Attachment Representation And Defense Style In Adolescent Patients With Somatoform Disorders

ObjectiveThe somatoform disorders are a group of psychiatric disorders. The primary diagnostic feature of somatoform disorders is the existence of multiple and variable unexplained physical symptoms. The lifetime prevalence of Somatoform disorders in adolescents is 2.7%. So far most of the researchers suggest psychosocial factors contribute the somatoform disorders, such as the disturbance of affect regulation, the personality disorders, and the childhood disaster. However, somatoform disorder patients extensively complain about these symptoms and attribute them to medical disease while denying that psychosocial factors may play a role in their suffering. It leads to difficult diagnosis and treatment, and forms high intense of doctor-patient relationship. This study will explore the attachment representation and defense style in adolescent patients with somatoform disorders based on the attachment theory. We hope we can get the pathopsychological characteristics of somatoform disorders, in order to provide evidences to psychotherapy, then form the safe therapy relationship and good effects. The aim of the present study is a) to examine the attachment style with parents and the anxious and avoidant related attachment in adolescent patients with somatoform disorders and b) to examine the defense style in adolescent patients with somatoform disorders and c) to investigate the correlations between attachment style with parents and the anxious and avoidant related attachment and the defense style in adolescent patients with somatoform disorders.MethodsIn this study, all of the 66 patients were from the psychiatry department of Shengjing hospital affiliated to China Medical University since February to December in 2009, and were diagnosed as somatoform disorder by two psychiatrists. In the control group,80 adolescents who had passed the screening of somatoform disorder were all from the elementary school and secondary school in Shenyang. They completed the assessments of common information, Experiences in Close Relationships Scales in Chinese version, and Defense Style Questionnaire. The data were calculated by SPSS 13.0.Results1. There were significant differences in the styles of attachment with parents between somatoform group and control group (P<0.001). The scores of avoidant and anxious related attachment with parents in somatoform group were significant higher than that in control group (P<0.001, P<0.01).2. Compared with control group, there were significant differences in the use of immature defenses, mature defenses, and neurotic defenses (P<0.05). Adolescents with somatoform disorder would use more immature defenses than normal controls, such as projection, passive aggression, acting out, splitting, somatization; use more neurotic defenses, such as reaction formation, idealization, omnipotence with disability, isolation, identity, denial, communication tendency; and use less mature defenses, such as suppression and humor.3. In somatoform group, there was a positive correlation between anxious related attachment and splitting (r=0.353, P<0.01), somatization (r=0.424, P<0.01), avoidance (r=0.271, P<0.05), identity (r=0.348, P<0.01), and wrap (r=0.259, P <0.05), and a negative correlation between desire (r=-0.306, P<0.05); There was a negative correlation between avoidant related attachment and pseudo-benefit others (r =-0.272, P<0.05)4. There was a significant difference in the use of defensive mechanism among the adolescents with different styles of attachment with parents who suffered from somatoform disorder (P<0.05). Conclusions1. There was a higher incidence of insecure attachment and higher level of anxious and avoidant related attachment in adolescent patients with somatoform disorder. The most common style was dismissing attachment, the second one was preoccupied attachment, the third one was secure attachment, and the last one was fearful attachment.2. Adolescent patients with somatoform disorder used more immature defenses and neurotic defenses, but less mature defenses.3. In the adolescent patients with somatoform disorder, the subjects with high level of anxious and avoidant related attachment would use more immature defenses, neurotic defenses, and wrap, but use less mature defenses.4. Different attachment styles could have specified defensive styles. Subjects with insecure attachment would use more immature defenses, neurotic defenses and wrap. Inversely, the subjects with secure attachment would use more mature defenses. Defensive styles might be the intermediate factors of attachment and somatoform symptoms.