Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,
Soc Psychiatry Psychiatr Epidemiol. 2014 Nov;49(11):1759-67. doi: 10.1007/s00127-014-0894-0. Epub 2014 Jun 17.
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.
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).
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.
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.
儿童期虐待（ChM）与精神病的关系已得到充分证实。然而，对于哪些因素导致这种关系，目前仍存在争议。一种解释是，ChM 与精神病之间的关系受成人依恋模式的影响。因此，在这项研究中，我们旨在调查成人依恋模式是否在 ChM 与阳性和阴性症状之间起中介作用。
我们调查了 131 名精神病患者、123 名兄弟姐妹和 72 名对照者的 ChM 与精神病症状之间的关系，同时考虑了（不安全）依恋水平。ChM 采用儿童期创伤问卷（CTQ）进行评估。焦虑和回避的依恋维度采用精神病 Attachment Measure（PAM）进行测量。
在患者和兄弟姐妹中，ChM 均预测阳性症状，且这种关系部分由依恋模式介导。与患者相比，这种关系在兄弟姐妹中更强。ChM 预测了患者和兄弟姐妹的阴性症状。在患者样本中，依恋模式并没有介导 ChM 与阴性症状之间的关系，而在兄弟姐妹样本中，依恋模式则是一种中介因素。
ChM 与患者和兄弟姐妹的阳性和阴性症状均相关。特别是在兄弟姐妹中，ChM 与精神病之间的关系似乎受成人依恋模式的影响。也许在亚临床水平上，依恋模式可能发挥更重要的作用。
