Psychological and somatic manifestations of dissociation: The role of childhood trauma, attachment, and alexithymia

Dissociation refers to disrupted integration of conscious awareness, emotions, memories, body representation, and motor control (American Psychiatric Association [APA], 2013). Despite the burden of unexplained somatic symptoms on individuals, and on healthcare providers, research to date has focused on the use of the Dissociative Experiences Questionnaire (DES-II) which measures the psychological components of dissociation, with measures of somatic manifestations of dissociation, such as the Somatoform Dissociation Questionnaire (SDQ-20) often being overlooked. The aim of the current study was to examine how attachment, alexithymia and childhood trauma relate to symptoms of psychoform and somatoform dissociation based on self-report measures. Additionally, the study sought to examine the mediating role of self-reported attachment-style and alexithymia in the relationship between childhood trauma and dissociation. A cross-sectional survey of 220 adults in the general population, aged 18 – 76, was carried out. Participants completed a number of self-report measures online. Hierarchical logistic regression and mediation analyses were conducted. Results indicated that the difficulty identifying feelings component of alexithymia significantly predicted an increased likelihood of scoring above the clinical cut-off for somatoform dissociation. Difficulty identifying feelings also partially mediated the relationship between physical neglect and somatoform dissociation scores. Avoidant attachment style and difficulty identifying feelings significantly predicted an increased likelihood of scoring above the clinical cut-off for psychoform dissociation. Both avoidant attachment style and difficulty identifying feelings partially mediated the relationship between emotional abuse and psychoform dissociation scores. The findings of the current study suggest that it may be of relevance to consider the role of both traumatic experiences and dissociative processes in persistent somatic presentations. Findings also suggest that treatments which support emotional awareness and are informed by attachment theory may relevant for those that self-report debilitating somatic symptoms