How does attachment affect help-seeking in people with paranoia and psychosis? The role of emotion regulation,...

Longer duration of untreated psychosis causes significant human and healthcare costs. Attachment avoidance and anxiety contribute to delays in help-seeking and help-acceptance in individuals with both non-clinical and clinical paranoia, though underlying mechanisms remain unclear. The aim of the study was to examine how attachment affects help-seeking and help-acceptance in people with paranoia. We recruited a non-clinical sample with paranoia (N = 501) and a clinical psychosis sample (N = 120), and found that attachment avoidance predicted reduced help-seeking and help-acceptance intentions in both groups, while attachment anxiety predicted lower social help-seeking in the clinical group. Emotion regulation did not mediate associations between attachment and help-seeking/acceptance. Self-stigma regarding help-seeking and mental illness mediated these associations in both groups, while perceived availability of help mediated the link between avoidance and help-seeking/acceptance in the non-clinical group. This is the first study to show that self-stigma and perceived help availability delay help-seeking in paranoia. Further research should investigate causal effects of attachment on self-stigma and perceived support, and so help-seeking.