Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK.
Br J Clin Psychol. 2020 Mar;59(1):39-65. doi: 10.1111/bjc.12231. Epub 2019 Aug 7.
Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality.
We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre-registered the review protocol and followed PRISMA guidelines.
Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia.
The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia.
There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
偏执是精神病的一个关键症状，与一系列不良后果有关。早期生活经历会增加偏执思维的易感性，而依恋理论被提出作为解释这种因果关系的关键模型。以前的综述强调了不安全依恋风格与精神病症状总体严重程度之间的关联证据。研究报告了不安全依恋与偏执之间的关联，但迄今为止，这一文献尚未得到充分综合。本研究的目的是报告已发表研究中偏执与不安全依恋之间关联的强度和一致性，并对研究质量进行系统评估。
我们使用电子数据库中的搜索词来捕获成人依恋、偏执和精神病的概念，进行了系统的文献综述。我们预先注册了审查方案，并遵循 PRISMA 指南。
在 12 项研究中有 11 项报告了不安全依恋与偏执之间存在显著关联，在控制共病症状的研究中，关联仍然显著。最强烈、最常报告的关系是焦虑型依恋与偏执之间的关系。
这些发现支持了依恋不安全感在精神病中偏执发展和维持中的作用，并强调了在偏执症治疗中需要解决不安全依恋的代表性问题。
有一致的证据表明不安全的依恋风格与偏执之间存在关联。与不安全的回避型依恋相比，不安全的焦虑型依恋与偏执的关联更为一致。在分析中控制关键混杂因素后，依恋与偏执之间的关联仍然显著。解决不安全依恋的代表性问题并促进更安全依恋的干预措施可能有助于减少偏执。
