Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (3): 45-54.doi: 10.6040/j.issn.1671-7554.0.2025.0504

• “Psychological Health in Children and Adolescents” Key Topics • Previous Articles    

Network analysis of childhood trauma and attachment in relation to adolescent somatic symptom disorder

WANG Shijian1, ZHENG Doudou2, AN Xuju2, YANG Ying2,3   

  1. 1. School of Mental Health, Jining Medical University, Jining 272013, Shandong, China;
    2. Child and Adolescent Psycho-behavioral Medicine Center, Shandong Mental Health Center, Shandong University, Jinan 250014, Shandong, China;
    3. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2026-03-19

PDF (PC)

1

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

CLC Number: 

  • R749.94
[1] 中华医学会心身医学分会躯体症状及相关障碍学组, 上海市医学会心身医学专科分会. 躯体症状障碍多学科诊疗专家共识[J]. 中华精神科杂志, 2024, 57(2): 65-77. Somatic Symptoms and Related Disorders Group of Psychosomatic Medicine Branch of Chinese Medical Association, Psychosomatic Medicine Branch of Shanghai Medical Association. Chinese expert consensus on multi-disciplinary diagnosis and treatment of somatic symptom disorder[J]. Chinese Journal of Psychiatry, 2024, 57(2): 65-77.
[2] Cao JY, Wei J, Fritzsche K, et al. Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care[J]. Gen Hosp Psychiatry, 2020, 62: 63-71. doi:10.1016/j.genhosppsych.2019.11.010
[3] Cozzi G, Minute M, Skabar A, et al. Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain[J]. Acta Paediatr, 2017, 106(4): 586-593.
[4] Malas N, Ortiz-Aguayo R, Giles L, et al. Pediatric somatic symptom disorders[J]. Curr Psychiatry Rep, 2017, 19(2): 11. doi:10.1007/s11920-017-0760-3
[5] Sirri L, Fava GA. Diagnostic criteria for psychosomatic research and somatic symptom disorders[J]. Int Rev Psychiatry, 2013, 25(1): 19-30.
[6] Kelly C, Molcho M, Doyle P, et al. Psychosomatic symptoms among schoolchildren[J]. Int J Adolesc Med Health, 2010, 22(2): 229-235.
[7] Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression: deve-lopmental psychopathology in pediatric practice[J]. J Child Psychol Psychiatry, 2012, 53(5): 575-592.
[8] Beck JE. A developmental perspective on functional somatic symptoms[J]. J Pediatr Psychol, 2008, 33(5): 547-562.
[9] Kalmakis KA, Chandler GE. Health consequences of adverse childhood experiences: a systematic review[J]. J Am Assoc Nurse Pract, 2015, 27(8): 457-465.
[10] Eilers H, Aan Het Rot M, Jeronimus BF. Childhood trauma and adult somatic symptoms[J]. Psychosom Med, 2023, 85(5): 408-416.
[11] Thomson K, Randall E, Ibeziako P, et al. Somatoform disorders and trauma in medically-admitted children, adolescents, and young adults: prevalence rates and psychosocial characteristics[J]. Psychosomatics, 2014, 55(6): 630-639.
[12] Rask CU, Ørnbøl E, Fink PK, et al. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds[J]. Pediatrics, 2013, 132(2): e459-e467.
[13] Lin HC, Yang Y, Elliott L, et al. Individual differences in attachment anxiety shape the association between adverse childhood experiences and adult somatic symptoms[J]. Child Abuse Negl, 2020, 101: 104325. doi:10.1016/j.chiabu.2019.104325
[14] Adam KS, Sheldon-Keller AE, West M. Attachment organization and history of suicidal behavior in clinical adolescents[J]. J Consult Clin Psychol, 1996, 64(2): 264-272.
[15] Pietromonaco PR, Beck LA. Adult attachment and physical health[J]. Curr Opin Psychol, 2019, 25: 115-120. doi:10.1016/j.copsyc.2018.04.004
[16] Landa A, Peterson BS, Fallon BA. Somatoform pain: a developmental theory and translational research review[J]. Psychosom Med, 2012, 74(7): 717-727.
[17] Vesterling C, Koglin U. The relationship between attachment and somatoform symptoms in children and adolescents: a systematic review and meta-analysis[J]. J Psychosom Res, 2020, 130: 109932. doi:10.1016/j.jpsychores.2020.109932
[18] Pollmann A, Bates KE, Fuhrmann D. A framework for understanding adverse adolescent experiences[J]. Nat Hum Behav, 2025, 9(3): 450-463.
[19] Brianda ME, Sacchi C, De Carli P, et al. Maltrattamento emotivo e sintomi somatici in età giovanile adulta. Il ruolo di mediazione dello stile di attaccamento romantico in Una popolazione femminile[J]. Psicologia Della Salute, 2018(1): 81-101.
[20] Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper[J]. Behav Res Methods, 2018, 50(1): 195-212.
[21] McNally RJ, Mair P, Mugno BL, et al. Co-morbid obsessive-compulsive disorder and depression: a Baye-sian network approach[J]. Psychol Med, 2017, 47(7): 1204-1214.
[22] 解欣然, 禚凤, 杨楹, 等. 青少年抑郁障碍与多种心理行为问题的网络分析[J]. 山东大学学报(医学版), 2024, 62(12): 49-58. XIE Xinran, ZHUO Feng, YANG Ying, et al. A network analysis of adolescent depressive disorders and multiple psycho-behavioural problems[J]. Journal of Shandong University(Health Science), 2024, 62(12): 49-58.
[23] Toussaint A, Hüsing P, Kohlmann S, et al. Detecting DSM-5 somatic symptom disorder: criterion validity of the Patient Health Questionnaire-15(PHQ-15)and the Somatic Symptom Scale-8(SSS-8)in combination with the Somatic Symptom Disorder - B Criteria Scale(SSD-12)[J]. Psychol Med, 2020, 50(2): 324-333.
[24] Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire[J]. Child Abuse Negl, 2003, 27(2): 169-190.
[25] 王雪云, 施星明, 赵玲慧, 等. 中文版儿童期创伤问卷在精神障碍患者中信度、效度分析[J]. 中国健康心理学杂志, 2018, 26(4): 618-622. WANG Xueyun, SHI Xingming, ZHAO Linghui, et al. Reliability and validity of Chinese version of childhood trauma questionnaire in patients with mental disorders[J]. China Journal of Health Psychology, 2018, 26(4): 618-622.
[26] Armsden GC, Greenberg MT. The inventory of parent and peer attachment: individual differences and their relationship to psychological well-being in adolescence[J]. J Youth Adolesc, 1987, 16(5): 427-454.
[27] 钱洁, 任致群, 于德华, 等. 患者健康问卷躯体症状群量表在综合医院的筛检价值[J]. 中国心理卫生杂志, 2014, 28(3): 173-178. QIAN Jie, REN Zhiqun, YU Dehua, et al. The value of the Patient Health Questionnaire-15(PHQ-15)for screening somatic symptoms in general hospital[J]. Chinese Mental Health Journal, 2014, 28(3): 173-178.
[28] Kearney CA, Wechsler A, Kaur H, et al. Posttraumatic stress disorder in maltreated youth: a review of contemporary research and thought[J]. Clin Child Fam Psychol Rev, 2010, 13(1): 46-76.
[29] Borsboom D. A network theory of mental disorders[J]. World Psychiatry, 2017, 16(1): 5-13.
[30] Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso[J]. Biostatistics, 2008, 9(3): 432-441.
[31] Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology[J]. Annu Rev Clin Psychol, 2013, 9: 91-121. doi:10.1146/annurev-clinpsy-050212-185608
[32] Bringmann LF, Elmer T, Epskamp S, et al. What do centrality measures measure in psychological networks?[J]. J Abnorm Psychol, 2019, 128(8): 892-903.
[33] Jones PJ, Ma RF, McNally RJ. Bridge centrality: a network approach to understanding comorbidity[J]. Multivariate Behav Res, 2021, 56(2): 353-367.
[34] Litzenburger A, Rothacher Y, Hanusch KU, et al. Network structure of functional somatic symptoms[J]. J Psychosom Res, 2025, 188: 111968. doi:10.1016/j.jpsychores.2024.111968
[35] Li Y, Jia SM, Cao BH, et al. Network analysis of somatic symptoms in Chinese patients with depressive disorder[J]. Front Public Health, 2023, 11: 1079873. doi:10.3389/fpubh.2023.1079873
[36] Gelfand AA. Pediatric and adolescent headache[J]. Continuum, 2018, 24(4): 1108-1136.
[37] Ionescu CG, Talasman AA, Badarau IA. Somatization and sleep quality on patients with comorbid anxiety/depression[J]. Maedica, 2021, 16(2): 246-254.
[38] 陈丽, 贾守梅, 李萍, 等. 抑郁症患者躯体化症状体验和认识的质性研究[J]. 中国全科医学, 2019, 22(29): 3634-3638. CHEN Li, JIA Shoumei, LI Ping, et al. Qualitative research on somatic symptoms in depression[J]. Chinese General Practice, 2019, 22(29): 3634-3638.
[39] Chen L, Jia SM, Li P, et al. Experiences and coping strategies of somatic symptoms in patients with depressive disorder: a qualitative study[J]. Arch Psychiatr Nurs, 2022, 38: 6-13. doi:10.1016/j.apnu.2022.01.004
[40] Godbout N, Daspe Mè, Runtz M, et al. Childhood maltreatment, attachment, and borderline personality-related symptoms: gender-specific structural equation models[J]. Psychol Trauma, 2019, 11(1): 90-98.
[41] Kamiya Y, Timonen V, Kenny RA. The impact of childhood sexual abuse on the mental and physical health, and healthcare utilization of older adults[J]. Int Psychogeriatr, 2016, 28(3): 415-422.
[42] 卜钰, 陈丽华, 郭海英, 等. 情感虐待与儿童社交焦虑: 基本心理需要和自尊的多重中介作用[J]. 中国临床心理学杂志, 2017, 25(2): 203-207. BU Yu, CHEN Lihua, GUO Haiying, et al. Emotional abuse and childrens social anxiety: mediating of basic psychological needs and self-esteem[J]. Chinese Journal of Clinical Psychology, 2017, 25(2): 203-207.
[43] Kugler BB, Bloom M, Kaercher LB, et al. Somatic symptoms in traumatized children and adolescents[J]. Child Psychiatry Hum Dev, 2012, 43(5): 661-673.
[44] Coan JA, Sbarra DA. Social baseline theory: the social regulation of risk and effort[J]. Curr Opin Psychol, 2015, 1: 87-91. doi:10.1016/j.copsyc.2014.12.021
[45] Dodge KA, Pettit GS, Bates JE, et al. Social information-processing patterns partially mediate the effect of early physical abuse on later conduct problems[J]. J Abnorm Psychol, 1995, 104(4): 632-643.
[46] Schury K, Kolassa IT. Biological memory of childhood maltreatment: current knowledge and recommendations for future research[J]. Ann N Y Acad Sci, 2012, 1262: 93-100. doi:10.1111/j.1749-6632.2012.06617.x
[47] Allen LA, Woolfolk RL. Cognitive behavioral therapy for somatoform disorders[J]. Psychiatr Clin North Am, 2010, 33(3): 579-593.
[48] Eminson DM. Medically unexplained symptoms in children and adolescents[J]. Clin Psychol Rev, 2007, 27(7): 855-871.
[49] Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials[J]. Psychosom Med, 2007, 69(9): 881-888.
[1] FANG Tingting, HU Zhangjie, ZHUO Feng, XIE Xinran, YANG Ying, KONG Linghua. A latent profile analysis and network analysis of cyber-deviance among adolescents: a case study of Jiangxi Province [J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 35-44.
[2] CHEN Yingying, WANG Lu, HU Xifeng, ZHU Gaopei, XUE Fuzhong. A Bayesian network-based risk prediction study of stroke in patients with type 2 diabetes mellitus [J]. Journal of Shandong University (Health Sciences), 2025, 63(8): 94-102.
[3] LUO Qi, WANG Xia, JIANG Meng. Application of functional brain network analysis in aphasia: insights into neuropathological mechanisms, clinical diagnosis, and assessment of therapeutic outcome [J]. Journal of Shandong University (Health Sciences), 2025, 63(8): 111-126.
[4] XIE Xinran, ZHUO Feng, YANG Ying, KONG Linghua. A network analysis of adolescent depressive disorders and multiple psycho-behavioural problems [J]. Journal of Shandong University (Health Sciences), 2024, 62(12): 49-58.
[5] ZHANG Botao, ZHANG Shuaijie, SUN Shuangshuang, YUAN Ying, HU Xifeng, JIA Xiaofeng, YU Yuanyuan, XUE Fuzhong. Development of the Bayesian network-based screening model for ischemic stroke [J]. Journal of Shandong University (Health Sciences), 2024, 62(11): 73-84.
[6] WANG Yutao, SUN Yan. Comprehensive analysis of single-cell transcriptomics and machine learning reveals potential biomarkers for abdominal aortic aneurysm [J]. Journal of Shandong University (Health Sciences), 2024, 62(11): 40-53.
[7] QIN Jinjin, CAO Chenyuan, XING Jiejie, AN Yan, HUANG Yuxiang. Predication and bioinformatics analysis of preeclampsia-related Siglec-6 core genes [J]. Journal of Shandong University (Health Sciences), 2024, 62(1): 31-37.
[8] ZHONG Lu, XUE Fuzhong. A Lung cancer risk prediction model based on Bayesian network uncertainty inference [J]. Journal of Shandong University (Health Sciences), 2023, 61(4): 86-94.
[9] XIU Dejian, GAO Zhengwen, SONG Tingting, CUI Nan, CUI Jing, SUN Jianping. Genes associated with cervical cancer by integrated bioinformatics analysis [J]. Journal of Shandong University (Health Sciences), 2022, 60(10): 99-109.
[10] GAO Wen, CAO Fenglin, CUI Naixue. Association between childhood trauma, early adulthood executive functions and negative emotions in medical students [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(9): 95-98.
[11] WANG Yan1, YANG Li-min1,2, SUN Meng-meng2, CUI Kai-yan2, YANG Xiao-dong2, QIAO Dong-dong1,2, WANG Ru-zhan2, ZHANG Jing-xuan2, LIU Lan-fen1,. Relationship between personality traits and childhood trauma in patients with schizophrenia [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(8): 103-106.
[12] ZHONG Nv-juan1, SONG Yong-mei2, LIU Gengsheng2, XUE Fu-zhong1, LIU Yan-xun1. Construction and application of the Bayes network model in
traditional Chinese medicine elements [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(2): 157-.
[13] QI Fang1， RONG Rong2， XUE Fu-zhong1. Application of the Bayesian network in Chinese herbal  medicine property recognition [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(5): 147-152.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd