Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences

Abstract

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.

The relationship between insecure attachment and paranoia in psychosis: A systematic literature review

“…Five different measures of attachment were used across the 12 studies. Six studies (Korver‐Nieberg et al ., ; Pearce et al ., ; Ponizovsky et al ., ; Sitko, Varese, Sellwood, Hammond, & Bentall, ; Strand, Goulding, & Tidefors, ; Wickham et al ., ) used The Relationship Questionnaire (RQ: Bartholomew & Horowitz, ) to measure attachment subtypes (secure, dismissing, pre‐occupied, fearful). Two studies (Korver‐Nieberg et al ., ; Wickham et al ., ) created superordinate attachment anxiety and avoidance dimensions by yielding scores from the four RQ subtypes.…”

“…Two studies were rated as strong (Sitko et al ., ; Wickham et al ., ) as these controlled for several relevant confounders. Three studies received a moderate rating (Berry et al ., ; Pearce et al ., ; Ponizovsky et al ., ) as confounders had been controlled for in one or two relevant analyses, but not all. Notably, only two studies used additional clinician measures to corroborate self‐report attachment (Berry et al ., ) and self‐report paranoia (Dozier & Lee, ), enabling some assessment of social desirability bias.…”

“…Of the three studies that explored specific associations between paranoia and fearful attachment, two reported positive associations (Pearce et al ., ; Ponizovsky et al ., ). Ponizovsky et al .…”

Childhood memories of threatening experiences and submissiveness and its relationship to hallucination proneness and ideas of reference: The mediating role of dissociation

“…Finally, we also found full mediation of general dissociation, and specifically, of absorption and depersonalization, between the memories of these threatening and submissiveness experiences and hallucination proneness. Previous studies have also found that dissociation generally mediates between traumatic interpersonal experiences, more specifically, sexual abuse, and hallucinations in subjects with psychiatric pathology (Pearce, Simpson, Berry, Bucci, Moskowitz & Varese, ; Varese, Barkus & Bentall, ) and in subjects with no psychiatric pathology (Gómez & Freyd, ). Our results are coherent with those found by Perona‐Garcelán et al .…”

Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder

“…The latter finding stands in contrast to the well‐established relationship between childhood adversity and the severity of hallucinations in people with psychotic disorders (Bailey et al, ). Similarly, dissociative experiences have been strongly related to voice hearing in psychotic disorders, and might be a mediating factor in the relationship between trauma and hallucinations in this group (Pearce et al, ; Pilton, Varese, Berry, & Bucci, ). However, in a study of 23 adults with BPD, no association was reported between dissociation and psychotic symptoms in general, or between dissociation and hallucinations (Tschoeke et al, ).…”