Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first-degree relatives and controls

Luis F. Varela, Katie H.T. Wong, Sukhi S. Shergill, Anne K.J. Fett

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Objectives: Theory of Mind (ToM) plays a role in social functioning and is impaired in patients with schizophrenia and to a lesser degree in first-degree relatives, compared to healthy controls. This study investigates whether attachment styles moderate these observed group differences in ToM. Methods: This cross-sectional study included a sample of 51 patients, 23 first-degree relatives, and 49 controls who completed assessments of anxious and avoidant attachment (Psychosis Attachment Measure), ToM (Reading the Mind in the Eyes Test), and estimated cognitive ability. Patients’ symptoms were assessed with the Positive and Negative Syndrome Scale. Results: Patients differed from controls and relatives in ToM performance but not in attachment avoidance or attachment anxiety. Attachment anxiety showed an interaction with group over ToM. The interaction was significant only between patients and controls but not between patients and relatives or relatives and controls. Post-hoc analysis showed that patients and controls showed differential ToM performance at average and high attachment anxiety. In patients, symptom levels did not moderate the association between attachment and ToM. Conclusions: Attachment anxiety is related to poorer levels of ToM in patients, suggesting this may have a contributory role in schizophrenia. The findings stress the need for longitudinal research into the directionality of the relationship between ToM and attachment anxiety. Practitioner points: Relationships with significant others might be a factor that influences the way in which social information is processed by persons with a diagnosis of a psychotic disorder. In patients, higher levels of attachment anxiety – that is, low self-worth, fear of abandonment and rejection, continuous vigilance of threat-related cues – were associated with a lower ability to understand the mental states of others. However, at lower levels of attachment anxiety, their ToM performance was comparable to that of relatives and controls. This effect was not influenced by symptom severity. Further research is required to confirm the potential influence of attachment insecurity on ToM ability as the latter is strongly related to patient’s functional outcomes.

Original languageEnglish
Pages (from-to)339-356
Number of pages18
JournalBritish Journal of Clinical Psychology
Issue number3
Publication statusPublished - Sept 2021


  • attachment
  • psychosis
  • theory of mind

ASJC Scopus subject areas

  • Clinical Psychology


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