The role of trauma, attachment, dissociation, and alexithymia in pathways to negative symptoms in psychosis

Objectives

Emerging models of trauma and psychosis highlight the role of attachment, dissociation, and emotion regulation processes in pathways to positive symptoms, yet little is known about the relevance of these processes to negative symptoms. The primary aim of this study was to examine trauma, attachment, dissociation, and alexithymia as predictors of negative symptoms in psychosis. A secondary, exploratory aim was to delineate pathways by which trauma may lead to negative symptoms (via attachment, dissociative or alexithymic processes).

Method

This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, negative symptoms, attachment, alexithymia, dissociation, and depression were completed.

Results

Regression analyses indicated that recurrent trauma, disorganized attachment, difficulty identifying feelings (DIF), and depression accounted for a significant portion of the variance in negative symptoms, though only DIF and depression were significant independent predictors. Subsequent serial mediation analyses indicated that recurrent trauma exerted its influence on negative symptoms through a sequence of disorganized attachment and DIF, while controlling for depression. As avoidant attachment was not associated with trauma and dissociation was not associated with total negative symptoms, hypothesized models related to these variables were not examined.

Conclusions

These exploratory findings highlight the relevance of trauma-related variables in our formulation and treatment of negative symptoms. Future research should focus on replication studies with larger clinical samples and longitudinal designs to establish causality.