Somatization in children and adolescents with headache: the role of attachment to parents

Primary headache is a common somatic disorder in childhood that significantly affects quality of life. The condition is strongly associated with a variety of internalizing and externalizing disorders, and several dimensions are recognized to play a role in its development and expression, including attachment bonds. The present study aimed at exploring the associations between somatic symptoms, internalizing and externalizing problems, and attachment dimensions in a group of children and adolescents suffering from headache. The predictive effect of internalizing/externalizing problems and attachment dimensions on somatic symptoms was also explored. A sample of 50 children/adolescents with a headache diagnosis (i.e., 36 girls, 14 boys; mean age 13.18 years; SD = 2.85) participated in the study and completed the Children’s Somatization Inventory-24, the Experiences in Close Relationships Scale–Revised Child version, and a brief sociodemographic questionnaire. Mothers completed the Child Behavior Checklist 6–18. The correlational analysis revealed positive associations between child somatic symptoms and age, internalizing problems, and attachment anxiety and avoidance to the mother and the father, respectively; and a negative association between child somatic symptoms and secure attachment to the father. The regression analysis highlighted the significant effect of ECR-RC Avoidance-Father and CBCL Internalizing Problems in predicting greater somatic symptoms in young headache patients. The present findings highlight avoidant attachment to fathers and internalizing problems as risk factors for greater somatic symptoms in children/adolescents with headache. The results suggest that greater somatic symptoms in this clinical population may represent a learned maladaptive behavior to satisfy attachment needs. Clinical implications are discussed.