Attachment styles and symptoms in individuals with psychosis (original) (raw)
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Social Psychiatry and Psychiatric Epidemiology, 2007
j Abstract Background If attachment theory is to help inform our understanding of relationship difficulties in people with psychosis, it is first important to understand the composition of attachment networks in this group and how attachment style measured with reference to relationships in general actually relates to attachment in relationships with specific others. Method We examined attachment networks and associations between general attachment style and attachment in relationships with parents and psychiatric staff in a sample of 58 patients with psychosis. We assessed attachment dimensions of anxiety and avoidance using the Psychosis Attachment Measure (PAM) and an adapted version of the instrument asking about relationships with specific others. Results Patients reported a median of two attachment relationships. Both attachment anxiety and avoidance measured with reference to close relationships in general were positively correlated with attachment in key worker and parental relationships, although levels of attachment anxiety and avoidance did vary across relationships. Conclusion Future research should determine factors influencing variations in attachment working models in samples of people with psychosis, as it may be possible to help individuals with insecure attachment styles develop more positive relationships with others.
Behaviour Research and Therapy, 2008
We investigated associations between adult attachment, symptoms and interpersonal functioning, including therapeutic relationships in 96 patients with psychosis. Using a prospective design, we also assessed changes in attachment in both psychiatrically unstable and stable groups. We measured attachment using the Psychosis Attachment Measure (PAM) and interpersonal problems and therapeutic relationships were assessed from both psychiatric staff and patient perspectives. Avoidant attachment was associated with positive symptoms, negative symptoms and paranoia. Attachment ratings were relatively stable over time, although changes in attachment anxiety were positively correlated with changes in symptoms. Predicted associations between high levels of attachment anxiety and avoidance and interpersonal problems were supported, and attachment avoidance was associated with difficulties in therapeutic relationships. Findings suggest that adult attachment style is a meaningful individual difference variable in people with psychosis and may be an important predictor of symptoms, interpersonal problems and difficulties in therapeutic relationships over and above severity of illness.
2020
a b s t r a c t Attachment theory provides key elements for understanding the psychosocial vulnerability for and response to the emergence of psychosis. This study examined (1) whether pre-treatment attachment styles are differentially associated with clinical and functional outcome in at-risk mental state (ARMS) for psychosis patients across one year of psychosocial treatment, and (2) whether clinical change is associated with changes in attachment ratings beyond the effect of baseline symptom severity. Thirtyeight ARMS patients (mean age¼16.7, S.D. ¼5.9) identified from a psychosocial needs-adapted treatment were evaluated with the Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Relationships Questionnaire. Lower levels of insecure-avoidant attachment predicted better clinical outcomes, whereas higher levels of secure attachment predicted improvement in functioning. A decrease in preoccupied-anxious attachment was associated with symptom amelior...
Psychiatry Research, 2015
Attachment theory is a powerful theoretical framework that complements and extents current models psychosis. We tested the hypothesis that attachment anxiety and avoidance are differentially associated with the severity of positive, negative and general psychopathology symptoms in patients with a diagnosis of psychosis. Five hundred patients with DSM-IV or ICD-10 diagnoses of psychotic disorders (schizophrenia, schizoaffective or non-affective psychosis) from independent samples from Netherlands, United Kingdom and Israel completed the Relationship Questionnaire. Psychopathology was assessed with the Positive and Negative Syndromes Scale. We used both categorical and dimensional approach to attachment data, which were analyzed using ANOVA with post-hoc tests, Pearson's correlations and multiple regression analysis. The conservative level of statistical significance was established (po0.001) to control for multiple testing. After adjustment for possible confounders, attachment anxiety predicted severity of positive symptoms as well as affective symptoms. Both attachment anxiety and avoidance were associated with severity of hallucinations and persecution Contrary to predictions, attachment avoidance was not associated with overall scores for negative symptoms, although there was some evidence of relatively weaker association between avoidance and social and emotional withdrawal.
Clinical Psychology Review, 2007
Attachment styles reflect individual differences in beliefs about self and others, interpersonal functioning and affect regulation. We review and critically appraise studies suggesting higher levels of insecure attachment, and dismissing attachment in particular, in samples with psychosis compared to controls. We also review the role of social cognition, interpersonal factors, and affect regulation in the development and maintenance of psychosis, and specific symptoms associated with the diagnosis. We review studies showing that insecure attachment is associated with poorer interpersonal relationships and less integrative recovery styles and highlight how recent theories and empirical findings in the psychosis literature can be understood within the framework of attachment theory. In doing so, we argue that investigations of the nature of attachment styles in psychosis and how they relate to the cognitive, interpersonal and affective factors that have been implicated in psychosis will help develop theoretical knowledge in relation to the condition. We conclude by outlining the clinical implications of applying attachment theory to the understanding of psychosis and summarising the conceptual and methodological limitations of the theory which should be addressed, including the need for studies with longitudinal designs, larger, more representative samples, and more valid measures of assessing attachment styles in psychosis.
2020
Background: In a longitudinal design, the present study examined: (a) the nature of attachment patterns and re- flective functioning (RF) in individuals at ultra-high risk for psychosis (UHR); (b) the association between RF and subclinical psychotic symtoms; and (c) the psychosis-predictive value of attachment patterns, RF, and the inter- action between these factors.Method: The sample comprised 57 UHR subjects and 53 clinical controls (non-UHR). UHR subjects were followed over a mean period of 14 months (SD = 2.7; range 11–19), during which time 11.5% developed psychosis. At- tachment patterns and RF were measured. Hierarchical logistic regression was used to examine the predictive value of variables in the transition to psychosis.Results: At baseline, significant differences were found between groups in secure attachment patterns and RF. RF was negatively associated with the attenuated psychotic symptoms described by the Unusual Thought Content/ Delusional Ideas, Suspiciousness/Pe...
Assessment of attachment in psychosis: A psychometric cause for concern
Psychiatry research, 2016
Attachment has recently been proposed as a key developmental construct in psychosis, in particular with respect to interpersonal functioning and social cognition. The current study examined the latent structure of the self-report Psychosis Attachment Measure (PAM) and its relationship to lower-level perceptual and higher-order inferential social cognitive processes. The PAM was administered to 138 psychiatrically stable outpatients with schizophrenia alongside a battery of symptom, social cognitive, and functional measures. PAM responses were analyzed using latent variable measurement models, which did not yield evidence of the coherent two-dimensional structure predicted by previous literature. A unidimensional subscale comprising 6 of the 16 original PAM items possessed the strongest psychometric properties. This subscale was generally uncorrelated with social cognitive measures and showed weak correlations with some symptoms measures and with community functioning. These results ...