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Measuring attachment and parental bonding in psychosis and its clinical implications

  • S. Mathews (a1) (a2), J. Onwumere (a1) (a2), S. Bissoli (a3), M. Ruggeri (a3), E. Kuipers (a1) and L. Valmaggia (a1) (a2)...

Abstract

Background.

Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Early relationships with parents or caregivers lay the foundations for attachment styles. These styles are proposed to influence how we relate to others during our life can be modified by the relationships and events we experience in our lifespan. A secure attachment style is associated with a capacity to manage distress, comfort with autonomy and the ability to form relationships with others, whereas insecure attachment can lead to dysfunctional relationships, emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people with psychosis. This paper aims to complement recent systematic reviews by providing an overview of attachment theory, its application to psychosis, including an understanding of measurement issues and the clinical implications offered.

Method.

A narrative review was completed of the measures of attachment and parental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illness course, social functioning and symptomatology. The following questions are addressed: What are the key attachment measures that have been used within the attachment and psychosis literature? What are the results of studies that have measured attachment or parental bonding in psychosis and what clinical implications can we derive from it? What are some of the key questions for future research from these findings in relation to the onset of psychosis research field?

Results.

The most commonly used measures of attachment in psychosis research are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recent years comprise a measure specifically developed for a psychosis group. The review suggests that insecure attachment styles are common in psychosis samples. Key relationships were observed between insecure, avoidant and anxious attachment styles and psychosis development, expression and long-term outcome.

Conclusions.

Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greater attention should be given to the assessment of attachment needs and to the development of interventions that seek to compensate for these difficulties. However, further investigations are required on specifying the exact mechanisms by which specific attachment styles impact on the development of psychosis and its course.

Copyright

Corresponding author

*Address for correspondence: Dr L. Valmaggia, Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience (PO77) De Crespigny Park, London SE5 8AF, UK. (Email: lucia.valmaggia@kcl.ac.uk)

References

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Ainsworth, MS, Blehar, MC, Waters, E, Wall, S (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Erlbaum: Hillsdale, NJ.
Berry, K, Wearden, A, Barrowclough, C, Liversidge, T (2006). Attachment styles, interpersonal relationships and psychotic phenomena in a non-clinical student sample. Personality and Individual Differences 41, 707718.
Berry, K, Band, R, Corcoran, R, Barrowclough, C, Wearden, A (2007 a). Attachment styles, earlier interpersonal relationships and schizotypy in a non-clinical sample. Psychology and Psychotherapy Practice 80, 963976.
Berry, K, Wearden, A, Barrowclough, C (2007 b). Adult attachment styles and psychosis: an investigation of associations between general attachment styles and attachment relationships with specific others. Social Psychiatry and Psychiatric Epidemiology 42, 972976.
Berry, K, Barrowclough, C, Wearden, A (2008). Attachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis. Behaviour Research and Therapy 46, 12751282.
Bowlby, J (1969). Attachment and Loss, Vol. 1: Attachment. Basic books: New York.
Bowlby, J (1973). Attachment and Loss, Vol. 2: Separation. Basic books: New York.
Brennan, KA, Clark, CL, Shaver, PR (1998). Self-report measurement of adult romantic attachment: an integrative overview. In Attachment Theory and Close Relationships (ed. Simpson, JA and Rholes, WS). Guilford Press: New York.
Couture, S, Lecomte, T, Leclerc, C (2007). Personality characteristics and attachment in first episode psychosis: impact on social functioning. Journal of Nervous and Mental Disease 195, 631939.
Crowell, JA, Hauser, ST (2008). AAIs in a high-risk sample: stability and relation to functioning from adolescence to 39 years. In Clinical Applications of the Adult Attachment Interview (ed. Steele, H and Steele, M). Guilford Press: New York.
Crowell, JA, Treboux, D (1995). A review of adult attachment measures: implications for theory and research. Social Development 4, 294327.
Crowell, JA, Treboux, D, Waters, E (1999). The adult attachment interview and the relationship questionnaire: relations to reports of mothers and partners. Personal Relationships 6, 118.
Crowell, JA, Fraley, RC, Shaver, PR (2008). Measures of individual differences in adolescent and adult attachment. In Handbook of Attachment: Theory, Research and Clinical Applications, 2nd edn. (ed. Cassidy, J and Shaver, PR). Guilford Press: New York.
Dozier, M, Lee, SW (1995). Discrepancies between self- and other-report of psychiatric symptomatology: effects of dismissing attachment strategies. Win, 1995. Development and Psychopathology 7, 217226.
Dozier, M, Stovall, KC, Albus, KE (1999). Attachment and psychopathology in adulthood. In Handbook of Attachment: Theory, Research, and Clinical Applications (ed. Cassidy, J. and Shaver, PR). Guilford Press: New York.
Feeney, JA, Noller, P, Hanrahan, M (1994). Assessing adult attachment. In Attachment in Adults: Clinical and Developmental Perspectives (ed. Sperling, MB and Berman, WH). Guilford Press: New York.
Fonagy, P, Steele, M, Steele, H, Higgitt, A, Target, M (1994). The Emanuel Miller Memorial Lecture 1992: the theory and practice of resilience. Child Psychology & Psychiatry & Allied Disciplines 35, 231257.
Fraley, RC (2002). Attachment stability from infancy to adulthood: meta-analysis and dynamic modeling of developmental mechanisms. Personality and Social Psychology Review 6, 123151.
Fraley, RC, Spieker, SJ (2003). What are the differences between dimensional and categorical models of individual differences in attachment? Developmental Psychology 39, 423429.
Gajwani, R, Patterson, P, Birchwood, M (2013) ‘Attachment: developmental pathways to affective dysregulation in young people at ultra-high risk of developing psychosis’. British Journal of Clinical Psychology, 52, 424437.
Greenberg, MT (1999). Attachment and psychopathology in childhood. In Handbook of Attachment: Theory, Research, and Clinical Applications (ed. Cassidy, J and Shaver, PR) New York, NY, US: Guilford Press.
Gumley, A, Braehler, C, Laithwite, H (2010). A compassion focused model of recovery after psychosis. International Journal of Cognitive Psychotherapy 3, 186201.
Gumley, AI, Taylor, HE, Schwannauer, M, Macbeth, A (2014). A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatrica Scandinavica 129, 257374.
Hazan, C, Shaver, P (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology 52, 511524.
Helgeland, MIW, Torgersen, S (1997). Maternal representations of patients with schizophrenia as measured by the Parental Bonding Instrument. Scandinavian Journal of Psychology 38, 3943.
Korver-Nieberg, N, Berry, K, Meijer, CJ, Haan, LD (2014). Adult attachment and psychotic phenomenology in clinical and non-clinical samples: a systematic review. Psychology and Psychotherapy 87, 127154.
MacBeth, A, Gumley, A, Schwannauer, M, Fisher, R (2011). Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample. Psychiatry and Psychotherapy 84, 4257. (Discussion 98–110).
Main, M, Goldwyn, R (1984). Adult Attachment Scoring and Classification System. University of California: Los Angeles.
Main, M, Solomon, J (1986). Discovery of an insecure-disoriented attachment pattern. In Affective Development in Infancy (ed. Brazelton, TB and Yogman, MW). Ablex: Norwood, NJ.
Main, M, Solomon, J (1990). Procedures for identifying disorganised/disoriented infants in the AInsworth Strange Situation. In Attachment in Preschool Years: Theory, Research and Interventions (ed. Greenberg, MT, Cicchetti, D and Cummings, EM). University of Chicago Press: Chicago.
Main, M, Hesse, E, Kaplan, N (2005). Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: the Berkeley Longitudinal Study. In Attachment from Infancy to Adulthood: The major Longitudinal Studies (eds. Grossmann, KE, Grossmann, K and Waters, E). Guilford: New York.
McFarlane, WR, Cook, WL (2007). Family expressed emotion prior to onset of psychosis. Family Process 46, 185197.
Mikulincer, M (1998). Adult attachment style and individual differences in functional versus dysfunctional experiences of anger. Journal of Personality and Social Psychology 74, 513524.
Mikulincer, M, Shaver, PR (2007). Attachment, group-related processes, and psychotherapy. International Journal of Group Psychotherapy 57, 233245.
Morgan, C, Fisher, H (2007). Environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.
O'Brien, MP, Gordon, JL, Bearden, CE, Lopez, SR, Kopelowicz, A, Cannon, TD (2006). Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophrenia Research 81, 269275.
Onstad, S, Skre, I, Torgersen, S, Kringlen, E (1994). Family interaction: parental representation in schizophrenic patients. Acta Psychiatrica Scandinavica, Supplementum 384, 6770.
Onwumere, J, Bebbington, P, Kuipers, E (2011). Family interventions in early psychosis: specificity and effectiveness. Epidemiology and Psychiatric Sciences 20, 113119.
Parker, G, Tupling, H, Brown, LB (1979). A parental bonding instrument. British Journal of Medical Psychology 52, 110.
Parker, G, Fairley, M, Greenwood, J, Jurd, S, Silove, D (1982). Parental representations of schizophrenics and their association with onset and course of schizophrenia. British Journal of Psychiatry 141, 573581.
Pietromonaco, PR, Barrett, LF (2000). Attachment theory as an organizing framework: a view from different levels of analysis. Review of General Psychology 4, 107110.
Ponizovsky, AM, Nechamkin, Y, Rosca, P. (2007) Attachment styles are associated with symptomatology and course of schizophrenia in male inpatients. American Journal of Orthopsychiatry, 77, 324331.
Read, J, Gumley, A (2010). Can attachment theory help explain the relationship between childhood adversity and psychosis? In Telling Stories? Attachment-Based Approaches to the Treatment of Psychosis (ed. Benamer, S). Karnac Books: London.
Read, J, Bentall, RP, Fosse, R (2009). Time to abandon the bio-bio-bio model of psychosis: exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiology and Psychiatric Sciences 18, 299310.
Roisman, GI, Holland, A, Fortuna, K, Fraley, C, Clausell, E, Clarke, A (2007). The Adult Attachment Interview and self-reports of attachment style: an empirical reapproachement. Journal of Personality and Social Psychology 92, 678697.
Shaver, PR, Mikulincer, M (2002). Dialogue on adult attachment: diversity and integration. Attachment and Human Development 4, 243257.
Tienari, P, Wynne, LC, Sorri, A, Lahti, I, Laksy, K, Moring, J, Naarala, M, Nieminen, P, Wahlberg, KE (2004). Genotype–environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. British Journal of Psychiatry 184, 216222.
Warner, R, Atkinson, M (1988). The relationship between schizophrenic patients' perceptions of their parents and the course of their illness. British Journal of Psychiatry 153, 344353.
Waters, E, Cummings, EM (2000). A secure base from which to explore close relationships. Child Development 71, 164172.
Willinger, U, Heiden, AM, Meszaros, K, Formann, AK, Aschauer, HN (2002). Maternal bonding behaviour in schizophrenia and schizoaffective disorder, considering premorbid personality traits. Australian and New Zealand Journal of Psychiatry 36, 663668.

Keywords

Measuring attachment and parental bonding in psychosis and its clinical implications

  • S. Mathews (a1) (a2), J. Onwumere (a1) (a2), S. Bissoli (a3), M. Ruggeri (a3), E. Kuipers (a1) and L. Valmaggia (a1) (a2)...

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