Paranoia and attachment

The delusional beliefs of people with psychosis reflect disruption of fundamental needs that are characteristic of our species. In the case of paranoid (persecutory) delusions, this disruption is to the need to affiliate with... [ view full abstract ]

The delusional beliefs of people with psychosis reflect disruption of fundamental needs that are characteristic of our species. In the case of paranoid (persecutory) delusions, this disruption is to the need to affiliate with others, leading to low self-esteem and distrust of others. Using taxometric methods on data from 2874 participants, including the general population as well as at- risk mental state and psychotic patients, we have confirmed previous findings that these beliefs exist on a continuum with sub-clinical forms of paranoia that are part of normal human experience

Our epidemiological work using data from the 1990 US National Comorbidity Survey, the 2007 Adult Psychiatric Morbidity Survey, and the UK Survey of Psychiatric Morbidity among Prisoners in England and Wales has shown that paranoia in adulthood is associated with attachment-disrupting early life experiences (neglect; being raised in an institution). In student samples, patient samples and also in the US NCS study, we have also found that paranoia is associated with insecure attachment styles. Importantly, the same associations were not evident in the case of hallucinations.
In a recent study we have used the Experience Sampling Method to study fluctuations in attachment-related thoughts in patients and non-patient controls. Attachment-related thoughts were much more unstable in the patients, and predicted exacerbations of paranoia but not hallucinations. Together the evidence strongly suggests that disrupted attachment processes play a specific role in paranoia. Implications for clinical intervention will be discussed.