ADOLESCENTS AT HIGH-RISK FOR PSYCHOSIS: EXPLORING THE ROLE OF ATTACHMENT PATTERNS, MENTALIZATION AND CHILDHOOD TRAUMATIC EXPERIENCES

Introduction: Identifying young people at clinical high-risk (CHR) for psychosis provides an important contribution to clinical practice, facilitating the development of intervention strategies aimed to prevent the onset of a full-blown psychotic disorder. Therefore, it is essential to investigate which variables are involved in the development and maintenance of CHR conditions in order to improve the diagnostic understanding and the effectiveness of treatments. Several studies showed high rates of childhood traumatic experiences in CHR individuals. Furthermore, there are pieces of evidence linking attachment adversity to the risk for developing psychosis – involving enduring alterations of specific neurobiological pathways. Previous researches also highlighted the role of mentalization in moderating the risk of transition to psychotic disorders. To date, attachment and mentalization have not been evaluated in CHR patients using interview-based measures. The aim of this study was to explore attachment patterns, mentalization and childhood traumatic experiences among CHR adolescences. Methods: 51 CHR outpatients were compared with 54 other outpatients who did not meet the high-risk criteria. A multi-method diagnostic assessment was implemented, including the Structured Interview for Prodromal Syndromes (SIPS). Adult Attachment Interview was also administered, and the transcripts were further assessed using both the Reflective Functioning (RF) Scale and the Complex Trauma Questionnaire. Results: Although no differences between groups with respect to childhood traumatic experiences have been found, CHR patients showed a higher degree of insecure and disorganized attachment patterns. Moreover, the RF scores were significantly lower in the HR sample and significant correlations between RF and SIPS subscales were found. Conclusions: Our results suggest that attachment-informed and mentalization-based psychotherapies may be effective preventive treatments for CHR patients.