Taylor R E, Mann A H, White N J, Goldberg D P
Department of Psychiatry, De Crespigny Park Institute of Psychiatry, London.
Psychol Med. 2000 Jul;30(4):931-41. doi: 10.1017/s0033291799002317.
Patients who present with physical symptoms that lack an organic explanation are common, difficult to help and poorly understood. Their medical help-seeking is a form of care-eliciting behaviour and, as such, may be understandable in terms of attachment style. Adult attachment style influences functioning in relationships, and may affect help-seeking behaviour from professional carers such as the family doctor.
A consecutive sample of 2,042 primary-care attenders completed questionnaires on: the reason for consultation, attribution of symptoms, psychiatric distress (GHQ), somatic distress (BSI), and self-reported adult attachment style (ASQ). Their doctors rated presentations into explained physical, unexplained physical, or psychological.
There is a powerful relationship between type of presentation and adult attachment style. Both abnormal attachment and level of psychiatric distress increased significantly from the explained physical group, through the unexplained physical group to the group who presented psychologically. Logistic regression models determined three explanatory variables that made significant independent contributions to presentation type: psychiatric distress, attachment style and symptom attribution.
Presentation to the doctor with unexplained physical symptoms is associated with both higher levels of psychiatric symptoms and abnormal attachment style when compared to presentations with organic physical symptoms. Patients who present overt psychological symptoms suffer more psychiatric distress and have more abnormal attachment than those presenting physical symptoms (either organically explained or unexplained). Models to explain these findings are discussed.
出现无器质性解释的身体症状的患者很常见，难以治疗且了解甚少。他们寻求医疗帮助是一种引发护理的行为，因此，从依恋风格的角度来看可能是可以理解的。成人依恋风格会影响人际关系中的功能，并且可能会影响向家庭医生等专业护理人员寻求帮助的行为。
对2042名连续就诊的初级保健患者进行抽样，让他们完成关于以下方面的问卷调查：咨询原因、症状归因、精神痛苦（一般健康问卷）、躯体痛苦（症状自评量表）以及自我报告的成人依恋风格（成人依恋问卷）。他们的医生将就诊情况分为有器质性解释的身体症状、无器质性解释的身体症状或心理症状。
就诊类型与成人依恋风格之间存在密切关系。从有器质性解释的身体症状组，到无器质性解释的身体症状组，再到表现为心理症状的组，异常依恋和精神痛苦程度均显著增加。逻辑回归模型确定了三个对就诊类型有显著独立贡献的解释变量：精神痛苦、依恋风格和症状归因。
与有器质性身体症状的就诊情况相比，以无器质性解释的身体症状就诊与更高水平的精神症状和异常依恋风格相关。表现出明显心理症状的患者比表现出身体症状（无论是有器质性解释还是无器质性解释）的患者遭受更多的精神痛苦，且有更异常的依恋。文中讨论了解释这些发现的模型。
