Attachment style in patients with unexplained physical complaints

Background. Patients who present with physical symptoms that lack an organi c explanation are common, difficult to help and poorly understood. Their me dical help-seeking is a form of care-eliciting behaviour and, as such, may be understandable in terms of attachment style. Adult attachment style infl uences functioning in relationships, and may affect help-seeking behaviour from professional carers such as the family doctor. Method. A consecutive sample of 2042 primary-care attenders completed quest ionnaires on: the reason for consultation, attribution of symptoms, psychia tric distress (GHQ), somatic distress (BSI), and self-reported adult attach ment style (ASQ). Their doctors rated presentations into explained physical , unexplained physical, or psychological. Results. There is a powerful relationship between type of presentation and adult attachment style. Both abnormal attachment and level of psychiatric d istress increased significantly from the explained physical group, through the unexplained physical group to the I:roup who presented psychologically. Logistic regression models determined three explanatory variables that mad e significant independent contributions to presentation type: psychiatric d istress, attachment style and symptom attribution. Conclusion Presentation to the doctor with unexplained physical symptoms is associated with both higher levels of psychiatric symptoms and abnormal at tachment style when compared to presentations with organic physical symptom s. Patients who present overt psychological symptoms suffer more psychiatri c distress and have more abnormal attachment than those presenting physical symptoms (either organically explained or unexplained). Models to explain these findings are discussed.