Tarantino Samuela, De Ranieri Cristiana, Dionisi Cecilia, Gagliardi Valentina, Paniccia Maria Francesca, Capuano Alessandro, Frusciante Roberto, Balestri Martina, Vigevano Federico, Gentile Simonetta, Valeriani Massimiliano
Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
Headache. 2017 Feb;57(2):266-275. doi: 10.1111/head.13007. Epub 2017 Jan 6.
We aimed to study the role of attachment style on headache severity and psychological symptoms in migraineurs children/adolescents. Moreover, we investigated the association between attachment style, migraine severity, and psychological symptoms.
Attachment theory suggests that early interpersonal relationships may be important determinants of psychopathology and pain management. In particular, individuals with insecure attachment styles have been shown to experience more pain than people with secure attachment style. Few studies focused on headache and data on attachment style in pediatric headache are scarce.
We studied 90 migraineurs (mean age 12.2 ± 2.6 years; female: 54, male: 36). Patients were divided in two groups according to headache attack frequency: (1) high frequency (HF) patients, having from weekly to daily episodes and (2) low frequency (LF) patients, showing ≤3 episodes per month. According to headache attack intensity, patients were classified in two groups: (1) mild pain (MP), allowing the patient to continue his/her daily activities and (2) severe pain (SP), leading to interruption of patient activities or forcing the child to go to bed. The psychological screening was assessed by SAFA Anxiety, Depression, and Somatization questionnaires. Attachment style was measured by the semi-projective test Separation Anxiety Test. Patients were divided into "secure," "avoidant," "ambivalent," and "disorganized/confused" attachment patterns.
We found a significant relationship between the attachment style and migraine features. The ambivalent attachment was the most common style among patients reporting high attack frequency (51%) and severe pain intensity (50%). Anxiety (SAFA-A Tot: F = 23.3, P < .001), depression (SAFA-D Tot: F = 11.8, P < .001), and somatization (SAFA-S Tot: F = 10.1, P < .001) were higher in patients with ambivalent attachment style. Moreover, our results showed an association between high attack frequency and high anxiety levels, in children with ambivalent attachment style (F = 6.7, P < .002).
Ambivalent attachment style may be a common vulnerability factor that impacts on pain severity, anxiety, depression, and somatization symptoms in young migraineurs. In particular, the present study provides the first evidence of the role of insecure attachment on the relationship between pain severity and psychological symptoms in migraine children.
我们旨在研究依恋风格对偏头痛儿童/青少年头痛严重程度和心理症状的作用。此外，我们还调查了依恋风格、偏头痛严重程度和心理症状之间的关联。
依恋理论表明，早期人际关系可能是精神病理学和疼痛管理的重要决定因素。特别是，不安全依恋风格的个体比安全依恋风格的个体经历更多疼痛。很少有研究关注头痛，儿科头痛中依恋风格的数据也很稀少。
我们研究了90名偏头痛患者（平均年龄12.2±2.6岁；女性54名，男性36名）。根据头痛发作频率将患者分为两组：（1）高频（HF）患者，每周至每天发作；（2）低频（LF）患者，每月发作≤3次。根据头痛发作强度，患者分为两组：（1）轻度疼痛（MP），患者能够继续日常活动；（2）重度疼痛（SP），导致患者活动中断或迫使孩子上床睡觉。通过SAFA焦虑、抑郁和躯体化问卷进行心理筛查。依恋风格通过半投射测试分离焦虑测试进行测量。患者被分为“安全型”“回避型”“矛盾型”和“混乱/困惑型”依恋模式。
我们发现依恋风格与偏头痛特征之间存在显著关系。矛盾型依恋是报告发作频率高（51%）和疼痛强度严重（50%）患者中最常见的风格。矛盾型依恋风格患者的焦虑（SAFA-A Tot：F = 23.3，P <.001）、抑郁（SAFA-D Tot：F = 11.8，P <.001）和躯体化（SAFA-S Tot：F = 10.1，P <.001）水平更高。此外，我们的结果显示，在矛盾型依恋风格儿童中，高发作频率与高焦虑水平之间存在关联（F = 6.7，P <.002）。
矛盾型依恋风格可能是影响年轻偏头痛患者疼痛严重程度、焦虑、抑郁和躯体化症状的常见脆弱因素。特别是本研究首次提供了不安全依恋在偏头痛儿童疼痛严重程度与心理症状关系中作用的证据。
