title: Childhood maltreatment, adult attachment and psychotic symptomatology: a study in patients, siblings and controls.
abstract: OBJECTIVE
  The association between childhood maltreatment (ChM) and psychotic disorders is well established. However, there is an ongoing debate about which factors account for this relationship. One explanation is that the relationship between ChM and psychosis is mediated by adult attachment style. Therefore, in this study, we aimed to investigate whether adult attachment style mediates the relationship between ChM and positive and negative symptomatology.
  
  
  METHODS
  We investigated the relation between ChM and psychotic symptoms, taking into account levels of (insecure) attachment, in 131 patients with psychotic illness, 123 siblings and 72 controls. ChM was assessed with the Childhood Trauma Questionnaire (CTQ). Attachment dimensions of anxiety and avoidance were measured using the Psychosis Attachment Measure (PAM).
  
  
  RESULTS
  In both patients and siblings, ChM predicted positive symptoms and this relationship was partly mediated by attachment style. This relationship was found to be stronger for siblings than for patients. ChM predicted negative symptoms in patients and siblings. In the patient sample, attachment style did not mediate the relationship between ChM and negative symptoms, whereas attachment style was found to be a mediator in the sibling sample.
  
  
  CONCLUSIONS
  ChM was associated with positive and negative symptomatology in both patients and siblings. Particularly in siblings, the relationship between ChM and psychosis seems to be mediated by adult attachment style. Perhaps attachment style may play a more prominent role on a subclinical level.
authors.affiliation: Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands, d.s.vandam@amc.uva.nl.
authors.forename: D S
authors.initials: DS
authors.lastname: van Dam
authors.forename: N
authors.initials: N
authors.lastname: Korver-Nieberg
authors.forename: E
authors.initials: E
authors.lastname: Velthorst
authors.forename: C J
authors.initials: CJ
authors.lastname: Meijer
authors.forename: L
authors.initials: L
authors.lastname: de Haan
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D001007:Anxiety / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D035781:Siblings / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult