Interpersonal functioning in psychosis: an empirical study and systematic review

Abstract

PURPOSE: The systematic review aimed to identify, synthesise and evaluate the state of evidence regarding quality of social relationships and interpersonal patterns experienced by people with early psychosis, including those with at risk mental states (ARMS). The research study aimed to explore relationships between experiences of trauma and neglect, ability to mentalise and interpersonal problems in people with psychosis.

METHOD: The review: article included a systematic search of four electronic databases, the search revealed eighteen articles. The research study involved gathering data via questionnaires, a semi-structured interview and a cartoon-based task from 48 participants with experience of psychosis. These outcome measures assessed childhood adversity, trauma related distress, ability to mentalise, interpersonal problems and psychotic symptomatology.

RESULTS: The review revealed that people in the early stages of psychosis and those with ARMS experience poor quality relationships and have difficulties with relating to others, such as struggling to prioritise and assert their own needs.

These difficulties appear early in the disorder and there was some evidence to suggest they may be related to distress. Further research is required to establish the predictors and consequences of these difficulties. The research article found that participants experienced high levels of trauma related distress and poor mentalising ability. Experience of childhood trauma and neglect was found to influence interpersonal problems via emotional distress and trauma related distress. Trauma related distress was also found to mediate the relationship between childhood adversity and negative symptoms. Mentalising was found to be unrelated to trauma and interpersonal problems.

CONCLUSIONS: Taken together the above findings indicate that people with psychosis experience relational difficulties. These difficulties appear to occur early in the disorder and potentially prior to onset. Difficulties in relationships appear to be influenced by experience of trauma, trauma related distress and emotional distress, indicating that a person’s adaptation to trauma is significant. Distress (e.g. depression, emotional distress, trauma symptoms) appears to be related to relational functioning. Results reflect that some people may cope with the aftermath of trauma by ‘deactivating’ and numbing emotional experiences, as trauma was found to indirectly affect negative symptoms via trauma related distress. Findings regarding mentalising appear inconsistent and potentially measures of mentalising require review and refinement.