Predictors and mediators of trait anger across the psychosis continuum: The role of attachment style, paranoia and social cognition

Anger in the context of psychosis has a significant impact on treatment outcomes and serious implications for risk management. Understanding mechanisms underlying anger will improve interventions and inform strategies for prevention. This study is the first to examine the relationships between anger and key theoretical drivers across different phases of the psychosis continuum. A battery including measures of theory of mind, attachment, hostile attribution bias, paranoia and anger was administered to 174 participants (14 ultra-high risk, 20 first-episode, 20 established psychosis, 120 non-clinical participants). We tested the model that insecure attachment, paranoia, impaired theory of mind and hostile attribution bias would predict trait anger using multiple regression. Attachment avoidance, paranoia and hostile attribution bias were significantly associated with anger but attachment anxiety and theory of mind were not. Mediation analysis showed that paranoia partially mediated the relationship between avoidant attachment and anger but hostile attribution bias did not. Findings emphasise the importance of interventions targeting paranoia to reduce anger and the potential of preventive strategies focused on attachment relationships in early life or adulthood to reduce adult paranoia and anger.