title: An Attachment-Based Model of the Relationship Between Childhood Adversity and Somatization in Children and Adults.
abstract: OBJECTIVE
  An attachment model was used to understand how maternal sensitivity and adverse childhood experiences are related to somatization.
  
  
  METHODS
  We examined maternal sensitivity at 6 and 18 months and somatization at 5 years in 292 children in a longitudinal cohort study. We next examined attachment insecurity and somatization (health anxiety, physical symptoms) in four adult cohorts: healthy primary care patients (AC1, n = 67), ulcerative colitis in remission (AC2, n = 100), hospital workers (AC3, n = 157), and paramedics (AC4, n = 188). Recall of childhood adversity was measured in AC3 and AC4. Attachment insecurity was tested as a possible mediator between childhood adversity and somatization in AC3 and AC4.
  
  
  RESULTS
  In children, there was a significant negative relationship between maternal sensitivity at 18 months and somatization at age 5 years (B = -3.52, standard error = 1.16, t = -3.02, p = .003), whereas maternal sensitivity at 6 months had no significant relationship. In adults, there were consistent, significant relationships between attachment insecurity and somatization, with the strongest findings for attachment anxiety and health anxiety (AC1, β = 0.51; AC2, β = 0.43). There was a significant indirect effect of childhood adversity on physical symptoms mediated by attachment anxiety in AC3 and AC4.
  
  
  CONCLUSIONS
  Deficits in maternal sensitivity at 18 months of age are related to the emergence of somatization by age 5 years. Adult attachment insecurity is related to somatization. Insecure attachment may partially mediate the relationship between early adversity and somatization.
authors.affiliation: From the Department of Psychiatry (Maunder, Hunter), Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Department of Psychology (Atkinson), Ryerson University, Toronto, Ontario, Canada; Departments of Psychiatry & Behavioural Neurosciences and Obstetrics & Gynecology (Steiner), McMaster University, Hamilton, Ontario, Canada; Centre for Child Development and Mental Health, McGill University, Montreal (Wazana), Quebec, Canada; Department of Psychology (Fleming), University of Toronto, Mississauga, Ontario, Canada; Department of Psychology (Moss), Université du Québec à Montreal, Montréal, Québec, Canada; Department of Psychiatry and Neurology (Gaudreau, Meaney), Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada; and Centre for Addiction and Mental Health and Department of Psychiatry (Levitan), University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Hunter
authors.forename: Leslie
authors.initials: L
authors.lastname: Atkinson
authors.forename: Meir
authors.initials: M
authors.lastname: Steiner
authors.forename: Ashley
authors.initials: A
authors.lastname: Wazana
authors.forename: Alison S
authors.initials: AS
authors.lastname: Fleming
authors.forename: Ellen
authors.initials: E
authors.lastname: Moss
authors.forename: Helene
authors.initials: H
authors.lastname: Gaudreau
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Meaney
authors.forename: Robert D
authors.initials: RD
authors.lastname: Levitan
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008875:Middle Aged; D008960:Models, Psychological; D009034:Mother-Child Relations / Q000523:psychology*; D009769:Object Attachment; D013001:Somatoform Disorders / Q000209:etiology*; D055815:Young Adult