Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem.
BACKGROUND
A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms.


METHODS
We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association.


RESULTS
Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia.


CONCLUSIONS
It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.
Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK.
S
S
Wickham
Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK.
K
K
Sitko
Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK.
R P
RP
Bentall
D000328:Adult; D005260:Female; D006212:Hallucinations / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D010259:Paranoid Disorders / Q000209:etiology / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000150:complications / Q000503:physiopathology*; D012559:Schizophrenia / Q000150:complications / Q000503:physiopathology*; D012649:Self Concept
self-esteem