# Associations Between Parent–Child Attachment and Psychosocial- and Health-Related Symptoms in Children with Functional Abdominal Pain Disorders

## TL;DR

Children with less secure parent-child attachment experience more severe abdominal pain and depression, partly due to catastrophizing.

## Contribution

This study explores the attachment-diathesis model in children with functional abdominal pain disorders, identifying catastrophizing as a mediator.

## Key findings

- Alienation from parents correlates with higher depression, gastrointestinal symptoms, and disability.
- Catastrophizing mediates 22–89% of the relationship between attachment and pain-related outcomes.
- Secure parent–child attachment is linked to fewer physical and psychological symptoms in children with FAPDs.

## Abstract

What are the main findings?

In youth with Functional Abdominal Pain Disorders (FAPDs), less secure parental attachment is associated with more severe gastrointestinal symptoms, greater depressive symptoms, and more functional impairment.

To varying degrees, pain catastrophizing mediated these relationships.

What is the implication of the main finding?

Results support an attachment-diathesis model of pediatric FAPDs.

Parent–child attachment and catastrophizing may be important treatment targets in children with FAPDs.

Background and Objectives: The attachment-diathesis model of chronic pain, which associates insecure attachment with pain catastrophizing and worse pain-related outcomes, is well-supported in adults. Although Functional Abdominal Pain Disorders (FAPDs) are common in youth, with symptoms influenced by the parent–child dynamic, an attachment-diathesis model of FAPDs is unexplored. The aim of this study was to investigate if insecure parental attachment is associated with pain catastrophizing and pain-related variables in youth with FAPDs. Methods: Baseline questionnaire data from an RCT of cognitive behavioral therapy for children with FAPDs (n = 200, 73% girls, 93% White, and a mean age of 11.2 years old) were used to examine relationships between parental attachment (subscales include Alienation, Trust, and Communication), catastrophizing, and pain-related variables (depression, disability, and gastrointestinal (GI) symptom severity). Results: Alienation was significantly correlated with depression (r = 0.39), GI symptom severity (r = 0.30), and disability (r = 0.22; ps < 0.05). Trust was also correlated with depression (r = −0.39), GI symptom severity (r = −0.19), and disability (r = −0.19; ps < 0.05). Communication was associated with depression (r = −0.30, p < 0.01). Catastrophizing mediated these associations, accounting for 22–89% of the relationship between attachment and pain-related variables. Conclusions: Children who report a less secure attachment to their parents report more physical and psychological symptomatology than children who describe their attachment as more secure. This association is partly explained by child catastrophizing. Results suggest that parent–child attachment and catastrophizing may be important treatment targets in children with FAPDs.