School of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, UK.
Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
Clin Psychol Psychother. 2017 Nov;24(6):1304-1312. doi: 10.1002/cpp.2100. Epub 2017 Jun 27.
Exposure to childhood trauma has been implicated in the development of paranoia and hearing voices, but the mechanisms responsible for these associations remain unclear. Understanding these mechanisms is essential for ensuring that targeted interventions can be developed to better support people experiencing distress associated with paranoia and voices. Recent models have proposed that dissociation may be a mechanism specifically involved in the development of voices and insecure attachment in the development of paranoia. Recent theoretical proposals have added to this and argued that fearful attachment could also lead to increased vulnerability for voices. This study was the first to examine whether dissociation and insecure attachment styles mediated the relationship between childhood trauma and these psychotic experiences. One hundred and twelve participants experiencing clinical levels of psychosis completed measures of dissociation, childhood trauma, attachment, voices, and paranoia. Results revealed positive associations between fearful (but not dismissive and anxious) attachment, dissociation, trauma, and psychotic experiences. Mediation analyses indicated that dissociation, but not fearful attachment, significantly mediated the relationship between trauma and voices. Conversely, both dissociation and fearful attachment significantly mediated the relationship between trauma and paranoia. The findings suggest that insecure attachment might be more strongly related to paranoia than hallucinations and suggest that fearful attachment may be a more promising mechanism to explain this relationship. Furthermore, the findings suggest that the impact of dissociation on psychotic experiences may extend to paranoia. Future research is required to replicate these findings using interview-based attachment measures.
童年创伤与偏执和幻听的发展有关，但导致这些关联的机制仍不清楚。了解这些机制对于确保可以开发有针对性的干预措施以更好地支持经历偏执和幻听相关困扰的人至关重要。最近的模型提出，分离可能是与幻听发展和偏执发展中不安全感依恋有关的特定机制。最近的理论建议在此基础上增加了观点，即恐惧依恋也可能导致对声音的易感性增加。这项研究首次检验了分离和不安全的依恋模式是否在童年创伤与这些精神病经历之间起中介作用。112 名经历精神病临床水平的参与者完成了分离、童年创伤、依恋、幻听和偏执的测量。结果显示，恐惧（而非轻视和焦虑）依恋、分离、创伤和精神病经历之间存在正相关。中介分析表明，分离而不是恐惧依恋，显著中介了创伤与幻听之间的关系。相反，分离和恐惧依恋都显著中介了创伤与偏执之间的关系。研究结果表明，不安全依恋可能与偏执比幻觉更相关，并表明恐惧依恋可能是解释这种关系的更有前途的机制。此外，研究结果表明，分离对精神病经历的影响可能扩展到偏执。需要使用基于访谈的依恋测量来复制这些发现。
