Anxious and avoidant attachment styles and indicators of recovery in schizophrenia: Associations with self-esteem and hope

Objectives Having an insecure attachment style in schizophrenia has been linked to treatment response and symptom severity in schizophrenia. This study sought to further examine whether attachment style is related to subjective indicators of recovery including hope and self-esteem, independent of symptom level and secondly, whether attachment style in schizophrenia differs from attachment style of persons facing adversity in the form of a prolonged non-psychiatric medical illness. Design Participants were 52 men with schizophrenia, and 26 with HIV/AIDS who had no history of experiencing severe mental illness. These groups were compared in terms of their endorsement of attachment style. Methods All participants were administered the Experiences in Close Relationships measure of adult attachment style. The schizophrenia group was also given the Rosenberg Self-Esteem Scale to assess self-esteem, the Beck Hopelessness Scale as a measure of hope, and the Positive and Negative Syndrome Scale, as an assessment of symptoms. Results Avoidant attachment in the schizophrenia group was linked with higher levels of hopelessness while anxious attachment was linked to lower levels of self-esteem. The association between anxious attachment and self-esteem persisted after controlling for severity of positive, negative, and depressive symptoms in a stepwise multiple regression analyses. Compared to the HIV/AIDS group, participants with schizophrenia had significantly higher levels of anxious attachment but not avoidant attachment style. Conclusions Attachment style may impact attainment of key subjective domains of recovery in schizophrenia such as self-esteem, independent of symptom severity. Practitioner points If self-esteem and/or hopelessness are identified as a focus of treatment, focusing on attachment style may be an important treatment component. Therapist understanding of patients' attachment style may allow for a better understanding of resistance in the therapeutic relationship. Helping persons with schizophrenia to recognize and change how they tend to relate to others may promote gains in subjective elements of recovery.