The role of attachment and alexithymia in the relationship between childhood trauma and mentalization in people with schizophrenia: a multicenter study

Patients with schizophrenia appear to experience higher levels of childhood trauma and lower levels of mentalization capacities. However, no studies have discussed the factors underlying the way in which childhood trauma impacts upon mentalization in schizophrenia. This study aimed to examine the impact of childhood trauma on mentalization in schizophrenia, and to determine the possible mediating role of attachment and alexithymia in this relationship. The study group included 194 schizophrenia patients. The Mentalization Questionnaire, Childhood Trauma Questionnaire (CTQ-SF), 20-item Toronto Alexithymia Scale (TAS-20) and Experiences in Close Relationships- Relationship Structures Scale (ECR-RSS) were administered to all participants. Mediation and path models were constructed, taking childhood trauma as independent variables, attachment avoidance and anxiety as mediators, and mentalization as the dependent variable. In addition, a sequential mediation model was tested, with attachment insecurity and alexithymia as mediators of the association between childhood trauma and mentalization. The findings supported the attachment avoidance and anxiety fully mediated the effect of childhood trauma on mentalization in schizophrenia patients. The sequential mediation model was established by using attachment and alexithymia as mediators between the relationship of childhood trauma and mentalization. The cross-sectional design of this study was a limitation in terms of determining the causality of the identified relationships. The results supported the hypothesis of sequential mediation via attachment insecurity and alexithymia. Accordingly, attachment insecurity and alexithymia should be discussed as the theme of psychotherapy for schizophrenia patients.