An attachment perspective on high risk for psychosis: clinical correlates and psychosis’ predictive value of attachment patterns and mentalization

Introduction: Identifying people at clinical high-risk (CHR) for psychosis facilitates the development of intervention strategies aimed to prevent the onset of a full-blown psychosis. There is evidence linking attachment adversity and poor mentalization to the risk for developing psychosis. Objectives: In this study we aimed at: (1) investigating attachment patterns in a clinical sample of adolescent/young adult help-seekers and comparing the distribution of attachment patterns in CHR vs non-CHR subjects; (2) exploring the association between reflective functioning and subclinical psychotic symptoms; and (3) longitudinally examining the predictivity of attachment patterns, reflective functioning, and the interaction between them, with respect to transition to psychosis. Methods: 57 CHR outpatients were compared with 53 other outpatients who did not meet the high-risk criteria. A multimethod diagnostic assessment was implemented, including the Structured Interview for Prodromal Syndromes (SIPS). Adult Attachment Interview was also administered, and the transcripts were further assessed using the Reflective Functioning (RF) Scale. Participants were followed-up over a mean period of 14 months. Results: CHR status was negatively associated to secure attachment patterns and positively associated to dismissing attachment patterns (χ2= 6.98, p = 0.03). The RF scores were significantly lower in the CHR sample (t=3.99; p<.001) and significant correlations between RF and SIPS subscales were found. Moreover, we found a significant effect of RF on the probability of transit in psychosis (β=.75, p=.03; OR=.473, 95% CI: .242, .924). Conclusions: Our results suggest that attachment-informed and mentalization-based psychotherapies may be effective preventive treatments for CHR patients