LAUSR

Abstract Background Research in both clinical and early psychosis samples is increasingly indicating that insecure attachment styles impact on psychosis symptom expression. Moreover, empirical support has been found for the assumption that specific types of insecure attachment predispose individuals to develop different symptom profiles. This study aimed to increase our understanding of the relevance of attachment styles in an early psychosis sample. To this end, we first examined the relationship of attachment styles with the severity of positive, negative and general symptom dimensions. Secondly, associations between attachment styles and specific positive psychotic symptoms were explored. Methods A total of 96 (60 At-Risk Mental State and 36 First Episode Psychosis) patients participated in the study. Patients’ attachment style was assessed by the Psychosis Attachment Measure (PAM) and the Relationship Questionnaire (RQ). The PAM was used to evaluate attachment dimensions (i.e., anxiety and avoidance), whereas RQ was employed to classify participants into an attachment prototypes (i.e., secure, fearful, preoccupied or dismissive). In addition, patients were administered the Positive and Negative Syndromes Scale. Correlation analyses examined the associations of patients’ attachment dimensions and patients’ attachment prototypes with symptom dimensions (positive, negative and general psychopathology) and specific positive psychotic symptoms (delusions, conceptual disorganization, hallucinations, excitement, grandiosity, paranoia and hostility). Results Patients’ attachment anxiety was associated with positive symptoms and general psychopathology, whereas no associations were found between attachment avoidance and symptom dimensions. Moreover, only attachment anxiety was related with specific positive symptoms, such as hallucinations and paranoia. Regarding the associations between attachment prototypes and symptom dimensions, only secure attachment was significantly related to decreased levels of general symptoms. Besides, secure attachment was associated with decreased levels of paranoia, whereas fearful attachment was related with increased levels of paranoid symptoms. No significant relationships were observed between dismissing and preoccupied attachment with specific positive symptoms. Discussion These findings highlight the potential role of secure attachment as a protective factor against poor clinical outcomes and are consistent with previous studies indicating that secure attachment confers a form of resilience for psychopathology. In contrast, attachment anxiety and fearful attachment might represent risk factors for general and positive symptoms. The fact that neither attachment dimensions nor attachment prototypes were associated with the negative symptom dimension seems to confirm previous findings and might suggest that the association of attachment with psychotic symptoms is more robust for the positive dimension. These findings highlight the need of tailoring interventions to patients’ attachment needs. This would include assessing patients’ attachment patterns, as the specific subtypes of insecure attachment style should provide guidance in the context of psychological formulation and treatment planning with early psychosis patients.