Attachment patterns, mentalization and childhood traumatic experiences in a sample of adolescence at ultra high risk for psychosis

The ultra-high risk (UHR) criteria were defined to identify young people at high and imminent risk of developing a first episode of psychosis. Identifying UHR individuals presents the opportunity for preventing the onset of a full psychotic disorder, or at least the possibility of reducing patient’s disability. The link between insecure attachment and the risk for developing psychosis has been explained by the alterations of specific neurobiological pathways. Some studies also underlined the role of mentalization processes in moderating the risk of transition to psychotic disorders. Nevertheless, to date, attachment and mentalization in UHR population have not been studied using “golden standard” measures. The aim of this study was to explore the quality of attachment representations, mentalization capacity and childhood traumatic experiences among UHR adolescence outpatients. 21 UHR adolescent outpatients were compared with 33 other who did not meet the ultra-high risk criteria. Each patient was evaluated with M.I.N.I., Childhood Trauma Questionnaire, Structured Interview for Prodromal Syndromes (SIPS) and Scale for Prodromal Symptoms (SOPS). During the first month of treatment the Adult Attachment Interview was also administered, and the AAI transcripts were assessed by the RF Scale. Although no differences between groups with respect to self-reported childhood traumatic experiences have been found, UHR patients showed a higher degree of “Unresolved” and “Cannot Classify” attachment patterns. Moreover, the RF scores were significantly lower in the UHR sample and significant negative correlations between RF and two SOPS’ subscales, “Suspiciousness/Persecutory Ideas” and “Expression of Emotion” were found. Our results underline the importance of taking both disorganized attachment and mentalization impairment into consideration when treating psychotic prodromal symptomatology.