title: Theory of Mind and attachment styles in people with psychotic disorders, their siblings, and controls.
abstract: OBJECTIVE
  Impaired Theory of Mind (ToM) and insecure (adult) attachment styles have been found in persons with schizophrenia as well as in their healthy siblings. ToM refers to the ability to infer mental states of self and others including beliefs and emotions. Insecure attachment is proposed to underlie impaired ToM, and comprises avoidant (discomfort with close relationships, high value of autonomy) and anxious (separation anxiety, dependency on others) attachment. Insight into the association between attachment style and ToM is clinically relevant, as it enhances our understanding and clinical approach to social dysfunction in schizophrenia. Therefore, we studied the association between insecure attachment styles and ToM in patients with schizophrenia, their siblings, and healthy controls.
  
  
  METHODS
  A total of 111 patients with a diagnosis in the schizophrenia spectrum, 106 non-affected siblings and 63 controls completed the Psychosis Attachment Measure, the Conflicting Beliefs and Emotions, a subsection of the Wechsler Adult Intelligence Scale, and the Childhood Trauma Questionnaire-Short Form. Severity of symptoms was assessed with the Community Assessment of Psychic Experiences and the Positive and Negative Syndrome Scale.
  
  
  RESULTS
  After controlling for sex, intelligence, history of trauma and symptom severity, avoidant attachment was significantly associated with cognitive as well as with affective ToM, showing U-shaped associations, indicating better ToM performance for patients with lower or higher levels of avoidant attachment compared to medium levels. Anxious attachment in patients was associated with more problems in cognitive ToM.
  
  
  CONCLUSIONS
  The results from this study support the idea that an anxious attachment style is associated with worse ToM performance in patients. Results also suggested a potential protective role of higher levels of avoidant attachment on ToM. These findings bear clinical relevance, as activation of (insecure) attachment mechanisms may affect interpersonal relations, as well as therapeutic working alliance. Further clarification is needed, especially on associations between ToM and avoidant attachment.
authors.affiliation: Early Psychosis Department, Amsterdam Medical Center, Department of Psychiatry, Amsterdam, The Netherlands K.Pos@amc.uva.nl.
authors.forename: Karin
authors.initials: K
authors.lastname: Pos
authors.affiliation: University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands.
authors.forename: Agna A
authors.initials: AA
authors.lastname: Bartels-Velthuis
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Center, European Graduate School of Neuroscience, SEARCH, Maastricht, The Netherlands Department Research and Development, Geestelijke Gezondheidszorg Eindhoven en De Kempen, Eindhoven, The Netherlands.
authors.forename: Claudia J P
authors.initials: CJ
authors.lastname: Simons
authors.affiliation: Early Psychosis Department, Amsterdam Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
authors.forename: Nikie
authors.initials: N
authors.lastname: Korver-Nieberg
authors.affiliation: Early Psychosis Department, Amsterdam Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
authors.forename: Carin J
authors.initials: CJ
authors.lastname: Meijer
authors.affiliation: Early Psychosis Department, Amsterdam Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
authors.forename: Lieuwe
authors.initials: L
authors.lastname: de Haan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011618:Psychotic Disorders / Q000503:physiopathology*; D012559:Schizophrenia / Q000503:physiopathology*; D035781:Siblings; D056345:Theory of Mind / Q000502:physiology*; D055815:Young Adult
keywords: Attachment; schizophrenia; social cognition