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Chronic dermatologic conditions raise risk of attachment insecurity in young people

Young dermatology patients, particularly those with the anxious-preoccupied attachment style, have a higher risk of attachment insecurity than their general population peers, according to new findings. The researchers also observed an association between attachment and psychosocial functioning similar to that seen in adult studies.

The findings were published in Child: Care, Health and Development.

“Dermatological conditions are common in childhood and, in their more severe forms, can cause pain, disability, and social marginalization,” the authors write. “Despite attachment being a known factor contributing to psychological and physiological development in childhood and several adult studies showing associations between attachment and dermatology outcomes, attachment in young dermatology patients has not been investigated.”

To explore this question, the researchers compared 122 eight- to 16-year-olds with chronic dermatologic conditions who attended a specialist pediatric dermatologic service to general population data using the Child Attachment Interview (CAI). They measured psychosocial functioning using the Strengths and Difficulties Questionnaire (SDQ).

Investigators found the dermatology group was significantly more likely to be insecurely attached than their general population peers (χ2[1]=4.76, p<0.05). The secure group self-reported significantly better psychological functioning on all indices compared to the insecure group (Total Difficulties: F[1,89]=15.30, p<0.001).

They found no significant differences between secure and insecure groups on parent-reported psychological measures (Total Difficulties: F[1,94]=0.67, p=0.42). Children with facial involvement were not significantly more likely to be insecurely attached.

“Clinically, these findings suggest that child attachment style be considered in order to optimize psychosocial and medical outcomes,” the authors write. “Addressing attachment insecurity has been shown, in several studies, to be associated with better coping with relationship stress including bullying, a known concern for young people with skin conditions.”

They also suggest that improving relational stress and stress-coping might also reduce the activation of stress-linked neurophysiological processes that can worsen dermatologic symptoms.

“The broad associations found in the current study indicate that further research in attachment style and pediatric dermatological conditions is warranted, but that greater specificity in attachment-related process and illness variables is needed to properly understand causal relationships.”

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