Measuring attachment and parental bonding in psychosis and its clinical implications

Background. Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Earlyrelationships with parents or caregivers lay the foundations for attachmentstyles. These styles are proposed to influence how we relate to others during ourlife can be modified by the relationships and events we experience in ourlifespan. A secure attachment style is associated with a capacity to managedistress, comfort with autonomy and the ability to form relationships withothers, whereas insecure attachment can lead to dysfunctional relationships,emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people withpsychosis. This paper aims to complement recent systematic reviews by providingan overview of attachment theory, its application to psychosis, including anunderstanding of measurement issues and the clinical implications offered.Method. A narrative review was completed of the measures of attachment andparental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illnesscourse, social functioning and symptomatology. The following questions areaddressed: What are the key attachment measures that have been used within theattachment and psychosis literature? What are the results of studies that havemeasured attachment or parental bonding in psychosis and what clinicalimplications can we derive from it? What are some of the key questions for futureresearch from these findings in relation to the onset of psychosis researchfield? Results. The most commonly used measures of attachment in psychosisresearch are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recentyears comprise a measure specifically developed for a psychosis group. The reviewsuggests that insecure attachment styles are common in psychosis samples. Keyrelationships were observed between insecure, avoidant and anxious attachmentstyles and psychosis development, expression and long-term outcome. Conclusions. Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greaterattention should be given to the assessment of attachment needs and to thedevelopment of interventions that seek to compensate for these difficulties.However, further investigations are required on specifying the exact mechanismsby which specific attachment styles impact on the development of psychosis andits course