童年期创伤与依恋对青少年躯体症状障碍影响的网络分析

doi:10.6040/j.issn.1671-7554.0.2025.0504

摘要/Abstract

摘要： 目的探讨青少年躯体症状障碍(somatic symptom disorder, SSD)患者的躯体症状、童年期创伤与依恋关系之间的相互关系,识别核心症状,推断潜在因果路径。方法选取 2024 年 6 月至12月就诊于山东省精神卫生中心的10~19岁SSD青少年438例,采用患者健康问卷躯体症状群量表(patient health questionnaire-15, PHQ-15)、童年创伤量表(the childhood trauma questionnaire, CTQ)及父母同伴依恋问卷(inventory of parent and peer attachment, IPPA)分别评估躯体症状、创伤经历及依恋关系,通过无向网络分析与贝叶斯网络模型探讨变量间交互关系及潜在的因果方向。结果无向网络中,“头痛”和“透不过气来”为核心躯体症状;“短时间晕倒”最有可能提示性虐待。此外,无向和有向网络均揭示同伴疏离与情感虐待为干预躯体症状的关键节点。结论情感虐待与同伴疏离是青少年SSD的核心风险因素。临床干预需关注创伤修复与依恋关系改善,以控制症状网络的加重。

关键词: 躯体症状障碍, 依恋关系, 童年期创伤, 网络分析, 贝叶斯网络

Abstract: Objective To explore the interrelationship between somatic symptoms, childhood trauma, and attachment styles in adolescents with somatic symptom disorder(SSD), identify core symptoms, and infer potential causal pathways. Methods A total of 438 adolescents aged 10-19 with SSD, who visited the Shandong Mental Health Center from June 2024 to December 2024, were included. The patient health questionnaire-15(PHQ-15), the childhood trauma questionnaire(CTQ), and the inventory of parent and peer attachment(IPPA)were used to assess somatic symptoms, traumatic experiences, and attachment relationships, respectively. Undirected network analysis and Bayesian network models were employed to explore the interrelationships between variables and potential causal directions. Results In the undirected network, “headache” and “shortness of breath” were identified as core somatic symptoms. “Brief fainting spells” were most indicative of sexual abuse. Both undirected and directed networks revealed peer alienation and emotional abuse as key nodes for intervening in somatic symptoms. Conclusion Emotional abuse and peer alienation are central risk factors for SSD in adolescents. Clinical interventions should focus on trauma healing and improving attachment relationships to control the exacerbation of the symptom network.

Key words: Somatic symptom disorder, Attachment relationship, Childhood trauma, Network analysis, Bayesian network

中图分类号:

R749.94

王诗健,郑逗逗,安序菊,杨楹. 童年期创伤与依恋对青少年躯体症状障碍影响的网络分析[J]. 山东大学学报 (医学版), 2026, 64(3): 45-54.

WANG Shijian, ZHENG Doudou, AN Xuju, YANG Ying. Network analysis of childhood trauma and attachment in relation to adolescent somatic symptom disorder[J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 45-54.

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