Beyond the symptoms: Exploring attachment styles and reality‐testing among schizophrenia clients from a nursing perspective
Authors: Helyel Eman Saad , El‐Sayed Mona Metwally 
Published: July 2024

Accessible SummaryWhat is known on the subject?

The insecure attachment styles are associated with mental health problems and can influence reality perception, particularly in individuals with schizophrenia.

What the paper adds to existing knowledge?

The paper provides empirical evidence for the correlation between insecure attachment styles and reality‐testing impairment in clients with schizophrenia.

Higher reality testing impairment scores were observed in specific demographics: males who were unmarried and aged between 40 and 50 years old, as well as those with a duration of illness of less than 5 years.

What are the implications for practice?

The findings underscore the importance for nurses to understand insecure attachment styles, particularly anxious and avoidant styles, in clients with schizophrenia.

Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships.

A secure, structured and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation.

Secure Attachment Style Psycho‐Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality‐testing impairment.

Imply early intervention through educating mothers on fostering secure bonds can potentially prevent future occurrences of schizophrenia.

What are the implications for future research?

Conducting empirical studies to explore the associations between insecure attachment style, social functioning, and poor service engagement is essential.

Research is needed to investigate specific techniques for managing insecure attachment styles, particularly the avoidant ones, and reality testing impairments within the therapeutic setting.

AbstractIntroductionInsecure attachment styles are associated with mental health problems and may influence reality perception.AimThis study investigated the link between attachment styles and reality‐testing impairment in individuals with schizophrenia.MethodsA cross‐sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality‐testing abilities (Bell Reality Testing Inventory).ResultsA significant positive correlation emerged between insecure attachment and poorer reality testing (r = .394, p < .001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality‐testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40–50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61).DiscussionInsecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains.Implication for PracticeHealthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho‐Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality‐testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers‐to‐be) and their children to promote healthy attachment styles as a preventive measure.