The relationship between attachment insecurity and experiences on the paranoia continuum: A meta-analysis

OBJECTIVES: Attachment has long been theorized to play a key role in the development of paranoia. Associations between both constructs have been reported over the last decade, but have ranged widely in magnitude to date. The present study is the first publication to synthesize existing literature and provide a meta-analytic estimate of the attachment-paranoia relationship. METHODS: A systematic search of studies available up to January 2019 was conducted using Embase, MEDLINE, CINAHL, PsycINFO, OpenGrey, and ProQuest Dissertations & Theses Global. This yielded 26 studies which met inclusion criteria (N = 10,539; mean age range 16-47; 45% male). Data were analysed using random effects models with restricted maximum likelihood variance estimator. Age and sex were examined as moderators in meta-regressions. RESULTS: Paranoia was significantly associated with attachment anxiety (r = .38; 95% CI: 0.32, 0.44; p < .0001; I(2) = 88%; k = 26) and attachment avoidance (r = .24; 95% CI: 0.18, 0.29; p < .0001; I(2) = 79%; k = 26). The strength of these associations did not differ between clinical and non-clinical participant samples. Neither age nor sex moderated identified relationships. CONCLUSIONS: There is a moderate association between both constructs of interest. These findings suggest that attachment insecurity may be an active agent in the aetiology and/or maintenance of experiences on the paranoia continuum. Implications for psychological treatment, for example, consideration of attachment status in formulations, are briefly discussed. PRACTITIONER POINTS: Paranoia is associated with both attachment anxiety and attachment avoidance. These associations are of similar strength for people with and without psychosis. Attachment may contribute to the development and/or maintenance of paranoia. It may be beneficial to target attachment in psychological therapies for psychosis.