The relationship between medically unexplained symptoms and insecure attachment

Helping someone with a successful benefits appeal, or into secure housing or out of a violent relationship might be our most effective therapeutic intervention.

Medically unexplained symptoms are physical symptoms that have no currently known physical pathological cause. They are common (accounting for as many as 1 in 5 of new primary care consultations) and can impair function and cause significant distress to patients.

This longitudinal cohort study conducted by researchers from London set out to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.

The study followed 410 patients with medically unexplained symptoms from 10 general practices in the UK. Patients answered a baseline questionnaire which assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. They were then consulted further via a telephone interview which measured health worry, GP management and their overall satisfaction with the consultation. The main outcome was annual GP consultation rate.

Here’s what the researchers found:

  • 18% of consecutive attenders had medically unexplained symptoms (MUS)
  • The MUS group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year
  • The prevalence of insecure attachment was 28% (95% CI 23-33).
  • A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]
  • The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]

The authors concluded:

Patients with medically unexplained symptoms who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.

Taylor RE, Marshall T, Mann A, Goldberg DP. Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychol Med. 2011 Aug 31:1-10. [Epub ahead of print] [PubMed abstract]

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

More posts - Website

Follow me here –