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Title: Paranoia in an attachment theory framework
Author: Sitko, Katarzyna
ISNI:       0000 0004 6058 452X
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2015
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Over the past decade evidence has consistently shown a relationship between adverse experiences in childhood and psychosis in adulthood. Recently, specific associations between attachment-disrupting life experiences and paranoia have been reported, leading to attempts to understand the psychological mechanisms involved in this association, and how these might interact with mechanisms previously found to be important in psychotic experiences. The three empirical studies included in this doctoral thesis used cross-sectional and longitudinal designs to examine whether experiences of paranoia could be understood within an attachment theory framework. Using an epidemiological dataset the study in Chapter 2 examined the effect of adverse childhood experiences on psychotic symptoms in adulthood. The findings demonstrated that, when co-occurring symptoms were controlled for, experiences of neglect were specifically associated with paranoia, while experiences of sexual abuse (rape, sexual molestation) were specifically associated with hallucinations. Furthermore, the association between neglect and paranoia was fully mediated by insecure attachment, but a similar association was not observed for the association between sexual abuse and hallucinations. The study in Chapter 3 used both a clinical and a control sample to examine the effect of insecure attachment-related thoughts on psychotic symptoms using a longitudinal design. The main finding revealed that, in the flow of daily life, elevated levels of attachment insecurity predicted subsequent paranoia. This effect was not observed for hallucinations, nor could it be explained through low self-esteem, which in previous studies, has been observed to precede increased levels of paranoia. The final study in Chapter 4 used a clinical sample to examine whether the association between insecure attachment (avoidant and anxious attachment dimensions) and paranoia was moderated by dissociation. The findings demonstrated that dissociation moderated the association between the anxious attachment dimension (increased negative view of the self) and paranoia. Conditional effects further showed that, at low levels of dissociation, the association between the anxious attachment dimension and paranoia was present, but that, at medium and high levels of dissociation the association did not exist. A similar effect was not observed for the avoidant attachment dimension (increased negative view of others). Findings from these studies suggest that adverse experiences in childhood, especially experiences of neglect, may be a risk factor for developing paranoia. Furthermore, this association, and experiences of paranoia in the flow of daily life can be understood within an attachment framework. Finally, the findings show that increased levels of dissociation can dampen the association between insecure attachment and paranoia. Overall these findings suggest that secure attachment may be associated with lower risk for paranoia. This has implications for clinical work, as therapists may focus their psychological interventions on addressing attachment beliefs and work towards establishing a sense of attachment security by strengthening positive beliefs and disconfirming negative beliefs about the self and others. As psychotic symptoms can co-occur, it is also important to assess how psychological mechanisms interact in their effect on specific symptoms. Finally, these findings suggest that policies that promote optimal child-caregiver relationships may enhance population mental health.
Supervisor: Bentall, R. ; Sellwood, W. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral