A systematic review of attachment and psychosis: measurement, construct validity and outcomes

Objective: This review sought to identify, summarise and critically
evaluate studies that investigated attachment amongst individuals with
psychosis.

Method: The following computerised databases searched were
CINAHL < 1980 to December 2012; EMBASE < 1980 to December
2012; Ovid MEDLINE (R) < 1980 to December 2012;
PsychINFO < 1980 to December 2012; and Google Scholar < 1980 to
December 2012.

Results: We identified 22 papers describing 21 studies comprising 1453
participants, with a mean age of 35.0 years (range of 12–71 years), of
whom 68.4% (n = 994) were male. Of our sample, 1112 (76.5%) had a
diagnosis of schizophrenia. We found small to moderate associations
between greater attachment insecurity (as reflected in anxiety and
avoidance) and poorer engagement with services, more interpersonal
problems, more avoidant coping strategies, more negative appraisals of
parenting experiences and more severe trauma. We also found small to
modest associations between attachment insecurity and more positive
and negative symptoms and greater affective symptom problems.

Conclusion: Attachment theory may be useful as a means of
understanding the developmental and interpersonal basis of recovery
and adaptation in the context of psychosis. However, further research
comprising more representative samples in their first episode and using
prospective designs is required