European Child & Adolescent Psychiatry

, Volume 28, Issue 5, pp 705–717 | Cite as

Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders

  • Fabiola BizziEmail author
  • Karin Ensink
  • Jessica L. Borelli
  • Simone Charpentier Mora
  • Donatella Cavanna
Original Contribution


Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8–15 years) spanning two groups—a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children’s RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.


Attachment Mentalization Reflective functioning Child psychopathology Somatic symptom disorders Disruptive behavior disorders 



We wish to express our special gratitude toward participants for their involvement in the study. We are also grateful to the experts of mental health of Gaslini (Prof. E. Veneselli, Dr. L. Sciarretta, M. Savoini) and interns for their help with data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human or animal studies

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Educational ScienceUniversity of GenoaGenoaItaly
  2. 2.Department of School of PsychologyUniversity of LavalQuebecCanada
  3. 3.Department of Psychology and Social BehaviorUniversity of CaliforniaIrvineUSA

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