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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])
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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 

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