Understanding the role of attachment in symptoms may help to gain insight into the development or persistence of symptoms. Associations between attachment and recovery style suggest that it may be helpful to improve attachment security in a context of therapeutic relationships or other social relationships before encouraging people to explore their experiences of psychosis. Associations between insecure attachment and impaired mentalization skills may help in understanding interpersonal difficulties and this knowledge can be used to improve recovery.
Patients had higher levels of attachment anxiety, but the groups did not differ in attachment avoidance. Basic trust was lower in patients than controls, as indicated by lower initial investments. During cooperation patients increased their trust towards levels of controls, i.e. they were able to learn and to override initial suspiciousness. Patients decreased their trust less than controls during unfair interactions. Anxious attachment was associated with higher basic trust and higher trust during unfair interactions and predicted trust independent of group status. Discussion Patients showed decreased basic trust but were able to learn from the trustworthy behaviour of their counterpart. Worries about the acceptance by others and low self-esteem are associated with psychosis and attachment anxiety and may explain behaviour that is focused on conciliation, rather than self-protection.
No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.
ChM was associated with positive and negative symptomatology in both patients and siblings. Particularly in siblings, the relationship between ChM and psychosis seems to be mediated by adult attachment style. Perhaps attachment style may play a more prominent role on a subclinical level.
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