The Associations between Attachment, Adverse Childhood Experiences and Re-Victimization in Patients with a Psychosis Spectrum Disorder

Abstract

Background: As attachment and trauma have been shown to be potential determinants of psychotic dysregulation and of recovery from psychosis, it is essential to better understand the associations between attachment, adverse childhood experiences (ACE) and re- victimization in patients with a psychosis spectrum disorder. Aims: To examine whether the occurrence and severity of ACE and re-victimization are differently associated with the various attachment categories (secure, dismissive, preoccupied and fearful-avoidant) within a population of patients with a psychosis spectrum disorder. Method: In this explorative study in a sample of 273 patients with psychotic disorder, we described the prevalence and severity of ACE and re-victimization and their associations with the four attachment styles in question (secure, dismissive, preoccupied and fearful- avoidant or disorganized). Results: The highest ACE frequencies were found for emotional abuse (36.6%), emotional neglect (36.6%) and domestic violence (32.6%). As well as emotional and physical abuse, emotional and physical neglect were noticeably more frequent in all the insecure attachment classes than in the secure attachment class. Household substance abuse was high in the fearful-avoidant attachment class and parental divorce in the dismissive and fearful- avoidant attachment classes. Re-victimization occurred in 64.5% of the total sample, with a repeatfrequency of 91.6% in the severe ACE class. The fearful-avoidant attachment style was very frequent (33.3%) in the severe re- victimization class. Conclusion: Attachment functioning, interpersonal childhood trauma and re-victimization all deserve greater recognition in populations with a psychosis spectrum disorder. If their associations are well understood, future treatment might be improved.