Attachment, Neurobiology, and Mentalizing along the Psychosis Continuum.
In this review article, we outline the evidence linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To better understand the neurobiological mechanisms through which insecure attachment may contribute to psychosis, we identify at least five neurobiological pathways linking attachment to risk for developing psychosis. Besides its well documented influence on the hypothalamic-pituary-adrenal (HPA) axis, insecure attachment may also contribute to neurodevelopmental risk through the dopaminergic and oxytonergic systems, as well as bear influence on neuroinflammation and oxidative stress responses. We further consider the neuroscientific and behavioral studies that underpin mentalization as a suite of processes potentially moderating the risk to transition to psychotic disorders. In particular, mentalization may help the individual compensate for endophenotypical impairments in the integration of sensory and metacognitive information. We propose a model where embodied mentalization would lie at the core of a protective, resilience response mitigating the adverse and potentially pathological influence of the neurodevelopmental cascade of risk for psychosis.
Faculty of Psychology and Educational Sciences, University of GenevaGeneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK; Office Médico-PédagogiqueGeneva, Switzerland.
Martin
M
Debbané
Research Department of Clinical, Educational and Health Psychology, University College London London, UK.
George
G
Salaminios
Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK; Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium.
Patrick
P
Luyten
Faculty of Psychology and Educational Sciences, University of Geneva Geneva, Switzerland.
Deborah
D
Badoud
Office Médico-Pédagogique Geneva, Switzerland.
Marco
M
Armando
Department of Psychiatry, Lausanne University Hospital (CHUV) Lausanne, Switzerland.
Alessandra
A
Solida Tozzi
Research Department of Clinical, Educational and Health Psychology, University College London London, UK.
Peter
P
Fonagy
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA.
Benjamin K
BK
Brent
HPA; UHR; mentalizing; schizophrenia; schizotypy; self; theory of mind