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. 2025 Jun;64(2):385-402.
doi: 10.1111/bjc.12511. Epub 2024 Oct 29.

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample

Shelley Grady  1 , Niall Crowley  2 , Seamus Scott  2 , Charles Ifegwu Ndukwe  2 , Rebecca Donohoe  2 , Keith Gaynor  1   3
Affiliations

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample

Shelley Grady et al. Br J Clin Psychol. 2025 Jun.

Abstract

Objectives: The trauma and social pathways model of psychosis proposes interactions between trauma, attachment, social rank and dissociation in pathways to psychosis, though this model has yet to be empirically investigated. The primary aim of this study was to examine the overall predictive value of the trauma and social pathways model using regression analysis. A secondary aim was to delineate hypothesized pathways between trauma and positive symptoms of psychosis using serial mediation analysis.

Method: This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, positive symptoms of psychosis, attachment, social comparison and dissociation were completed.

Results: A model of recurrent trauma, insecure attachment, social rank and dissociation predicted 23.2% of the variance in positive symptoms of psychosis. Recurrent trauma, attachment and dissociation contributed significantly to the model, while social rank did not. Further, serial mediation analysis indicated that the sequence of disorganized attachment and dissociation fully mediated the relationship between recurrent trauma and positive symptoms.

Conclusions: Results provide preliminary support for the trauma and social pathways model of psychosis, specifically as it relates to recurrent trauma, insecure attachment and dissociation. Results did not support the social rank component of this model, however. These findings provide clear targets for the development of next-wave psychological interventions that focus on trauma-related variables in psychosis. Future studies should replicate these findings with a larger clinical sample, and consider a measure of shame to further elucidate social processes in pathways to psychosis.

Keywords: attachment; dissociation; mechanisms; pathways; psychosis; social rank; trauma.

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Conflict of interest statement

No conflicts of interest were identified.

Figures

FIGURE 1
FIGURE 1
Mediation model testing if disorganized attachment and dissociation serially mediate the relationship between recurrent trauma and positive symptoms. ***p < .001; ns nonsignificant.
FIGURE 2
FIGURE 2
Mediation model testing if disorganized attachment and dissociation serially mediate the relationship between recurrent trauma and hallucinations. **p < .01; ***p < .001; ns nonsignificant.
FIGURE 3
FIGURE 3
Mediation model testing if disorganized attachment and dissociation serially mediate the relationship between recurrent trauma and delusions, while controlling for gender. **p < .01; ***p < .001; ns nonsignificant.
See this image and copyright information in PMC

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