Attachment and Interpersonal Relatedness as Models Predicting Somatization, Physical Health, and Utilization in Primary Care

Abstract

The present study examined the degree to which the self and other models of attachment and object relations can predict somatization, overall physical health and healthcare utilization in a primary care sample of men and women. Attachment and Object Relations theories provide valuable information regarding how one understands and communicates their symptoms, their mentalizing capacities, and how they experience relationships. There is a growing interest in merging primary care and mental health services to address patients’ psychosocial stressors, indicating the correlations between physical and psychological health-related concerns. One hypothesis states that attachment and object relations independently predict somatization, physical health, and healthcare utilization and that object relations and attachment may together better predict the degree of somatization, physical health, and healthcare utilization experienced among participants than either model alone. Participants (N=102) at a primary care clinic completed the Experiences In Close Relationships questionnaire-Short Form (ECR-S), the Relationship Questionnaire (RQ), Early Memory Narratives, Patient Health Questionnaire-15 (PHQ-15), Brief Symptom Inventory-7 (BSI-7), rating of physical health (Doctor’s also provided a rating) and total ER visits, overnight stays, and Doctor’s visits. Early memories were rated using the Social Cognition and Object Relations Scale- Global rating method (SCORS-G). Results indicated that a factor analysis of the SCORS-G produced two factors: cognitive and affective. These factors were used in a series of step-wise regressions which showed that together the affective factor and two attachment concepts, the anxiety dimension and preoccupied attachment style, predicted somatization. Independently, the affective factor also significantly predicted overnight hospital stays, somatization, self-reported physical health, and Doctor’s rated health of patients’. The fearful attachment style predicted self-reported physical health and somatic symptoms and the preoccupied attachment style predicted somatic symptoms.. Using a multi-method approach of both clinician ratings (SCORS-G), participant-rated measures (ECR-S, RQ, PHQ-15, BSI-7), and doctor’s ratings of the patient, provides further understanding of how object relations and attachment style can be useful within a primary care setting.