Early trauma, attachment experiences and comorbidities in schizophrenia

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.

摘要
研究目的：本研究旨在评估精神分裂症患者的依恋模式，及其与早期创伤事件、精神病性症状及共病状况的关联。
方法：按照《精神障碍诊断与统计手册（第五版）》（Diagnostic and Statistical Manual of Mental Disorders, 5th edition, DSM-5）的诊断标准纳入20例精神分裂症患者，对其开展回顾性症状评估，并细致评估童年期照料者更换的次数与方式。采用精神病与情感障碍诊断访谈量表（Diagnostic Interview for Psychosis and Affective Disorders, DI-PAD）评估与精神分裂症相关的症状（阳性与阴性症状）、抑郁及躁狂症状。采用利伯维茨社交焦虑量表（Liebowitz Social Anxiety Scale, LSAS）、耶鲁-布朗强迫量表（Yale-Brown Obsessions and Compulsions Scale, Y-BOCS）以及惊恐与精神分裂症访谈量表（Panic and Schizophrenia Interview, PaSI）评估焦虑障碍共病情况。分别采用亲密关系经历量表-关系结构版（Experience in Close Relationships – Relationship Structures, ECR-RS）与早期创伤自评量表简版（Early Trauma Inventory Self Report-Short Form, ETISR-SF）评估依恋模式与创伤史。
结果：依恋模式与早期创伤之间存在中等强度的显著相关：早期创伤总发生频率越高，焦虑依恋的严重程度越高（斯皮尔曼ρ=0.446，p=0.04），其中总体创伤（包括父母患病与分离、自然灾害及严重事故）的相关性尤为显著（ρ=0.526，p=0.017）。在早期创伤与共病症状的相关性分析中，精神分裂症发病前出现的惊恐发作与ETISR-SF总分及性创伤子量表得分均呈显著正相关。
结论：早期情感生活不稳定的儿童更易出现精神病理症状，例如惊恐焦虑症状；创伤事件也可能是后续罹患精神分裂症的预测因素。