Attachment Style and Reality-Testing Impairment Among Patients with Schizophrenia: A Descriptive Correlational Study

Abstract

Background: Insecure attachment styles are an area of research that is currently receiving much attention because it has an important role in developing many psychological disorders and might have an effect on an individual's perception of his outer reality. In this respect, assessment of attachment styles among patients with schizophrenia can be informative in indicating how well the patients perceive their reality accurately. Aim: This study aimed to determine the attachment style and reality testing impairment among patients with schizophrenia. As well, investigate the relationship between them among those patients. Setting: This study was conducted at El-Maamoura hospital for Psychiatric Medicine in Alexandria. Subjects: A representative sample of 200 randomly recruited patients with schizophrenia were the subjects of the present study. Tools: A Socio-Demographic and Clinical Data Sheet, Bell Reality Testing Inventory (BRTI), and The Psychosis Attachment Measure (PAM). Results: The study showed that 54.5% of the studied patients exhibited an avoidant attachment style and the patients who exhibited an anxious attachment style constitute 40%. Moreover, 60% of the studied patients had a moderate level of reality-testing impairment and 36.5% had severe impairment. A statistically significant positive correlation between psychotic attachment styles and reality-testing impairment was found (r=0.394, p=0.000). More specifically, there was a statistically significant positive correlation between the avoidant attachment style and the three domains of reality-testing impairment as well as the total scores (r= 0.577, 0.179, 0.278, 0.501 respectively, were p=0.000). Meanwhile, a statistically significant positive correlation between the anxious attachment style was found only with the Hallucinations & Delusions domain of reality-testing impairment (r =0.291, p=0.000). Conclusion: It can be concluded that almost all patients with schizophrenia exhibit insecure attachment styles, with avoidant attachment style being the most prevalent, usually at a severe level in the majority of cases. On the other hand, the great majority of these same patients present with reality-testing impairment reflected in its three domains: reality distortion, the uncertainty of perception, and hallucinations & delusions. Evidence of a correlation between attachment styles and reality testing impairment, (both of the total and sub total domains) in these patients usually and frequently there. Recommendations: Building up a secure, structured, and consistent environment for patients with schizophrenia to modify their insecure attachment styles and hope to become more reality-oriented.