Attachment in Schizophrenia: Its Associations with Theory of Mind, Childhood Trauma and Psychosocial Functioning

Schizophrenia is a chronic psychiatric disorder that arises from the interaction of biopsychosocial factors. Both the disorder itself and psychosocial variables, such as attachment styles and childhood trauma have been associated with impairments in mentalization processes observed in schizophrenia. This study aimed to assess attachment styles in individuals with schizophrenia and explore the associations between insecure attachment, theory of mind, childhood trauma and psychosocial functioning.

The study included 45 patients with schizophrenia and 45 healthy controls. Assessments included the Psychosis Attachment Measure (PAM), Dokuz Eylül Theory of Mind Index (DEZİKÖ), Childhood Trauma Questionnaire (CTQ) and Personal and Social Performance Scale (PSP). Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale (CDS) were also administered to patients.

Patients with schizophrenia exhibited significantly higher levels of childhood trauma and insecure attachment alongside impaired theory of mind and poorer psychosocial functioning compared to controls. In the schizophrenia group, insecure attachment correlated with greater symptom severity, higher trauma burden and lower functioning. A moderate negative correlation was found between insecure attachment and theory of mind. However, childhood trauma did not significantly mediate the relationship between insecure attachment and theory of mind performance.

In individuals with schizophrenia, insecure attachment styles are prevalent and are associated with greater symptom severity and poorer psychosocial functioning. Anxious attachment was found to be associated with reduced theory of mind performance; however, no evidence supporting a mediating role of childhood trauma in this relationship was obtained.