Social support and attachment in persons diagnosed with psychotic spectrum disorders

Philipp Stang, Martin Köllner, Maren Weiss

Abstract


Introduction: Individuals with diagnosed psychotic spectrum disorders often suffer from impaired social functioning and related additional adverse effects on an interpersonal relationship level, like a smaller social network or less social support compared to unaffected persons. This means additional negative psychological effects in an already challenging situation.


Materials and methods: Individuals with a diagnosed psychotic spectrum disorder (n = 24) were compared to a healthy adult control group (n = 145) on the German versions of the Interpersonal Relationships and Attachment Personality Inventory (Beziehungs- und Bindungs-Persönlichkeitsinventar; BB-PI; Andresen, 2012) and the Questionnaire on Social Support (Fragebogen zur sozialen Unterstützung; F-SozU; Fydrich et al., 2007).


Results: The clinical sample had a higher self-reported need for attachment, higher relationship insecurity, but also a higher trust in their attractiveness and ability to seduce other individuals. In addition, after correcting for age, affected individuals reported less social support on all sub-scales with the exception of the scales Social Integration and Satisfaction with Social Support. In additional analyses, among other results, protective effects of being in a dyadic romantic relationship emerged.


Conclusion: It is concluded that a diagnosed psychotic spectrum disorder goes along with specific interpersonal relationship styles and reduced social support. Social aspects should be an essential part of a successful therapeutic concept.


Keywords


Interpersonal relationships; Psychotic spectrum disorders; Relationship styles; Schizophrenia; Social support.

Full Text:

PDF

References


Abdallah, C., Cohen, C. I., Sanchez-Almira, M., Reyes, P. & Ramirez, P. (2009). Community integration and associated factors among older adults with schizophrenia. Psychiatric services (Washington, D.C.), 60(12), 1642–1648. https://doi.org/10.1176/ps.2009.60.12.1642

Afe, T. O., Emedoh, T. C., Ogunsemi, O. & Adegbohun, A. A. (2016). Intimate partner violence, psychopathology and the women with schizophrenia in an outpatient clinic South-South, Nigeria. BMC psychiatry, 16, 197. https://doi.org/10.1186/s12888-016-0898-2

Ainsworth, M. D., Blehar, M. c., Waters, E. & Wall, S. N. (2015). Patterns of attachment: A psychological study of the strange [Interpersonal Relationships and Attachment Personality Inventory]. Psychology Press.

Andresen, B. (2012). BB-PI. Beziehungs- und Bindungs-Persönlichkeitsinventar: Manual. Hogrefe.

Augustin, V., Haas, K. & Egger, J. W. (2011). Liebe und Sexualität bei PsychotikerInnen. Psychologische und sozialpsychiatrische Aspekte im sexuellen und partnerschaftlichen Erleben und Verhalten von PatientInnen mit psychotischen Erkrankungen [Love and sexuality in psychotics - Psychological and socio-psychiatric aspects in the sexual and partner experiences and behavior of patients with psychotic illnesses]. Psychologische Medizin, 22(1), 21–30.

Baer, N. & Fasel, T. (2009). "Sie wäre so begabt". Die Arbeitssituation von Menschen nach Psychosen [“She would be so talented.” The working situation of people after psychoses.]. Familiendynamik, 34(4), 346–359.

Bailer, M. & Hautzinger, M. (1993). Psychosenrisiko und Sozialverhalten: Soziale Kompetenz und soziale Kontakte bei jungen Erwachsenen mit schizotypischen bzw. zyklothymen Merkmalen [Risk of psychosis and social behavior: Social competence and social contacts in young adults with schizotypal or cyclothymic features.]. Zeitschrift für Klinische Psychologie, 22(4), 406–419.

Bengtsson-Tops, A. & Hansson, L. (2001). Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. The International journal of social psychiatry, 47(3), 67–77. https://doi.org/10.1177/002076400104700307

Bowlby, J. A. (1969). Attachment and Loss. Basic Books.

Bowlby, J. A. (1988). Secure base: clinical applications of attachment theory. Routledge.

Bowlby, J. A. (2008). Attachment: Attachment and Loss Trilogy. Basic Books.

Chatziioannidis, S., Andreou, C., Agorastos, A., Kaprinis, S., Malliaris, Y., Garyfallos, G. & Bozikas, V. P. (2019). The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis. Psychiatry research, 276, 223–231. https://doi.org/10.1016/j.psychres.2019.05.021

França, G., Laranjeira, E., Silva, F., Monteiro, L., Moreira, A. M. & Carvalho, S. (2020). Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. The Psychiatric quarterly, 91(1), 31–43. https://doi.org/10.1007/s11126-019-09675-8

Fydrich, T., Sommer, G. & Brähler, E. (2007). F-SozU. Fragebogen zur Sozialen Unterstützung: Manual [Questionnaire on Social Support]. Hogrefe.

Gemeinsame Ethikkommission der Hochschulen Bayerns. (2022). Unterlage zur Selbsteinschätzung "Ethik und Datenschutz" [Self-assessment document “Ethics and data protection”.]. https://www.gehba.de/fileadmin/daten/Gehba/GEHBa-Selbsteinschaetzung_2.2.docx

Gizdic, A., Hinojosa-Marqués, L., Kwapil, T. R. & Barrantes Vidal, N. (2020). M113. The Relationship between attachment styles and clinical presentation in early psychosis patients. Schizophrenia Bulletin, 46(Supplement_1), S177-S178. https://doi.org/10.1093/schbul/sbaa030.425

Greenberg, J. S., Seltzer, M. M., Krauss, M. W., Chou, R. J.-A. & Hong, J. (2004). The effect of quality of the relationship between mothers and adult children with schizophrenia, autism, or down syndrome on maternal well-being: the mediating role of optimism. The American journal of orthopsychiatry, 74(1), 14–25. https://doi.org/10.1037/0002-9432.74.1.14

Grube, M. & Dorn, A. (2007). Elternschaft bei psychisch Kranken [Parenthood and mental illness]. Psychiatrische Praxis, 34(2), 66–71. https://doi.org/10.1055/s-2005-915394

Gumley, A. I., Taylor, H. E. F., Schwannauer, M. & MacBeth, A. (2014). A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta psychiatrica Scandinavica, 129(4), 257–274. https://doi.org/10.1111/acps.12172

Harley, E. W.-Y., Boardman, J. & Craig, T. (2012). Friendship in people with schizophrenia: a survey. Social psychiatry and psychiatric epidemiology, 47(8), 1291–1299. https://doi.org/10.1007/s00127-011-0437-x

Hell, D. & Fürer, M. (1987). Schizophrenieverlauf bei Ehekonstanz und Partnerverlust [Course of schizophrenia with marital stability and partner loss]. Sozial- und Praventivmedizin, 32(3), 154–156.

Herstell, S., Betz, L. T., Penzel, N., Chechelnizki, R., Filihagh, L., Antonucci, L. & Kambeitz, J. (2021). Insecure attachment as a transdiagnostic risk factor for major psychiatric conditions: A meta-analysis in bipolar disorder, depression and schizophrenia spectrum disorder. Journal of psychiatric research, 144, 190–201. https://doi.org/10.1016/j.jpsychires.2021.10.002

Hinz, A., Kuhn, J., Decker, O., Lenz, A. & Jungbauer, J. (2010). Lebenszufriedenheit und subjektive Relevanz von Lebensbereichen bei schizophren Erkrankten [Life satisfaction and subjective importance of life domains in schizophrenia patients: the role of partnership and parenthood]. Fortschritte der Neurologie-Psychiatrie, 78(3), 147–153. https://doi.org/10.1055/s-0028-1110026

Kilian, R., Lindenbach, I., Löbig, U., Uhle, M. & Angermeyer, M. C. (2001). Self-perceived social integration and the use of day centers of persons with severe and persistent schizophrenia living in the community: a qualitative analysis. Social psychiatry and psychiatric epidemiology, 36(11), 545–552. https://doi.org/10.1007/s001270170005

Korver-Nieberg, N., Berry, K., Meijer, C. J. & Haan, L. de (2014). Adult attachment and psychotic phenomenology in clinical and non-clinical samples: a systematic review. Psychology and psychotherapy, 87(2), 127–154. https://doi.org/10.1111/papt.12010

Kvrgic, S., Beck, E.-M., Cavelti, M., Kossowsky, J., Stieglitz, R.-D. & Vauth, R. (2012). Focusing on the adult attachment style in schizophrenia in community mental health centres: validation of the Psychosis Attachment Measure (PAM) in a German-speaking sample. The International journal of social psychiatry, 58(4), 362–373. https://doi.org/10.1177/0020764011399004

Maß, R. (2001). Eppendorfer Schizophrenie-Inventar.: Manual [Eppendorf Schizophrenia Inventory]. Hogrefe.

Mentzos, S. (2017). Lehrbuch der Psychodynamik: Die Funktion der Dysfunktionalität psychischer Störungen [Textbook of psychodynamics: The function of the dysfunctionality of mental disorders]. Vandenhoeck & Ruprecht.

Monfort-Escrig, C. & Pena-Garijo, J. (2021). Attachment Dimensions predict Social Functioning in persons with Schizophrenia-Spectrum Disorders, regardless of Symptom Severity. Actas espanolas de psiquiatria, 49(6), 269–281.

Müller, P., Gaebel, W., Bandelow, B., Köpcke, W., Linden, M., Müller-Spahn, F., Pietzcker, A. & Tegeler, J. (1998). Zur sozialen Situation schizophrener Patienten [On the social situation of schizophrenic patients]. Der Nervenarzt, 69(3), 204–209. https://doi.org/10.1007/s001150050261

Nyer, M., Kasckow, J., Fellows, I., Lawrence, E. C., Golshan, S., Solorzano, E. & Zisook, S. (2010). The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 22(3), 172–179.

Pearce, J., Simpson, J., Berry, K., Bucci, S., Moskowitz, A. & Varese, F. (2017). Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences. Clinical psychology & psychotherapy, 24(6), 1304–1312. https://doi.org/10.1002/cpp.2100

Ponizovsky, A. M., Nechamkin, Y. & Rosca, P. (2007). Attachment patterns are associated with symptomatology and course of schizophrenia in male inpatients. The American journal of orthopsychiatry, 77(2), 324–331. https://doi.org/10.1037/0002-9432.77.2.324

Sörgaard, K. W., Hansson, L., Heikkilä, J., Vinding, H. R., Bjarnason, O., Bengtsson-Tops, A., Merinder, L., Nilsson, L. L., Sandlund, M. & Middelboe, T. (2001). Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study. Social psychiatry and psychiatric epidemiology, 36(1), 13–19. https://doi.org/10.1007/s001270050285

Stain, H. J., Galletly, C. A., Clark, S., Wilson, J., Killen, E. A., Anthes, L., Campbell, L. E., Hanlon, M.-C. & Harvey, C. (2012). Understanding the social costs of psychosis: the experience of adults affected by psychosis identified within the second Australian National Survey of Psychosis. The Australian and New Zealand journal of psychiatry, 46(9), 879–889. https://doi.org/10.1177/0004867412449060

Stuart, H. & Arboleda-Flórez, J. (2001). Community attitudes toward people with schizophrenia. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 46(3), 245–252. https://doi.org/10.1177/070674370104600304

Stuke, F., Bröcker, A.-L., Bayer, S., Heinz, A., Bermpohl, F., Lempa, G., Haebler, D. von & Montag, C. (2020). Between a rock and a hard place: Associations between Mentzos' "dilemma", self-reported interpersonal problems, and psychosocial functioning in individuals with non-affective psychoses. Clinical psychology & psychotherapy, 27(4), 528–541. https://doi.org/10.1002/cpp.2437

Tasa-Vinyals, E., Álvarez, M.-J., Puigoriol-Juvanteny, E., Roura-Poch, P., García-Eslava, J. S. & Escoté-Llobet, S. (2020). Intimate Partner Violence Among Patients Diagnosed With Severe Mental Disorder. The Journal of nervous and mental disease, 208(10), 749–754. https://doi.org/10.1097/NMD.0000000000001207

Velthorst, E., Fett, A.-K. J., Reichenberg, A., Perlman, G., van Os, J., Bromet, E. J. & Kotov, R. (2017). The 20-Year Longitudinal Trajectories of Social Functioning in Individuals With Psychotic Disorders. The American journal of psychiatry, 174(11), 1075–1085. https://doi.org/10.1176/appi.ajp.2016.15111419

Wickham, S., Sitko, K. & Bentall, R. P. (2015). Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem. Psychological medicine, 45(7), 1495–1507. https://doi.org/10.1017/S0033291714002633

Wieland, M. E., Rosenstock, J., Kelsey, S. F., Ganguli, M. & Wisniewski, S. R. (2007). Distal support and community living among individuals diagnosed with schizophrenia and schizoaffective disorder. Psychiatry, 70(1), 1–11. https://doi.org/10.1521/psyc.2007.70.1.1

Wisman-van der Teen, A., Lemmers-Jansen, I. L. J., Oorschot, M. & Krabbendam, L. (2022). Exploring the association between social behaviour, trust, and its neural correlates in first episode psychosis patients and in individuals at clinical high risk for psychosis. The British journal of clinical psychology, 61(3), 629–646. https://doi.org/10.1111/bjc.12327

Won, Y.-L. I. & Solomon, P. L. (2002). Community integration of persons with psychiatric disabilities in supportive independent housing: a conceptual model and methodological considerations. Mental health services research, 4(1), 13–28. https://doi.org/10.1023/A:1014093008857

Xanthopoulou, P. D., Mbanu, J., Chevalier, A., Webber, M. & Giacco, D. (2022). Social Isolation and Psychosis: Perspectives from People with Psychosis, Family Caregivers and Mental Health Professionals. Community mental health journal, 58(7), 1338–1345. https://doi.org/10.1007/s10597-022-00941-x




DOI: https://doi.org/10.13129/2282-1619/mjcp-4055

Refbacks

  • There are currently no refbacks.