Date of Award

2025

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Or Dagan, Ph.D.

Second Advisor

Marc Diener, Ph.D.

Third Advisor

Jennifer May, Ph.D.

Abstract

Early repeated child-parent experiences impact the emergence of children’s reality testing by providing them with secure, trusting relationships with reality-oriented caregivers in which beliefs can be evaluated and refined. These relationships facilitate open and reciprocal communication about thoughts and feelings. Caregivers facilitate the development of children’s reflective capacities by helping them connect their inner experiences to their behavior. This process encourages them to assess whether their thoughts and feelings accurately reflect reality by remaining attuned to the perceptions of reality that are shared with others. Given the centrality of early caregiving experiences to one’s development of reality testing, attachment theory may contribute a unique insight into the developmental origins of delusions. Several studies have thus far assessed the association between attachment relationships across the lifespan and psychotic symptoms. Delusions, a key symptom of psychotic disorders, can occur at subclinical levels in individuals without a formal diagnosis. To clarify the association between attachment relationships and delusions and facilitate future research on this topic, the current systematic review surveyed the empirical evidence pertaining to this association in both clinical and nonclinical adult populations. We found evidence for an association between attachment relationships and several manifestations of delusional ideation across clinical and normative-risk samples. In addition, cognitive, affective, and interpersonal mechanisms that explain these associations were identified, allowing us to propose a model of the association between early child-parent experiences and delusions. Understanding the developmental origins of delusions may inform treatment and research of these debilitating, life-altering symptoms.

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