The association between attachment anxiety and avoidance, social functioning and personal empowerment in patients with severe mental illnesses

Abstract

Background: Social functioning and personal empowerment are particularly important for recovery from psychopathology, especially for individuals with severe mental illnesses (SMI). SMI-patients, however, frequently show problems in social functioning and have an insecure attachment, experiencing either high attachment anxiety and/or avoidance. Attachment anxiety and avoidance negatively affect SMI-patients’ social functioning, psychopathology and recovery, and perhaps subsequently, personal empowerment. Therefore, SMI-patients are hypothesized to experience high attachment anxiety and/or avoidance and decreased personal empowerment. Still, the direct association between attachment anxiety and avoidance and personal empowerment, plus the role of social functioning, remain unclear. Aim: To investigate the association between attachment anxiety and avoidance and personal empowerment, and whether this association is mediated by (difficulties in) social functioning. Methods: A sample of SMI-patients (N = 154, M = 39.89, SD = 11.07) completed self-report questionnaires and interviews. The hypothesized mediation model was analyzed with PROCESS Macro 4. Results: Attachment anxiety and avoidance were significantly negatively related to personal empowerment. Only the relation between attachment anxiety (not attachment avoidance) and personal empowerment was partially mediated by self-rated difficulties in social functioning. Conclusion: Showing high attachment anxiety and avoidance may decrease SMI-patients’ personal empowerment. Furthermore, having high attachment anxiety may increase SMI-patients’ perceived difficulties in social functioning, which subsequently may decrease their personal empowerment. Hence, attention should be given to attachment as a transdiagnostic factor in treatment.