Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T20:57:14.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem

Published online by Cambridge University Press:  12 November 2014

S. Wickham ,
K. Sitko  and
R. P. Bentall
S. Wickham*
Affiliation:
Department of Psychological Sciences, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
K. Sitko
Affiliation:
Department of Psychological Sciences, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
R. P. Bentall
Affiliation:
Department of Psychological Sciences, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
*
* Address for correspondence: S. Wickham, Department of Psychological Sciences, University of Liverpool, Waterhouse Building, Block B (2nd floor), Liverpool L69 3GL, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms.

Method

We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association.

Results

Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia.

Conclusions

It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.

Keywords

Attachmenthallucinationsmediationparanoiaself-esteem
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1495 - 1507
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bartholomew, K, Horowitz, LM (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology 61, 226–244.CrossRefGoogle ScholarPubMed
Bentall, RP (2009). Doctoring the Mind: Why Psychiatric Treatments Fail. Penguin Group: London.Google Scholar
Bentall, RP, Corcoran, R, Howard, R, Blackwood, N, Kinderman, P (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review 21, 1143–1192.CrossRefGoogle ScholarPubMed
Bentall, RP, Fernyhough, C (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin 34, 1012–1020.CrossRefGoogle ScholarPubMed
Bentall, RP, Wickham, S, Shevlin, M, Varese, F (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734–740.CrossRefGoogle ScholarPubMed
Bentler, PM (1990). Comparative fix indices in structural models. Psychological Bulletin 107, 238–246.CrossRefGoogle Scholar
Berry, K, Barrowclough, C, Wearden, A (2008). Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis. Behaviour Research and Therapy 46, 1275–1282.Google Scholar
Berry, K, Wearden, A, Barrowclough, C (2007). Adult attachment styles and psychosis: an investigation of associations between general attachment styles and attachment relationships with specific others. Social Psychiatry and Psychiatric Epidemiology 42, 972–976.Google Scholar
Berry, K, Wearden, A, Barrowclough, C, Liversidge, T (2006). Attachment styles, interpersonal relationships and psychotic phenomena in a non-clinical student sample. Personality and Individual Differences 41, 707–718.Google Scholar
Berry, K, Wearden, A, Barrowclough, C, Oakland, L, Bradley, J (2012). An investigation of adult attachment and the nature of relationships with voices. British Journal of Clinical Psychology 51, 280–291.Google Scholar
Bowlby, J (1969). Attachment and Loss. Volume I: Attachment, p. 3. Basic Books: New York.Google Scholar
Bowlby, J (1973). Attachment and Loss. Volume II: Separation: Anxiety and Anger, p. 456. Basic Books: New York.Google Scholar
Buckley, PF, Miller, BJ, Lehrer, DS, Castle, DJ (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin 35, 383–402.CrossRefGoogle ScholarPubMed
Carpenter, L, Chung, MC (2011). Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychology and Psychotherapy 84, 367–388.Google Scholar
Dozier, M (1990). Attachment organization and treatment use for adults with serious psychopathological disorders. Development and Psychopathology 2, 47.Google Scholar
Dozier, M, Cue, KL, Barnett, L (1994). Clinicians as caregivers: role of attachment organization in treatment. Journal of Consulting and Clinical Psychology 62, 793–800.Google Scholar
Dozier, M, Stevenson, AL, Lee, SW, Velligan, DI (1991). Attachment organization and familial overinvolvement for adults with serious psychopathological disorders. Development and Psychopathology 3, 475.Google Scholar
Dozier, M, Stovall, KC, Albus, KE (1999). Attachment and psychopathology in adulthood. In Handbook of Attachment: Theory, Research, and Clinical Applications (ed. Cassidy, J. and Shaver, P. R.), pp. 497–519. Guilford: New York.Google Scholar
Fibiger, HC (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia Bulletin 38, 649–650.Google Scholar
Fowler, D, Hodgekins, J, Garety, P, Freeman, D, Kuipers, E, Dunn, G, Smith, B, Bebbington, P (2012). Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophrenia Bulletin 38, 1063–1073.Google Scholar
Fowler, JC, Allen, JG, Oldham, JM, Frueh, BC (2013). Exposure to interpersonal trauma, attachment insecurity, and depression severity. Journal of Affective Disorders 149, 313–318.CrossRefGoogle ScholarPubMed
Fraley, RC, Vicary, AM, Brumbaugh, CC, Roisman, GI (2011). Patterns of stability in adult attachment: an empirical test of two models of continuity and change. Journal of Personality and Social Psychology 101, 974–992.Google Scholar
Freeman, D, Garety, P, Fowler, D, Kuipers, E, Dunn, G, Bebbington, PE, Hadley, C (1998). The London-East Anglia randomized controlled trial of cognitive–behaviour therapy for psychosis IV: self-esteem and persecutory delusions. British Journal of Clinical Psychology 37, 415.Google Scholar
Freeman, D, Garety, PA (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 41, 923–947.Google Scholar
Freeman, D, Garety, PA, Bebbington, PE, Smith, B, Rollinson, R, Fowler, D, Kuipers, E, Ray, K, Dunn, G (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427–435.CrossRefGoogle Scholar
Freeman, D, Garety, PA, Kuipers, E, Fowler, D, Bebbington, PE (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331–341.CrossRefGoogle ScholarPubMed
Griffin, DW, Bartholomew, K (1994). Models of the self and other: fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology 67, 430–445.CrossRefGoogle Scholar
Gumley, AI, Schwannauer, M, Macbeth, A, Fisher, R, Clark, S, Rattrie, L, Fraser, G, McCabe, R, Blair, A, Davidson, K, Birchwood, M (2014). Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up. British Journal of Psychiatry 205, 60–67.Google Scholar
Hoyle, RH, Panter, AT (1995). Writing about structural equation models. In Structural Equation Modeling: Concepts, Issues and Applications (ed. Hoyle, R. H.), pp. 158–176. Sage: Thousand Oaks, CA.Google Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6, 1–55.Google Scholar
Jöreskog, KG, Sörbom, D (1993). Structural Equation Modeling with the SIMPLIS Command Language. Scientific Software Inc.: Chicago.Google Scholar
Kaney, S, Bentall, RP (1989). Persecutory delusions and attributional style. British Journal of Medical Psychology 62, 191–198.Google Scholar
Kay, SR, Fiszbein, A, Opfer, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Korver-Nieberg, N, Berry, K, Meijer, CJ, de Haan, L (2014). Adult attachment and psychotic phenomenology in clinical and non-clinical samples: a systematic review. Psychology and Psychotherapy 87, 127–154.Google Scholar
Krabbendam, L, Janssen, I, Bak, M, Bijl, R, de Graaf, R, van Os, J (2002). Neuroticism and low self-esteem as risk factors for psychosis. Social Psychiatry and Psychiatric Epidemiology 37, 1–6.Google Scholar
Lecomte, T, Corbière, M, Laisné, F (2006). Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form. Psychiatry Research 143, 99–108.Google Scholar
Levenson, H (1973). Multidimensional locus of control in psychiatric patients. Journal of Consulting and Clinical Psychology 41, 397–404.CrossRefGoogle ScholarPubMed
MacBeth, A, Gumley, A, Schwannauer, M, Fisher, R (2011). Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample. Psychology and Psychotherapy 84, 42–57.Google Scholar
MacBeth, A, Schwannauer, M, Gumley, A (2008). The association between attachment style, social mentalities, and paranoid ideation: an analogue study. Psychology and Psychotherapy 81, 79–93.Google Scholar
Marmarosh, CL, Kivlighan, DM, Bieri, K, LaFauci Schutt, JM, Barone, C, Choi, J (2014). The insecure psychotherapy base: using client and therapist attachment styles to understand the early alliance. Psychotherapy 51, 404–412.Google Scholar
Melo, S, Corcoran, R, Shryane, N, Bentall, RP (2009). The Persecution and Deservedness Scale. Psychology and Psychotherapy 82, 247–260.Google Scholar
Mickelson, KD, Kessler, RC, Shaver, PR (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology 73, 1092–1106.Google Scholar
Mikulincer, M, Shaver, PR (2010). Attachment in Adulthood: Structure, Dynamics, and Change. Guilford Press: New York.Google Scholar
Morgan, C, Kirkbride, J, Leff, J, Craig, T, Hutchinson, G, McKenzie, K, Morgan, K, Dazzan, P, Doody, G, Jones, P, Murray, R, Fearon, P (2007). Parental separation, loss and psychosis in different ethnic groups: a case–control study. Psychological Medicine 37, 495–503.Google Scholar
Morrison, AP, Shryane, N, Beck, R, Heffernan, S, Law, H, McCusker, M, Bentall, RP (2013). Psychosocial and neuropsychiatric predictors of subjective recovery from psychosis. Psychiatry Research 208, 203–209.CrossRefGoogle ScholarPubMed
Morriss, RK, van der Gucht, E, Lancaster, G, Bentall, RP (2009). Adult attachment in bipolar 1 disorder. Psychology and Psychotherapy 82, 267–277.Google Scholar
Muller, RT, Sicoli, LA, Lemieux, KE (2000). Relationship between attachment style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse. Journal of Traumatic Stress 13, 321–332.Google Scholar
Muthén, LK, Muthén, BO (1998–2010). Mplus User's Guide, 6th edn. Muthén & Muthén: Los Angeles.Google Scholar
Myhrman, A, Rantakallio, P, Isohanni, M, Jones, P, Partanen, U (1996). Unwantedness of a pregnancy and schizophrenia in the child. British Journal of Psychiatry 169, 637–640.Google Scholar
Ortigo, KM, Westen, D, Defife, JA, Bradley, B (2013). Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations. Journal of Traumatic Stress 26, 361–368.Google Scholar
Owen, KA, Haddock, G, Berry, K (2013). The role of the therapeutic alliance in the regulation of emotion in psychosis: an attachment perspective. Clinical Psychology and Psychotherapy 20, 523–530.CrossRefGoogle Scholar
Pickering, L, Simpson, J, Bentall, RP (2008). Insecure attachment predicts proneness to paranoia but not hallucinations. Personality and Individual Differences 44, 1212–1224.Google Scholar
Ponizovsky, AM, Vitenberg, E, Baumgarten-Katz, I, Grinshpoon, A (2013). Attachment styles and affect regulation among outpatients with schizophrenia: relationships to symptomatology and emotional distress. Psychology and Psychotherapy 86, 164–182.Google Scholar
Preacher, K, Hayes, A (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.Google Scholar
Read, J, Gumley, A (2008). Can attachment theory help explain the relationship between childhood adversity and psychosis? Attachment: New Directions in Psychotherapy and Relational Psychoanalysis 2, 1–35.Google Scholar
Sitko, K, Bentall, RP, Shevlin, M, O'Sullivan, N, Sellwood, W (2014). Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatry Research 217, 202–209.Google Scholar
Steiger, JH (1990). Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research 25, 173–180.Google Scholar
Tucker, LR, Lewis, C (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38, 1–10.Google Scholar
Valiente, C, Cantero, D, Vázquez, C, Sanchez, A, Provencio, M, Espinosa, R (2011). Implicit and explicit self-esteem discrepancies in paranoia and depression. Journal of Abnormal Psychology 120, 691–699.CrossRefGoogle ScholarPubMed
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient–control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661–671.Google Scholar
Warren, SL, Huston, L, Egeland, B, Sroufe, LA (1997). Child and adolescent anxiety disorders and early attachment. Journal of the American Academy of Child and Adolescent Psychiatry 36, 637–644.CrossRefGoogle ScholarPubMed