Adult Attachment and Psychotic Phenomenology in Clinical and Non-clinical Samples: a Systematic Review

Objectives: It has been argued that attachment theory could enhance our knowledge and understanding of psychotic phenomenology.

Design: We systematically reviewed and critically appraised research investigating attachment and psychotic phenomenology in clinical and non-clinical samples.

Methods: We searched databases Pub Med, PsycINFO, Medline and Web of Science using the keywords. Attachment, Adult Attachment, Psychosis, Schizotypy and Schizophrenia and identified 29 studies assessing adult attachment in combination with psychotic phenomenology.

Result: The findings indicated that both insecure anxious and insecure avoidant attachment are associated with psychotic phenomenology. Insecurely attached individuals are more vulnerable to developing maladaptive coping strategies in recovering from psychosis. The importance of attachment experiences for processing social information, mentalization skills and developing social relationships, including therapeutic relationships, in samples with psychosis is also highlighted.

Conclusion: Attachment style is a clinically relevant construct in relation to development, course and treatment of psychosis.

Practitioner Points: 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.