Alexithymia and Attachment Style in Patients With Somatic Symptoms

NCT05666921 | Recruiting

• 1 other identifier: somatic symptoms
• Study Type: observational
• Target: 300
• Locations: 1 country
• Sites: 2

Brief Summary

To evaluate whether emotional awareness, attachment style and the ability to abstract and symbolize (IQ) influence the appearance of somatic symptoms. Hypothesis: the investigators expect the presence of somatic symptoms linked to the lower ability of emotional awareness, to lower ability to abstract and symbolize and to an insecure attachment style.

Conditions

Somatic Symptom Disorder

Keywords

somatic symptoms; alexithymia; attachment style; pain; reflective function

Outcome Measures

Primary Outcomes (3)

• Emotional awareness

  Emotion Awareness Questionnaire - EAQ-30 (Rieffe et al., 2008; Camodeca \& Rieffe, 2013) The EAQ is a self-report test aimed at measuring the emotional awareness of children and adolescents, it is composed of 6 subscales and 30 items and has a Likert scale of 3 points. High scores obtained at the different subscales indicate a high emotional awareness. The cut offs are specific for age and sex, for the interpretation of the scores reference is made to the scores obtained by the control group in the study by Camodeca et al., 2013.

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• attachment style

  The Saparation Anxiety Test - SAT, Italian version adapted from Attili (2001) is a semi-projective tool aimed at measuring the attachment style of the child and adolescent, through the analysis of reactions and verbal responses to stimuli that illustrate 6 hypothetical situations of separation by parental figures. The responses are then classified into 8 categories which calculate a score that is compared with reference score ranges that correspond to 4 different attachment styles. Specifically, scores equal to or greater than 4 indicate secure attachment, scores between 3 and 1 an ambivalent insecure attachment, scores between 0 and -2 an avoidant insecure attachment, and finally scores equal to or lower than -3 are indicative of an attachment style disorganized / confused.

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• Ability to abstract and symbolize (IQ)

  Raven's Standard Progressive Matrices - SPM-RA (Raven, 1982), are a test that aims to measure the general factor of fluid intelligence. the test consists of four series (A, B, C, D) of 12 items each of increasing complexity. It is an excellent test from both a psychometric and a factorial point of view. The updated report - SPM-RA (prepared by Picone, Orsini and Pezzuti) will be used as a reference for the test scoring, which allows the instrument to be used for a sample aged 6 to 18. An intelligence score above 25/36 indicates an above average intelligence level, scores between 17/36 and 25/36 are to be considered indicative of an average intelligence level, scores below 17/36 below average intelligence medium (Picone, Orsini and Pezzuti)

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

Secondary Outcomes (9)

• Stressful life events

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• Behavioral and emotional issues

  Parents fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• stress and protection indicators

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• pain coping strategies

  Patients fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

• Demographic and health variables

  Parents fill out the questionnaire at their enrollment in the study, during their first psychological consult after medical referral.

Study Arms (2)

Pediatric patients

The group is made up of pediatric patients, and an accompanying caregiver, belonging to the functional chronic pain clinic of Pain Therapy and Palliative Care, to the Gastroenterology and Nutrition Unit, to the Bronchopneumology Unit and Medical Pediatrics as well as to the Pediatric Psychology Unit, who present with somatic symptom disorders.

Other: psychological assessment

Control group

The population of the control group, recruited through informal channels according to a sampling of convenience, will be enrolled on the basis of the expected inclusion criteria.

Other: psychological assessment

Interventions

psychological assessment OTHER

The intervention consists in the assessment of some psychological aspects (emotional awareness, attachment style and the ability to abstract and symbolize (IQ)) of pediatric patients who present with somatic symptom disorders. , through specific tests. Each patient fills out the test battery during the psychological consult. At the same time, it is involved a parent to collect personal and clinical data through an ad hoc questionnaire.

Control group; Pediatric patients

Eligibility Criteria

• Age: 11 Years - 17 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)
• Sampling Method: Probability Sample

Study Population

The population under study is made up of pediatric patients (aged from 11 to 17), and an accompanying caregiver, belonging to the functional chronic pain clinic of Pain Therapy and Palliative Care, to the SOC of Gastroenterology and Nutrition, to the SOSA of Bronchopneumology and to the SOC of Medical Pediatrics as well as to the SOSA of Pediatric Hospital Psychology who present with somatic symptom disorders. All consecutive patients and accompanying caregivers who access the aforementioned services and who meet the expected inclusion criteria will be enrolled.

You may qualify if:

• Clinical condition characterized by somatic symptoms such as recurrent abdominal pain, recurrent vomiting, dyspepsia, psychogenic cough, and chronic functional pain (headache, migraine, musculoskeletal pain) for which an organic cause has been excluded and whose symptom has had a strong impact on the quality of life (presence of the symptom for six months, school absenteeism, social isolation, immobility, psychological distress, difficulty in participating in sports and extracurricular activities, etc.), as per Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.
• Age between 11 and 17 years
• Italian speaking
• Patients' and parents' consent

You may not qualify if:

• Cognitive and/or developmental impairment
• Difficulty in understanding the Italian language
• Presence of organic disease diagnosis
• Lack of informed consent
• Patient who does not meet DSM-5 criteria for somatic symptom disorder
• Cognitive deficits
• Difficulty in understanding the Italian language
• Lack of informed consent
• Age between 11 and 17 years
• Adequate knowledge of the Italian language
• Consent to participate

Sponsors & Collaborators

• Meyer Children's Hospital IRCCS: lead

Study Sites (2)

Meyer Children's Hospital

Florence, Firenze, 50139, Italy

RECRUITING

IRCCS Gianna Gaslini

Genova, Italy

RECRUITING

Related Publications (25)

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MeSH Terms

Conditions

Medically Unexplained Symptoms; Affective Symptoms; Pain

Condition Hierarchy (Ancestors)

Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavioral Symptoms; Behavior; Neurologic Manifestations

Study Officials

• Rosanna Martin, MSc

  Meyer Children's Hospital IRCCS

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Rosanna Martin, MSc

CONTACT

055 5662475; rosanna.martin@meyer.it

Giulia Ricci, MSc

CONTACT

giulia.ricci@meyer.it

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: January 5, 2022
• First Posted: December 28, 2022
• Study Start: June 15, 2021
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026
• Last Updated: September 26, 2025

Record last verified: 2025-09

Locations

IT (2)