The relationship between attachment insecurity and experiences on the paranoia continuum: A meta-analysis

Regina Murphy, Karen Goodall, Amanda Woodrow

Research output: Contribution to journalArticlepeer-review


Objectives: Attachment has long been theorised to play a key role in the development of paranoia. Associations between both constructs have been reported over the last decade, but have ranged widely in magnitude to date. The present study is the first publication to synthesise existing literature and provide a meta-analytic estimate of the attachment-paranoia relationship. 
Methods: A systematic search of studies available up to January 2019 was conducted using EMBASE, MEDLINE, CINAHL, PsycINFO, OpenGrey and ProQuest Dissertations & Theses Global. This yielded 26 studies which met inclusion criteria (N=10,539; mean age range 16-47; 45% male). Data were analysed using random effects models with restricted maximum likelihood variance estimator. Age and sex were examined as moderators in meta-regressions.
Results: Paranoia was significantly associated with attachment anxiety (r = .38; 95% CI: 0.32, 0.44; p < .0001; I2 = 88%; k = 26) and attachment avoidance (r = .24; 95% CI: 0.18, 0.29; p < .0001; I2 = 79%; k = 26). The strength of these associations did not differ between clinical and non-clinical participant samples. Neither age nor sex moderated identified relationships.
Conclusions: There is a moderate association between both constructs of interest. These findings suggest that attachment insecurity may be an active agent in the etiology and/or maintenance of experiences on the paranoia continuum. Implications for psychological treatment, e.g. consideration of attachment status in formulations, are briefly discussed.
Original languageEnglish
Pages (from-to)290-318
JournalBritish Journal of Clinical Psychology
Issue number3
Early online date30 Mar 2020
Publication statusPublished - Sep 2020


  • attachment
  • paranoia
  • psychosis
  • meta-analysis


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