How Attachment Styles Influence Emotional Distress and Psychiatric Symptoms Among Individuals With Schizophrenia: A Cross-Sectional Nursing Survey.

Abstract

Introduction: Insecure attachment styles among people with schizophrenia may exacerbate psychiatric symptoms and emotional distress, complicating recovery.

Objectives: This study aimed to assess attachment styles among individuals with schizophrenia and explore their relationship to symptomatology and emotional distress.

Methods: A cross-sectional descriptive correlational design was employed, involving 220 patients diagnosed with schizophrenia. Participants were assessed using the Psychosis Attachment Measure (PAM) to determine attachment styles, the Robertson Emotional Distress Scale (REDS) to evaluate emotional distress, and the Positive and Negative Syndrome Scale (PANSS) to assess psychiatric symptoms.

Results: The study found that 72.5% of participants exhibited high levels of avoidant attachment, while 61.7% displayed significant anxious attachment tendencies. Emotional distress was prevalent, with a mean REDS score of 43.48 ± 3.54, indicating high emotional distress levels. Positive correlations were identified between emotional distress and both avoidant (r = .378, p = .008) and anxious attachment (r = .644, p < .01). Additionally, psychiatric symptoms correlated positively with avoidant (r = .434, p = .018) and anxious attachment (r = .474, p < .01). Multiple regression analysis indicated that anxious attachment was a stronger predictor of psychiatric symptoms (B = 0.72, p < .001) and emotional distress (B = 0.82, p < .001) compared to avoidant attachment.

Conclusion: This study highlights the relationship between attachment styles, emotional distress, and psychiatric symptoms in schizophrenia. Participants exhibited avoidant and anxious attachment, linked to heightened emotional distress and severe symptoms. Avoidant attachment was characterized by emotional withdrawal and self-reliance, while anxious attachment involved dependency and relational anxiety. These insecure patterns predicted the severity of psychiatric symptoms, emotional distress, and anxious attachment. The findings emphasize the importance of addressing attachment dynamics in therapeutic nursing for schizophrenia, as these factors may worsen symptoms and emotional challenges. Using attachment-focused approaches can enable mental health nurses to better support symptom management and enhance well-being.