City Research Online

Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first‐degree relatives and controls

Varela, L., Wong, K., Shergill, S. & Fett, A-K. ORCID: 0000-0003-0282-273X (2021). Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first‐degree relatives and controls. British Journal of Clinical Psychology, 60(3), pp. 339-356. doi: 10.1111/bjc.12308


Theory of Mind (ToM) plays a role in social functioning and is impaired in patients with schizophrenia and to a lesser degree in first-degree relatives relative to healthy controls. This study investigates whether attachment styles moderate these observed group differences in ToM.

This cross-sectional study included a sample of 51 patients, 23 first-degree relatives, and 49 controls who completed assessments of anxious and avoidant attachment (Psychosis Attachment Measure), ToM (Reading the Eyes in the Mind Test), and estimated cognitive ability. Patients’ symptoms were assessed with the Positive and Negative Syndrome Scale.

Patients differed from controls and relatives in ToM performance and in attachment avoidance, but not attachment anxiety. Attachment anxiety demonstrated a significant interaction effect between group and attachment between controls and patients. Post-hoc analysis showed that patients and controls showed differential ToM performance at average and high attachment anxiety. In patients, symptoms levels did not moderate the association between attachment and ToM.

Attachment anxiety is related to poorer levels of ToM in patients, suggesting this may have a contributory role in schizophrenia. The findings stress the need for longitudinal research into the directionality of the relationship between ToM and attachment anxiety.

Practitioner points
- Relationships with significant others might be a factor that influence the way in which social information is processed by persons with diagnosis of psychotic disorders.
- In patients, higher levels of attachment anxiety – that is, low self-worth, fear of abandonment and rejection, continuous vigilance of threat-related cues – were associated with a lower ability to understand the mental states of others. However, at lower levels of attachment anxiety, their Theory of Mind performance was comparable to that of relatives and controls. This effect was not influenced by symptom severity.
- Further research is required to confirm the potential influence of attachment insecurity on ToM ability as the latter is strongly related to patient’s functional outcomes.

Publication Type: Article
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health & Psychological Sciences > Psychology
SWORD Depositor:
[thumbnail of BJCP_Attachment_ToM.pdf]
Text - Accepted Version
Download (334kB) | Preview


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login