Attachment in schizophrenia: Relationship with theory of mind, social functionality and childhood trauvma

Objective: According to current opinion, schizophrenia is thought to be caused by environmental and genetic factors together. Environmental factors include early traumatic life events, urbanization, cannabinoid use, and social isolation, which are thought to affect social brain development. It is not clear how these situations affect each other. Our aim is to assess the relationship between the subtypes of insecure attachment and its severity, the theory of mind, childhood trauma, and psychosocial functioning in schizophrenia patients. Method: Forty-five patients with schizophrenia diagnosis according to DSM-IV diagnostic criteria and 45 healthy controls were included in the study. All participants were asked to use the Psychosis Attachment Scale, the Dokuz Eylul Theory of Mind Scale (DEZTÖ) to measure their mental function, the Childhood Trauma Scale to measure past traumatic experiences, and the Personal and Social Performance Scale (PSP) in order to evaluate their regular functionality. The Positive and Negative Symptom Scale (PANSS) and the Calgary Depression Scale were used to assess the clinical status of the patients. Findings: When the patients and control groups were compared, there was a statistically significant difference between the two groups in terms of anxious and avoidant attachment severity, all subscales of the theory of mind and all childhood trauma types except sexual abuse and physical neglect. When the schizophrenic patients were evaluated within their own groups, a negative correlation was found between the severity of attachment problems and the total metaphor subscale scores of DEZTÖ. There was a moderate correlation between the mean total scores of psychotic attachment scale and the total scores of childhood trauma scale; however a strong relation with emotional neglect type was found. Attachment severity and PANSS subscales' suspicion and hostile items were found to be related. When the linear regression analysis performed, anxious attachment and theory of mind in schizophrenic patients were not found to have been significantly affected by the severity of childhood trauma. There was also a relationship between the severity of anxious and avoidant attachment and the severity of psychosocial functioning. Conclusion: In our study, it was determined that the severity of anxious and avoidant attachment in schizophrenic patients was high, the scale scores of the theory of mind were low and childhood traumas were frequent. In patients with schizophrenia with a high degree of anxious attachment, the scores of suspicion and hostile items were high. These findings will help us to investigate the etiology of schizophrenia and to understand the factors that affect the severity of the disease Key words: Schizophrenia, Attachment Theory, Theory of Mind, Childhood Traumas, Psychosocial Functioning