Attachment in schizophrenia--implications for research, prevention, and treatment

Susanne Harder, Susanne Harder

Abstract

Attachment is a promising area for elucidating psychosocial mechanisms important for development, prevention, and treatment of schizophrenia. This report gives a short summary of studies of attachment in psychosis. It was found that dismissing and disorganized forms of attachment were over-represented in psychosis. Evidence pointed to associations between a dismissing attachment pattern and positive psychotic symptoms, negative symptoms, and poor engagement with services. Furthermore, insecure attachment was found to predict impaired recovery from negative symptoms. Possible major risk processes in development linking dismissing attachment to symptom development were externalizing and deactivation of affects and poor mentalization. For a disorganized form of attachment, possible risk mechanisms were heightened stress-sensitivity and dissociation. Based on this initial evidence, further research in attachment in psychosis focusing on these risk mechanisms seems warranted. In addition, the evidence supported a focus on attachment-related risk processes to enhance the prevention and treatment of psychosis.

Keywords: dismissing attachment; disorganized attachment; negative symptoms; psychological treatment; stress-sensitivity.

© The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Fig. 1.
Fig. 1.
Psychosocial risk mechanisms in development of psychosis—an attachment based model.

References

    1. Cassidy JE, Shaver PR. Handbook of Attachment: Theory, Research, and Clinical Applications. New York, NY: Guildford Press; 2008
    1. Bowlby J. Attachment and Loss, 3 vols. New York, NY: Basic Books; 1969
    1. Hesse E. The adult attachment interview: protocol, method of analysis, and empirical studies. In: Cassidy JE, Shaver PR, eds. Handbook of Attachment: Theory, Research, and Clinical Applications. New York, NY: Guildford Press; 2008:552–599
    1. Berry K, Wearden A, Barrowclough C, Liversidge T. Attachment styles, interpersonal relationships and psychotic phenomena in a non-clinical student sample. Pers Individ Dif. 2006;41:707–718
    1. Bakermans-Kranenburg MJ, van IJzendoorn MH. The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attach Hum Dev. 2009;11:223–263
    1. MacBeth A, Gumley A, Schwannauer M, Fisher R. Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample. Psychol Psychother. 2011;84:42–57
    1. Gumley AI, Schwannauer M, Macbeth A, et al. Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up. Br J Psychiatry. 2014;205:60–67
    1. Dozier M, Stovall-McClough KC, Albus KE. Attachment and psychopathology in adulthood. In: Cassidy JE, Shaver PR, eds. Handbook of Attachment: Theory, Research, and Clinical Applications. New York, NY: Guildford Press; 2008:718–745
    1. Stovall-McClough KC, Cloitre M. Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. J Consult Clin Psychol. 2006;74:219–228
    1. Gumley AI, Taylor HE, Schwannauer M, MacBeth A. A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatr Scand. 2014;129:257–274
    1. Korver-Nieberg N, Berry K, Meijer CJ, de Haan L. Adult attachment and psychotic phenomenology in clinical and non-clinical samples: a systematic review. Psychol Psychother. 2014;87:127–154
    1. Varghese D, Scott J, McGrath J. Correlates of delusion-like experiences in a non-psychotic community sample. Aust N Z J Psychiatry. 2008;42:505–508
    1. Lysaker PH, Dimaggio G. Metacognitive capacities for reflection in schizophrenia: implications for developing treatments. Schizophr Bull. 2014;40:487–491
    1. Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Lapsley AM, Roisman GI. The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta-analytic study. Child Dev. 2010;81:435–456
    1. Dhossche D, Ferdinand R, Van der Ende J, Hofstra MB, Verhulst F. Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychol Med. 2002;32:619–627
    1. Brookwell ML, Bentall RP, Varese F. Externalizing biases and hallucinations in source-monitoring, self-monitoring and signal detection studies: a meta-analytic review. Psychol Med. 2013;43:2465–2475
    1. Varese F, Smeets F, Drukker M, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 2012;38:661–671
    1. Sroufe LA, Egeland B, Carlson EA, Collins WA. The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to adulthood. New York, NY: Guilford Press; 2009
    1. Lyons-Ruth K, Dutra L, Schuder MR, Bianchi I. From infant attachment disorganization to adult dissociation:relational adaptations or traumatic experiences? Psychiatr Clin N Am. 2006;29:63
    1. Lieberman AF. Traumatic stress and quality of attachment:reality and internalization in disorders of infant mental health. Infant Ment Health J. 2004;25:336–351
    1. Tyrka AR, Burgers DE, Philip NS, Price LH, Carpenter LL. The neurobiological correlates of childhood adversity and implications for treatment. Acta Psychiatr Scand. 2013;128:434–447
    1. Read J, Fosse R, Moskowitz A, Perry B. The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry. 2014;4:65–79
    1. Hertsgaard L, Gunnar M, Erickson MF, Nachmias M. Adrenocortical responses to the strange situation in infants with disorganized/disoriented attachment relationships. Child Dev. 1995;66:1100–1106
    1. Elzinga BM, Roelofs K, Tollenaar MS, Bakvis P, van Pelt J, Spinhoven P. Diminished cortisol responses to psychosocial stress associated with lifetime adverse events a study among healthy young subjects. Psychoneuroendocrinology. 2008;33:227–237
    1. Liotti G. Attachment and disorganization. In: Dell PF, o’Neil JA, eds. Dissociation and the Dissociative Disorders. London, UK: Routledge; 2009
    1. Carlson EA. A prospective longitudinal study of attachment disorganization/disorientation. Child Dev. 1998;69:1107–1128
    1. Varese F, Barkus E, Bentall RP. Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med. 2012;42:1025–1036
    1. Gumley AI, Schwannauer M. Staying Well After Psychosis:A Cognitive Interpersonal Approach to Recovery and Relapse Prevention. Chichester: John Wiley & Sons; 2006
    1. Harder S, Folke S. Affect regulation and metacognition in psychotherapy of psychosis: An integrative approach. J Psychothe Integr. 2012;22:330–343

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere