Manijeh Firoozi - Tehran- University of Tehran

IntroductionThe development of persistent pain post-accident injury is still an unresolved mystery despite the fact that approximately 50% of individuals reporting accident develop persistent pain. Recently attachment insecurity has been proposed as a vulnerability factor for both pain and PTSD. In order to guide treatment, it is important to examine possible mechanisms which may cause persistent pain and medically unexplained symptoms after an intensive motor vehicle accident. The present study examines attachment insecurity as possible vulnerability factors in relation to high levels of pain and somatization after motor vehicle accident.Methods Data were collected from 203patients referred consecutively to the emergency unit after acute motor vehicle accident injury. Within 1-month post injury, patients answered a questionnaire regarding attachment insecurity, pain, somatization, and PTSD symptoms. Multiple mediation analyses were performed to assess whether the attachment insecurity symptom clusters mediated the association between PTSD, pain,and somatization. Results Attachment style increased the likelihood of belonging to the moderate-severe pain group three-fold. In relation to somatization the likelihood of belonging to the group was almost increased four-fold. The symptom clusters of avoidance and hyper arousalmediated the association between the PTSD, pain, and somatization. Impaired attachment did not correlate with pain but not somatization when models were adjusted on sociodemographic variables and history of psychological distress.Conclusion Acknowledging that attachment insecurity is part of the etiology involved in explaining persistent symptoms after accident, may help sufferers to gain early and more suited treatment, which in turn may prevent the condition from becoming chronic.

Motor vehicle accident، Insecurity attachment، Post-traumatic stress (PTSD)، Pain، Somatization