Psychology Department, University of Southampton, Southampton, UK.
Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK.
Psychol Psychother. 2024 Jun;97(2):372-392. doi: 10.1111/papt.12521. Epub 2024 Feb 15.
Insecure attachment may constitute a vulnerability factor for psychosis, and dissociation may be a key mechanism in the development of auditory hallucinations specifically. While there is good evidence for the role of these processes in isolation, it is unclear whether dissociation accounts for the association between insecure attachment and psychosis. This systematic review takes a theory-driven approach to examine proposed causal relationships across the clinical and nonclinical literature.
We searched five databases (PubMeD, Web of Science, PsycINFO, CINAHL and ETHOS) for published and unpublished research examining attachment, dissociation and psychosis. Two independent reviewers extracted the data and assessed the quality of all included studies.
We identified 242 potential articles and included 13 in the final review (2096 participants). We found that (1) disorganised attachment was consistently associated with dissociation and inconsistently associated with voices and paranoia, (2) dissociation was associated with voices and paranoia, and these links were stronger in clinical samples, and (3) dissociation played a role in the impact of insecure attachment on voice hearing and paranoia in clinical groups.
This is the first review to synthesise the research examining attachment, dissociation, and psychosis. The evidence is consistent with proposed causal hypotheses and raises conceptual and measurement issues, for example, the need to clarify the relative contributions of different insecure attachment styles, and utilise behavioural/observational measures to strengthen study designs. Most importantly, we need experimental and longitudinal studies to confirm causal links and targets for treatment.
不安全依恋可能构成精神病的脆弱因素，而分离可能是特定听觉幻觉发展的关键机制。虽然这些过程在孤立状态下有很好的证据支持，但分离是否解释了不安全依恋与精神病之间的关联尚不清楚。本系统评价采用理论驱动的方法，在临床和非临床文献中检查了拟议的因果关系。
我们在五个数据库（PubMeD、Web of Science、PsycINFO、CINAHL 和 ETHOS）中搜索了发表和未发表的研究，以检查依恋、分离和精神病。两名独立的审查员提取数据并评估所有纳入研究的质量。
我们确定了 242 篇潜在文章，并在最终审查中纳入了 13 篇（2096 名参与者）。我们发现：（1）组织混乱的依恋与分离始终相关，与声音和妄想不一致相关，（2）分离与声音和妄想相关，这些联系在临床样本中更强，（3）分离在临床群体中不安全依恋对声音感知和妄想的影响中发挥了作用。
这是第一项综合研究依恋、分离和精神病的综述。该证据与提出的因果假设一致，并提出了概念和测量问题，例如需要澄清不同不安全依恋风格的相对贡献，以及利用行为/观察措施来加强研究设计。最重要的是，我们需要进行实验和纵向研究来确认因果关系和治疗靶点。
