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.