Barts and the London School of Medicine and Dentistry, Queen Mary, Charterhouse Square, London, UK.
Psychol Med. 2012 Apr;42(4):855-64. doi: 10.1017/S0033291711001589. Epub 2011 Aug 31.
In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.
We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.
Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.
Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.
在初级保健中，频繁就诊且存在无法用医学解释的症状（MUS）的患者给临床和医疗资源带来了挑战。我们试图从医患关系的角度来理解这些表现，特别是为了验证这样一种假设，即这些患者具有不安全的情感依恋。
我们对 410 名 MUS 患者进行了队列随访研究。基线问卷评估了成人依恋风格、心理困扰、对症状的信念、非特异性躯体症状和身体功能。在咨询后进行电话访谈，评估健康担忧、全科医生（GP）管理和对咨询的满意度。主要结局是年度 GP 就诊率。
连续就诊者中，18%存在 MUS。该组在随访年内的平均就诊频率较高，为 5.24[95%置信区间（CI）为 4.79-5.69]。不安全依恋的患病率为 28（95%CI 为 23-33）%。即使在调整了社会人口学特征、慢性躯体疾病和基线身体功能后，仍发现不安全依恋风格与频繁就诊之间存在显著关联[比值比（OR）为 1.96（95%CI 为 1.05-3.67）]。在那些认为自己最初 MUS 存在身体原因的患者中，这种关联尤其强烈[OR 为 9.52（95%CI 为 2.67-33.93）]。提出了一种依恋风格与频繁就诊之间关系的可能模型。
频繁就诊且存在 MUS 的患者具有不安全的成人依恋风格，因此他们的高就诊率可以被概念化为与不安全依恋相关的病理性求医行为。将频繁就诊理解为与照顾者关系困难导致的病理性寻求帮助的行为，可能有助于医生以不同的方式管理他们频繁就诊的患者。
