R.M. and Parker J.D. (2016). What’s in the name “alexithymia’? A commentary on “Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud’s legacy”. Neuroscience & Biobehavioral Reviews, 68: 1006-1020.

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Maria Elena Brianda, Chiara Sacchi, Pietro De Carli, Alessandra Simonelli, Maltrattamento emotivo e sintomi somatici in età giovanile adulta. Il ruolo di mediazione dello stile di attaccamento romantico in una popolazione femminile in "PSICOLOGIA DELLA SALUTE" 1/2018, pp 81-101, DOI: 10.3280/PDS2018-001005