Somatic symptoms and the need for connection: Insights from attachment theory and clinical care

Sarah is a patient we encountered while working in a medical and psychiatric partial hospital program (PHP) for children and adolescents (name and details have been altered for confidentiality). She identified as an 11-year-old, white, cisgender female. She was referred to the program by her gastroenterologist for treatment of somatic symptom disorder (SSD) and rumination disorder. (In rumination disorder, despite a functioning stomach and esophagus, the brain sends signals that cause undigested food to come back up, even though the person is not trying to vomit). For Sarah, rumination was triggered by anxiety, feeling unsupported, and emotional distress. At the time of admission, Sarah was vomiting several times a day and reported multiple somatic complaints, including blurred vision, dizziness, and musculoskeletal pain. These symptoms had a profound impact on her functioning — she was unable to attend school and could not participate in social or extracurricular activities.