The revised Psychosis Attachment Measure: Measuring disorganized attachment.

Catherine Pollard,Katherine Berry,Angus Macbeth,Sandra Bucci

doi:10.1111/bjc.12249

Abstract

ObjectivesThe Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample.MethodsClinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment.ResultsAn exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs.ConclusionsThese results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed.Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity.These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis.Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis.Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.

Highlights

Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the Psychosis Attachment Measure (PAM)
Test–retest reliability was completed at Time 2 (T2) by 52 participants within an average time frame of 16.1 days (SD = 3.59)
A large positive correlation was shown between the new disorganized subscale and frequency of positive symptoms of psychosis, and a moderate positive correlation with distress associated with positive symptoms of psychosis, as measured by the Community Assessment Psychic Experiences – 42 (CAPE)-42 positive symptoms subscale. These findings demonstrate a link between positive symptoms and disorganized attachment, in line with reports in the literature that disorganized attachment is over-represented in people experiencing psychosis and recent research conducted by Bucci et al (2017), who identified that disorganized attachment is significantly associated with positive symptoms of psychosis

Summary

Objectives

The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. Confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed

Methods

Results

Discussion

Conclusion