The specific role of insecure attachment in paranoid delusions

Psychosis is a heterogeneous phenomenon, and it therefore seems unlikely that all of its symptoms will be accountable for by the same underlying psychological mechanisms. We argue that as early attachment relationships provide the foundation for the development of interpersonal trust, it seems plausible that insecure attachment will play a particularly important role in paranoid symptoms (delusions of persecution), which are one of the most common positive symptoms of psychosis. We describe a series of studies that have shown that: (a) attachment-threatening early life experiences such as being raised in a children's home are particularly associated with paranoia in population and samples diagnosed with mental health problems; (b) that paranoid beliefs in healthy individuals, and in people with psychosis, are associated with insecure attachment styles; and (c) that reported attachment insecurity fluctuates over time so that, in people with psychosis, increases in attachment insecurity precede increases in paranoid ideation. We argue that the relationship between insecure attachment and paranoia appears to be mediated by low self-esteem. Importantly, similar mechanisms do not seem to be implicated in auditory-verbal hallucinations, the other main positive symptom of psychosis.