An attachment perspective on the risk for psychosis: Clinical correlates and the predictive value of attachment patterns and mentalization

Tommaso Boldrini, Maria Pontillo, Annalisa Tanzilli, Guido Giovanardi, Giuseppe Di Cicilia, Silvia Salcuni, Stefano Vicari, Vittorio Lingiardi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In a longitudinal design, the present study examined: (a) the nature of attachment patterns and reflective functioning (RF) in individuals at ultra-high risk for psychosis (UHR); (b) the association between RF and subclinical psychotic symtoms; and (c) the psychosis-predictive value of attachment patterns, RF, and the interaction between these factors. Method: The sample comprised 57 UHR subjects and 53 clinical controls (non-UHR). UHR subjects were followed over a mean period of 14 months (SD = 2.7; range 11–19), during which time 11.5% developed psychosis. Attachment patterns and RF were measured. Hierarchical logistic regression was used to examine the predictive value of variables in the transition to psychosis. Results: At baseline, significant differences were found between groups in secure attachment patterns and RF. RF was negatively associated with the attenuated psychotic symptoms described by the Unusual Thought Content/Delusional Ideas, Suspiciousness/Persecutory Ideas, and Disorganized Communication subscales. Moreover, poor mentalization was related to an increased likelihood of developing a psychotic disorder (OR = 0.427, 95% CI [0.188, 0.970]); conversely, no predictive effects of the attachment variables and their interaction with RF on the transition to psychosis were found. Notably, an optimal threshold value of RF = 1.25 was found to distinguish UHR subjects who made the transition to psychosis from those who did not develop this pathology. Conclusion: The results suggest that aberrant mentalizing patterns can predict the development of psychosis. Clinical implications of these results for the development of preventive treatments are discussed.

Original languageEnglish
Pages (from-to)209-217
Number of pages9
JournalSchizophrenia Research
Volume222
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Attachment patterns
  • Attenuated psychotic symptoms
  • Attenuated psychotic syndrome
  • Mentalization
  • Reflective functioning
  • Ultra-high risk for psychosis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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