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Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature

Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature
Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature
Purpose: 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.

Methods: we searched five databases (PubMeD, Web of Science, PsycINFO, CINAHL and ETHOS) for published and unpublished research examining attachment, dissociation and psychosis.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.

Results: 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.

Conclusions: 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.
attachment, auditory hallucinations, dissociation, paranoia, psychosis, systematic review, voice hearing
1476-0835
372-392
Puckett, Joseph Francis
e91599d3-266e-4263-bb67-b977e06cccd8
Sood, Monica
185fb97e-a111-45e1-bbe8-d865d301ef9f
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
Puckett, Joseph Francis
e91599d3-266e-4263-bb67-b977e06cccd8
Sood, Monica
185fb97e-a111-45e1-bbe8-d865d301ef9f
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7

Puckett, Joseph Francis, Sood, Monica and Newman-Taylor, Katherine (2024) Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature. Psychology and Psychotherapy: Theory, Research and Practice, 97 (2), 372-392. (doi:10.1111/papt.12521).

Record type: Article

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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More information

e-pub ahead of print date: 15 February 2024
Published date: June 2024
Additional Information: Publisher Copyright: © 2024 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.
Keywords: attachment, auditory hallucinations, dissociation, paranoia, psychosis, systematic review, voice hearing

Identifiers

Local EPrints ID: 487395
URI: http://eprints.soton.ac.uk/id/eprint/487395
ISSN: 1476-0835
PURE UUID: 64045008-8dc6-4140-a9a4-ac127f5a5838
ORCID for Monica Sood: ORCID iD orcid.org/0000-0003-3242-7925
ORCID for Katherine Newman-Taylor: ORCID iD orcid.org/0000-0003-1579-7959

Catalogue record

Date deposited: 20 Feb 2024 12:41
Last modified: 14 Dec 2024 03:10

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Contributors

Author: Joseph Francis Puckett
Author: Monica Sood ORCID iD

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