“Ontological Insecurity” May Play A Role in Psychotic Experiences

An unstable sense of self may mediate the impact of attachment styles and childhood trauma on developing psychotic experiences.

Ayurdhi Dhar, PhD
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In a new study published in the Journal of Clinical Psychology, researchers tested how well “ontological insecurity” predicted psychotic-like experiences (PLEs). They found that ontological insecurity was more strongly related to PLEs than childhood trauma, attachment styles, and sub-par parenting.

Led by Nicholas Marlowe of Macquarie Street Psychology Center, Australia, this is the first empirical study that tests R. D. Laing’s concept of ontological insecurity with psychotic like-experiences (PLEs). The researchers write that ontological insecurity is defined as

“Vulnerability to psychosis, wherein the self is experienced as lacking in coherence and consistency, precariously separated from the body, others, and the world and on the brink of disintegration into psychosis.”

Woman reflected and visible behind glass
Photo by Omid Armin on Unsplash.

According to R. D. Laing’s theory, ontological insecurity could lead to full blown psychosis when significant others interact with a person in a confusing, intense, and critical way. At its core it is the lack of a coherent and stable self. It is related to a crippling fear of loss of autonomy, especially the fear of engulfment, implosion, or depersonalization, in relationships with others.

Recent research has found significant connections between psychotic experiences and traumatic experiences, and this especially holds true for childhood trauma. Other studies have linked social adversity and exposure to crime and poverty to the development of psychotic experiences. Poverty has even been associated with reducing the efficacy of psychotherapy.

Despite the presence of literature linking psychosis to psychosocial factors, the first line of treatment for psychosis remains administration of antipsychotics, which have been related to numerous ill effects, especially when taken over a long period.

Other studies have shown the promise of psychosocial interventions, and some have explored the influence of race and class factors on the diagnosis of schizophrenia. Some approaches, like the Hearing Voices Network, have included trauma centered interventions, and still others, such as the Open Dialogue approach, place importance on transparency and dialogue with the patient.

Previous research has also found associations between children who have a secure attachment style (their early interactions with parents were loving and made them feel safe) and adult psychological well-being. Other studies point to an association between psychosis and avoidant and anxious attachment style. The causes of anxious, insecure, avoidant, or disorganized attachment styles are believed to be uncaring, neglectful, controlling, or threatening parenting. These styles are believed to define people’s relationships into adulthood.

Marlowe and the other researchers in the current study wanted to explore the predictive relationship between ontological insecurity and PLEs, especially in light of the already-established associations between “positive” PLEs and childhood trauma, parenting styles, and attachment styles. “Positive” PLEs include hallucinations and delusions, while “negative” ones refer to emotional blunting and social withdrawal.

The authors used Ontological Insecurity Scale (OIS-34) to measure levels of unstable sense of self in 298 individuals in a non-clinical sample, and the Community Assessment of Psychiatric Experiences Questionnaire (CAPE-42) to measure for PLEs (both positive and negative). Childhood trauma and neglect, attachment styles, and suboptimal parental relationships were measured using Childhood Trauma Questionnaire-Short Form (CTQ-SF), Psychosis Attachment Measure (PAM), and Parental Bonding Instrument (PBI) respectively.

Additionally, they also used self-report measures to test for substance use and a mental health history questionnaire to give context to their findings. All data was collected using the internet platform Qualtrics, and both correlational and multiple regression analysis was conducted on the data.

The researchers found that, after controlling for demographic variables and mental health history, any relationship between the PBI, CTQ-SF, or PAM scales and PLEs vanished once the OIS was included in the regression analysis. In other words, ontological insecurity turned out to be a much stronger predictive factor for psychotic-like experiences than sub-par parental bonding, childhood traumatic experiences, and even anxious and avoidant adult attachment styles. Thus, while attachment types and trauma were correlated with psychotic-like experiences, those relationships were mediated by an unstable and incoherent sense of self.

“Although anxious and avoidant adult attachment each accounted for significant variance in scores on the OIS‐34, as well as on the PSI, their relationships with positive PLEs ceased to be significant once the OIS‐34 entered the equation. Such a pattern of findings suggests that the relationship of adult attachment to positive PLEs is mediated by ontological insecurity.”

Given these results, the researchers suggest that clinicians should consider ontological insecurity while developing theoretical frameworks for both positive and negative psychotic-like experiences.

One of the more surprising findings was the lack of a significant relationship between childhood trauma and the “positive” symptoms of hallucinations and delusions. The authors suggest that, given the extensive research which shows the presence of such a relationship, their own findings should not be generalized to clinical samples. Older studies have also found a correlation between avoidant and anxious attachment style with psychosis, but none of them included ontological insecurity as a mediating factor.

The researchers do point out many limitations of their study. Most importantly, the study was conducted on a non-clinical population, meaning that the participants did not have a diagnosis of a mental health disorder. This could limit their findings, as the researchers could not answer whether ontological insecurity could still have as much impact for people who actually experience clinical psychosis. They urge other researchers to attempt to replicate their findings on a clinical sample. Additionally, they admit that since most participants had higher education (48.3 % undergraduates) and around 75% were female, one should show caution before generalizing the findings to men and people with lower educational attainment.

In conclusion, the authors suggest that given the strength of their findings, it is essential that ontological insecurity be properly explored. They write that it could be a useful framework in one-on-one psychotherapy or the Open Dialogue approach.

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Marlowe, N.I., Perry, K.N., & Lee, J. (2019). Ontological Insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like symptoms. Journal of Clinical Psychology, 1-21. doi: 10.1002/jclp.22905

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Ayurdhi Dhar, PhD
MIA Research News Team: Ayurdhi Dhar is assistant professor of psychology at Mount Mary University. She is the author of Madness and Subjectivity: A Cross-Cultural Examination of Psychosis in the West and India (to be released in September 2019). Her research interests include the relation between schizophrenia and immigration, discursive practices sustaining the concept of mental illness, and critiques of acontextual and ahistorical forms of knowledge.

19 COMMENTS

  1. If anyone wants to look at the ‘latest science’ thinking on psychosis and pretty much all the other stuff… it’s on the NMDA receptor :

    https://www.cshl.edu/first-structural-views-of-the-nmda-receptor-in-action-will-aid-drug-development/

    ——

    Mr Dominic Cummings is Boris Johnsons top Aide. It seems he is looking for:

    ‘weirdos and misfits with odd skills’ and people who ‘fought their way out of appalling hell holes’.

    https://www.dailymail.co.uk/news/article-7846317/Boris-Johnsons-aide-Dominic-Cummings-posts-bizarre-job-advert.html

    Well this is the right place to look, but you know we’re not ‘weirdo’s’, we have fought our way out of hell holes that’s for sure, and the smartest people on the fraud that is called mental Health are on here.

    So you state what you want, here is what I want:

    Intel on what the special interest group: Evolutionary Psychiatry are discussing, not the stuff they publish. I want to know the identity of JadedJean who would post on BBC Newsnight blog, some 10 plus years ago and seemed to be a eugenicists maybe also psychiatrist. I want to know what they have been writing/doing, what post they have/had. I want to discus implementing Cytochrome P450 gene test independently of any doctors. I want a very significant research team to thoroughly investigate all deaths over the last 10 – 15 years in all psychiatric hospitals and as outpatients outside in the context of the drugs they were subject to re serious adverse drug events that are not diagnosed by doctors because the cause them: Akathisia/Toxic Psychosis, Neuroleptic Malignant Syndrome and Prolonged QT interval to name just some.

    I want to deprogram peoples use of words such as: Schizophrenia, Autism, bi-polar, ADHD… etc These terms are destructive just as the N word is racist destructive.

    Then I want you to conceive of a world without psychiatry at all. Would that be too ‘weirdo’ for you ?

  2. “Previous research has also found associations between children who have a secure attachment style (their early interactions with parents were loving and made them feel safe) and adult psychological well-being. Other studies point to an association between psychosis and avoidant and anxious attachment style. The causes of anxious, insecure, avoidant, or disorganized attachment styles are believed to be uncaring, neglectful, controlling, or threatening parenting. These styles are believed to define people’s relationships into adulthood.”

    It’s very tempting to respond sarcastically to this because it’s hard to understand how this isn’t understood to be a universal truth. Without secure attachments, you cannot learn to trust. Without trust, you can’t feel safe in the world. Without safety, you can’t form a cohesive narrative and stable sense of who you are. In these cases, there is no solid ground to leave footprints upon and to retrace your steps to safety.

    “Drowning typically occurs silently, with only a few people able to wave their hands or call for help.”

    https://en.wikipedia.org/wiki/Drowning

    • So perhaps all suffering is from this “ontological insecurity”….so then what? We go from an unstable sense of self to get a more stable sense from psychiatry??
      I don’t find it helpful to be told by psychiatry.
      I also find it not helpful to be told about theories like “attachment theory”
      It can all send you down a hole.
      Because much info or how people present it, reeks of hopelessness. Then helpers say things like “don’t lose hope”. For someone that lost it, this is silly advice, although well meaning.
      For many, there are subliminal messages that come through. Much talk is people talking through their reality and projecting. This leads to anxiety, since the client might not even have entertained the thoughts until they were mentioned.
      I have been at the end of internalizing messages from parents and others, why do I want more of that.

      “In these cases, there is no solid ground to leave footprints upon and to retrace your steps to safety.”
      Sentences such as this, if not followed by sound proven effective ‘therapy’, resonate a hopelessness.
      Or is it just me 🙂

  3. “The researchers found that, after controlling for demographic variables and mental health history, any relationship between the PBI, CTQ-SF, or PAM scales and PLEs vanished once the OIS was included in the regression analysis.”

    So, if your father, uncle and grandfather, all raped you, the significance vanishes once OIS is included in the regression analysis.

    Wonderful. Freud would love this. All “false” memories.

    The study, though, has some limitations. The subjects were never traumatized. And never experienced real “psychosis”.

    Freud was “traumatized” by his peers (his livelyhood was in jeopardy), then he got smart and made everything up after that.

  4. Ontological insecurity is defined as Quote:
    “Vulnerability to psychosis, wherein the self is experienced as lacking in coherence and consistency, precariously separated from the body, others, and the world and on the brink of disintegration into psychosis.”

    If I’m reading this correctly, this is just another way of saying ontological insecurity is the result of major, entrenched dissociation caused by trauma. From my understanding of how psychosis is described, I think it can be understood as the mind’s attempt to reintegrate dissociated, traumatic memories but as it attempts to do so, there is an overlap between the past memory and current reality which leaves the person experiencing it disoriented and unable to tell the difference between past and present. If I’m correct, it’s why I really don’t believe in psychosis because I think it would be better explained as experiencing overlapping realities (one past; one present) rather than the more common view that it is a ‘break’ from reality.

    Quote:
    According to R. D. Laing’s theory, ontological insecurity could lead to full blown psychosis when significant others interact with a person in a confusing, intense, and critical way. At its core it is the lack of a coherent and stable self. It is related to a crippling fear of loss of autonomy, especially the fear of engulfment, implosion, or depersonalization, in relationships with others.

    This is where the SO’s understanding of the attachment concepts of ‘safe haven’ and ‘affect regulation’ and ‘proximity maintenance’ are key. It really didn’t matter which attachment style my wife was currently experiencing when she was in an ‘extreme state.’ What mattered was that I satisfied her need for a safe haven and affect regulation by remaining calm, cool and anchoring her to the present and that I was physically present. A few times I let her pull me into her fear/anguish from the extreme state, and then I just elevated her distress, but when I stayed grounded, I was able to ground her and she would more quickly come out of those states, and, happily, that is what her mind seemed to need to begin the process of integrating those traumatic memories into her personal narrative to the point now that she rarely experiences ‘extreme states’ and they are rather mild when she does.

    I believe attachment concepts provided me a way to ‘hold’ my wife during psychotic-like events, gently cocooning her while she herself felt ‘ontologically’ fractured and insecure, and by me doing so, it gave her time to heal and gain that sense of self-security that she had previously lacked.

    Sam

    • I believe that you misunderstand the blog: “If I’m reading this correctly, this is just another way of saying ontological insecurity is the result of major, entrenched dissociation caused by trauma.” I understand “ontological” to mean that something exists independently… not caused by experiences like trauma; I believe that it supports psychiatry in advocating a “genetic predisposition” for insecurity. The article is advocating that trauma does not cause the insecurity expressed in “mental illness”; it advocates that trauma does not impact human psychology. Instead, the article is advocating that the insecurity expressed in “mental illness” is caused by a genetic predisposition for insecurity that they label “ontological” insecurity. I believe that the article advocates “Pollyanna”; do others agree?

      • Hi Steve,

        well, I did qualify my response because Ayurdhi writes in a more clinical style than I am used to reading. That’s why I wrote ‘if I’m reading this correctly.’ It seemed that this blog was a largely positive portrayal of the study designed by Marlowe, Perry and Lee. But I am aware that I was going against the prevailing negative opinion of this blog in the comments section.

        So with that said, IF I am reading Ayurdhi correctly, then I stand by what I stated previously. I have tried many times to lay out my understanding of dissociation on this website to little effect. But I do understand my understanding isn’t mainstream but has come after 11 years of walking thru its many aspects with my wife on our healing journey. I would love to do a series on dissociation here like I did on my personal blog, but I won’t hold my breath. I think it would help make sense of the many confounding things that the various authors on this website note, but have no explanation for. And that’s why I tried to interject my understanding into this blog because the original authors seem to understand there is something more going on than they can explain: thus, their call for further study. I see it thru the lens of dissociation and thus, I think their study is a great start and hope they will continue to pursue it.
        Sam

      • I think we would not know about “ontological insecurity” or any other MI word, if not experiencing some discontent that sends us looking for ‘help’.
        But god help us once we do. We will learn about every theory out there, and be told not to lose hope.
        I would suggest never to bring up theories that we learned from experts.
        It was not until I heard about all these horrible sad afflictions that I really started navel gazing.
        I might just have that, since it fits with this and that. A psychological hypochondriac.
        The hardest thing is to escape once you enter. What a horrid prison. It might be why people in 3rd world countries used to have better MI. They did not learn to identify with all the terminology for what ailed them.
        Went through their garbage without getting ‘stuck’.

        • Hi Sam,
          I’m sorry for the terrible things you’ve suffered at the hands of the ‘experts’, but I didn’t learn about attachment theory from them. My wife asked me NOT to read any of the literature out there the first couple of years we started our healing journey. And so she and I just kind of developed our own style. A lot of it was based on the Golden Rule, though I always tried to listen to her feedback if she didn’t like something I was doing.

          If she was crying or scared, I’d try to comfort her, just like I would want comforted if I were in her position. I spent many nights literally carrying her around the house as she would bury her face in my neck. I tried to be calm, when she couldn’t be. I learned to validate her fears from the past, but after I had done that, I redirected her to her new reality that she was no longer alone: I was with her and I would take care of her and protect her. It helped that the other girls (‘alters’) fronted as little girls because it helped me throw off the terrible maxims so many of us adults have been taught in our hyper-independent, western cultures to be strong, self-reliant and not ‘needy’.

          After a few years of us doing things our own way, I thought I ought to read and see why things were going relatively well for us, and that was when I ‘discovered’ attachment theory…but it was just stuff we’d been doing all along since we didn’t have anyone to tell me otherwise (that’s also when I found out I was doing things all ‘wrong’ according to the ‘experts’ despite how well she was doing, lol). After that I became a little more purposeful about some of the best points of that theory, but I in no way changed how we’d been doing things from the start.

          As for the ‘navel gazing’, my wife used to get caught up in that, too, and I try to steer her away from it. I tell her, “let’s just focus on the trauma and the dissociation, and the rest of the stuff will take care of itself” and for the most part that has been true.
          Sam

          • Power of suggestion works, especially when one is in a questioning state. To an expert one never measures up.
            They will tell us when we are fixed, which of course is never.

  5. Sorry, but I am an American and so live in a country that has no national health care, no right to housing, or a job, or to have a sense that I belong and that I matter.
    The intelligentsia prefers diagnosis over…community.
    Of course Madness is almost always the result of trauma. You cannot get and stay healthy without belonging, without friends, without hope. Leave a person alone long enough immersed in a terribly lonely prison and that person will choose fantasy over the impossible to survive pain of rejection.
    If a shrink wants to understand emotional dysfunction, live for a year on the street.
    Hugh Massengill, Eugene Oregon

  6. “Vulnerability to psychosis” is created when one is put on the antidepressants and/or antipsychotics, since both drug classes are anticholinergic drugs. Thus both drug classes can make a person vulnerable to ‘psychosis,’ via anticholinergic toxidrome.

    “According to R. D. Laing’s theory, ontological insecurity could lead to full blown psychosis when significant others interact with a person in a confusing, intense, and critical way.” Which is exactly the manner in which the child abuse and rape covering up and profiteering, DSM defaming, psychologists and psychiatrists behave.

    Since, of course, their belief that “all distress is caused by chemical imbalances in people’s brains” is an insane and confusing belief system, for those of us who have common sense. Was I really supposed to assume the ‘mental health’ workers’ thought that distress caused by 9/11/2001, right after 9/11, was caused by a “chemical imbalance” in my brain alone? My former “mental health” workers are insane people, who participated in political abuse of psychiatry and psychology, which is illegal. But so is covering up the abuse of a woman’s child, for a pastor.

    “One of the more surprising findings was the lack of a significant relationship between childhood trauma and the ‘positive’ symptoms of hallucinations and delusions.” I don’t find this that surprising, as one who was not abused as a child. I did have “‘positive symptoms of hallucinations and delusions,” during my drug withdrawal induced super sensitivity manic psychosis. Although, the drug induced anticholinergic toxidrome psychosis was disgusting.

    This ‘positive’ awakening to my subconscious dreams was not bothersome to me, just to doctors who wanted to continue to profiteer off of attempting to neurotoxic poison and defame me, one of whom is now in jail. This ‘positive’ psychosis/awakening to my subconscious dreams took the form of a born again story, which is not remotely bothersome for one who believes in God. And the theory that we are all “one in the Spirit, one in the Lord.”

    Which is largely the opposite of having a “Vulnerability to psychosis, wherein the self is experienced as lacking in coherence and consistency, precariously separated from the body, others, and the world and on the brink of disintegration into psychosis.”

    Sometimes having a “vulnerability to psychosis” is merely caused by being given, then withdrawn from, the anticholinergic drugs, which include both the antidepressant and the antipsychotic drug classes.

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