Department of Educational Science, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy.
Department of School of Psychology, University of Laval, Quebec, Canada.
Eur Child Adolesc Psychiatry. 2019 May;28(5):705-717. doi: 10.1007/s00787-018-1238-5. Epub 2018 Oct 22.
Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8-15 years) spanning two groups-a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children's RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.
我们进行这项研究的目的是检验躯体症状障碍（SSD）和破坏性行为障碍（DBD）儿童与对照组相比，是否具有更高的不安全或组织混乱依恋率，以及心理化困难（操作性定义为反射功能）。参与者包括 131 名儿童（8-15 岁），分为两组-临床组（n=85），由符合我们目标诊断分类标准的儿童组成（SSD：n=45；DBD：n=40），以及健康对照组儿童（n=46）。儿童完成了儿童依恋访谈，该访谈后来由可靠的评估者对依恋安全性和反射功能（RF）进行编码。与我们的预测一致，临床组儿童的 RF 明显较低，且不安全（超过 80%）和组织混乱（超过 40%）的比例明显高于对照组儿童。此外，DBD 儿童的 RF 明显低于 SSD 儿童。此外，在 SSD 组中，儿童对自我的 RF 明显低于对他人的 RF。最后，与先前的研究一致，RF 和依恋是相关的。研究结果表明，患有 SSD 和 DBD 的学龄儿童具有更高的不安全和组织混乱依恋率。与理论一致，RF 和依恋之间的联系是松散的，但 RF 本身可以区分诊断亚组。讨论了治疗和预防的意义。
