How does attachment affect help-seeking in people with paranoia and psychosis? The role of emotion regulation, self-stigma, and perceived support

Longer duration of untreated psychosis causes significant human and healthcare costs. Attachment avoidance and anxiety contribute to delays in help-seeking and help-acceptance in individuals with both non-clinical and clinical paranoia, though underlying mechanisms remain unclear. The aim of the study was to examine how attachment affects help-seeking and help-acceptance in people with paranoia. We recruited a non-clinical sample with paranoia (N = 501) and a clinical psychosis sample (N = 120), and found that attachment avoidance predicted reduced help-seeking and help-acceptance intentions in both groups, while attachment anxiety predicted lower social help-seeking in the clinical group. Emotion regulation did not mediate associations between attachment and help-seeking/acceptance. Self-stigma regarding help-seeking and mental illness mediated these associations in both groups, while perceived availability of help mediated the link between avoidance and help-seeking/acceptance in the non-clinical group. This is the first study to show that self-stigma and perceived help availability delay help-seeking in paranoia. Further research should investigate causal effects of attachment on self-stigma and perceived support, and so help-seeking.