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

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 < /div>
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.