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Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices

Published online by Cambridge University Press:  31 August 2011

R. E. Taylor ,
T. Marshall ,
A. Mann  and
D. P. Goldberg
R. E. Taylor*
Affiliation:
Barts and the London School of Medicine and Dentistry, Queen Mary, Charterhouse Square, London, UK
T. Marshall
Affiliation:
London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
A. Mann
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
D. P. Goldberg
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
*
*Address for correspondence: R. E. Taylor, Ph.D., Barts and the London School of Medicine and Dentistry, Queen Mary, Centre for Psychiatry, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK. (Email: [email protected])
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Abstract

Background

In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor–patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.

Method

We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.

Results

Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79–5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23–33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05–3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67–33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.

Conclusions

Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.

Keywords

Attachment styledoctor–patient relationshipfrequent attendersmedically unexplained symptomsprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 4 , April 2012 , pp. 855 - 864
Copyright
Copyright © Cambridge University Press 2011

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