Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0005
Trends in Psychiatry and Psychotherapy
Original Article

Early trauma, attachment experiences and comorbidities in schizophrenia

Relação entre traumas precoces, experiências de apego e comorbidades na esquizofrenia

Thalita Gabínio; Thaysse Ricci; Jeffrey P. Kahn; Dolores Malaspina; Helena Moreira; André B. Veras

http://dx.doi.org/10.1590/2237-6089-2017-0005 Trends Psychiatry Psychother, vol.40, n3, p.179-184, 2018
PDF
SciELO
Downloads: 0
Views: 600

Abstract

Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships – Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.

Keywords

Schizophrenia, early traumas, attachment, schizoaffective disorder

Resumo

Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.

Palavras-chave

Esquizofrenia, apego, relações vinculares

References

Sideli L, Mule A, La Barbera D, Murray RM. Do child abuse and maltreatment increase risk of schizophrenia?. Psychiatry Investig. 2012;9:87-99.

Ruby E, Polito S, McMahon K, Gorovitz M, Corcoran C, Malaspina D. Pathways associating childhood trauma to the neurobiology of schizophrenia. Front Psychol Behav Sci. 2014;3:1-17.

Ruby E, Rothman K, Corcoran C, Goetz RR, Malaspina D. Influence of early trauma on features of schizophrenia. Early Interv Psychiatry. 2017;11:322-33.

Martins TC, Canavarro MC, Moreira H. Adult attachment insecurity and dyadic adjustment: The mediating role of self-criticism. Psychol Psychother. 2015;88:378-93.

Moreira H, Martins ABT, Gouveia MJ, Canavarro MC. Assessing adult attachment across different contexts: validation of the Portuguese version of the experiences in Close Relationships–Relationship Structures questionnaire. J Pers Assess. 2014;97:22-30.

Training manual: Diagnostic Interview for Psychosis and Affective Disorders. 2009.

Leibowitz MR. Social phobia. Mod Probl Pharm. 1987;22:141-73.

Goodman WK, Price LH, Rasmussem S, Mazure C, Fleischman RL, Hill CL. The Yale-Brown Obsessive-Compulsive Scale: development, use and reliability. Arch Gen Psychiatry. 1989;46:1006-11.

Savitz AJ, Kahn TA, McGovern KE, Kahn JP. Carbon dioxide induction of panic anxiety in schizophrenia with auditory hallucinations. Psychiatr Res. 2011;189:38-42.

Bremner JD, Bolus R, Mayer EA. Psychometric properties of the Early Trauma Inventory – Self Report. J Nerv Ment Dis. 2007;195:211-8.

Osório FL, Salum GA, Donadon MF, Forni-dos-Santos L, Loureiro SR. Psychometrics properties of Early Trauma Inventory Self Report – Short Form (ETISR-SR) for the Brazilian context. PLoS One. 2013;8.

Pos K, Bartels-Velthuis AA, Simons CJ, Korver-Nieberg N, Meijer CJ, Haan L. Theory of mind and attachment styles in people with psychotic disorders, their siblings, and controls. Aust N Z J Psychiatry. 2015;49:171-80.

Ward MJ, Lee SS, Polan HJ. Attachment and psychopathology in a community sample. Attach Hum Dev. 2006;8:327-40.

Newman MG, Shin KE, Zuellig AR. Developmental risk factors in generalized anxiety disorder and panic disorder. J Affect Disord. 2016;206:94-102.

Fernandes V, Osório FL. Are there associations between early emotional trauma and anxiety disorders? Evidence from a systematic literature review and meta-analysis. Eur Psychiatry. 2015;30:756-64.

Dozier M, Bernard K. The impact of attachment-based interventions on the quality of attachment among infants and young children. Encyclopedia on Early Childhood Development. 2004.

Pavlova B, Perroud N, Cordera P, Uher R, Dayer A, Aubry JM. Childhood maltreatment and comorbid anxiety in people with bipolar disorder. J Affect Disord. 2016;192:22-7.

Anglin DM, Cohen PR, Chen H. Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife. Schizophr Res. 2008;103:143-50.

Bowlby J. Formação e rompimento dos laços afetivos. 1979.

Bowlby J, S.M. Barros. Uma base segura: aplicações clínicas da teoria do apego. 1988.

The effects of infant child care on infant-mother attachment security: results of the NICHD study of early child care. Child Dev. 1997;68:860-79.

Dalbem JX, Dell’Aglio DD. Teoria do apego: bases conceituais e desenvolvimento dos modelos internos de funcionamento. Arq Bras Psicol. 2005;57:3-27.

Wicks S, Hjern A, Gunnel D, Lewis G, Dalman C. Social adversity in childhood and the risk of developing psychosis: a national cohort study. Am J Psychiatry. 2005;162:1652-7.

Read J, Jerry BD, Moskowitz A, Conolly J. The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry. 2001;64:319-45.

Soares I. Psicopatologia do desenvolvimento: trajectórias (in)adaptativas ao longo da vida. 2000.

Gabinio T, Veras AB, Kahn JP. Self-consciousness and panic. Panic disorder: neurobiological and treatment aspects. 2016:217-22.

Goodwin R, Lyons JS, McNally RJ. Panic attacks in schizophrenia. Schizophr Res. 2002;58:213-20.

6169bdc8a953954d8c5293c2 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections