Personality and attachment patterns in a clinical sample of adolescents at ultra-high risk for psychosis

The ultra-high risk (UHR) criteria were defined to identify young people at imminent risk of developing a first episode of psychosis. Identifying UHR individuals can help guide mental health practitioners in their treatment decision-making and adapt their interventions to the individual characteristics of patients in order to prevent the onset of psychosis. To date, only few studies have focused on personality features of the UHR patients’ population, using mostly self-report instruments despite their crucial limitations in this field. Moreover, very little research has examined the link between the risk for developing psychosis and insecure attachment. Notably, no empirical investigations have studied this relationship using the gold standard measure for attachment. This study aimed at examining with valid and reliable measures both personality features and attachment patterns in a clinical sample of UHR adolescents. Methods: 40 adolescent UHR outpatients were compared to 40 individuals who didn’t meet the ultra-high risk criteria. Each patient received a DSM personality diagnosis and was assessed using the Brief Psychiatric Rating Scale (BPRS) and Structured Interview for Prodromal Syndromes (SIPS/SOPS), the Shedler-Westen Assessment Procedure (SWAP-200-A), as well as the Adult Attachment Interview (AAI). Results: No differences between groups have been found when personality disorders were measured according to the DSM-IV-TR categories. However, UHR patients showed more impaired personality functioning and higher scores on two Q-factors of the SWAP-200: “inhibited/self- critical” and “emotionally dysregulated”. Finally, a higher degree of “cannot classify low- coherence” attachment patterns was found in UHR patients’ group. Conclusions: These primary findings seem to suggest the importance of taking into account the emotional dysregulation, social inhibition and disorganized attachment in treatment planning of UHR patients.