title: Attachment styles and affect regulation among outpatients with schizophrenia: relationships to symptomatology and emotional distress.
abstract: OBJECTIVE
  Using the model of activation and dynamics of the attachment system (Shaver & Mikulincer, 2002) and dynamic stress-vulnerability models of psychosis (Ingmar & Luxton, 2005) as the analytical frameworks, the authors tested the hypothesis that the insecure attachment styles are differentially associated with the severity of psychopathological symptoms and emotional distress among outpatients with International Classification of Diseases, Tenth edition (ICD-10) diagnosis of schizophrenia.
  
  
  METHODS
  Attachment styles were identified using the Relationship Questionnaire (Bartholomew & Horowitz, 1991) among 100 outpatients with an ICD-10 schizophrenia diagnosis. Current symptom severity was measured by the Positive and Negative Syndromes Scale (Kay, Fiszbein, & Opler, 1987) and emotional distress by the General Health Questionnaire (Goldberg & Williams, 1988). Univariate and multivariate analyses were performed to test the hypotheses.
  
  
  RESULTS
  The preoccupied and fearful-avoidant attachment patterns were associated with higher scores of psychotic (delusions, suspiciousness/persecution, and hallucinatory behaviour) and affective (anxiety, tension, guilt feeling, and depression) symptoms, whereas the dismissing-avoidant style was associated with only anxiety. All the insecure attachment styles were associated with elevated emotional distress.
  
  
  CONCLUSIONS
  The findings support the hypothesis of a predisposing role of the preoccupied and fearful-avoidant styles in psychotic symptom formation and call for cognitive interpersonal interventions geared to reduce symptom and emotional distress severity.
authors.affiliation: Mental Health Services, Ministry of Health, Jerusalem, Israel. alexander.ponizovsky@moh.health.gov.il
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Ponizovsky
authors.forename: Elena
authors.initials: E
authors.lastname: Vitenberg
authors.forename: Inbar
authors.initials: I
authors.lastname: Baumgarten-Katz
authors.forename: Alexander
authors.initials: A
authors.lastname: Grinshpoon
mesh_terms: D000328:Adult; D000339:Affect; D000704:Analysis of Variance; D004198:Disease Susceptibility; D056348:Emotional Intelligence / Q000502:physiology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011582:Psychological Theory; D012044:Regression Analysis; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires