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Mapping the Road From Childhood Trauma to Adult Somatization: The Role of Attachment

Waldinger, Robert J. MD; Schulz, Marc S. PhD; Barsky, Arthur J. MD; Ahern, David K. PhD

doi: 10.1097/01.psy.0000195834.37094.a4
Original Articles

Objective: This study tested whether insecure attachment mediates the link between childhood trauma and adult somatization.

Methods: A community sample of 101 couples completed self-report measures, including the Relationship Scales Questionnaire, the Childhood Trauma Questionnaire, the Somatic Symptom Inventory, the Beck Depression Inventory, and the Conflict Tactics Scale.

Results: Childhood trauma was associated with higher levels of somatization and insecure attachment. Insecure attachment style was also associated with higher levels of somatization. Controlling for age, income, and recent intimate partner violence, analyses showed that fearful attachment fully mediated the link between childhood trauma and somatization for women. For men, there was no such mediation, but both childhood trauma and insecure attachment styles made independent contributions to predicting levels of somatization.

Conclusions: Findings are consistent with the hypothesis that, for women, childhood trauma influences adult levels of somatization by fostering insecure adult attachment. For men, findings suggest that trauma and attachment are both important independent predictors of adult somatization. Study results support the idea that childhood trauma shapes patients' styles of relating to others in times of need, and these styles, in turn, influence the somatization process and how patients respond to providers. Screening for attachment style may provide information that could allow health care providers to tailor treatment more effectively.

CTQ = Childhood Trauma Questionnaire; CTS2 = Conflict Tactics Scale version 2; SSI = Somatic Symptom Inventory; RSQ = Relationship Scales Questionnaire; BDI = Beck Depression Inventory.

From the Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.W., A.J.B., D.K.A.); and Bryn Mawr College, Bryn Mawr, PA (M.S.S.).

Address correspondence and reprint requests to Robert J. Waldinger, MD, Department of Psychiatry, Brigham and Women's Hospital, 1249 Boylston Street, Boston, MA 02215. E-mail:

This study was supported by grants from the National Institute of Mental Health K08 MH01555 (Waldinger), MH042248-18 (Waldinger), MH40487 (Barsky and Ahern).

Received for publication April 25, 2005; revision received August 16, 2005.

Copyright © 2006 by American Psychosomatic Society
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