The association between attachment insecurity and negative symptoms in clinical and non‐clinical populations: A systematic review and meta‐analysis

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PURPOSE: Attachment insecurity has been theorised to be associated with the development and maintenance of negative symptoms. Previous reviews examining the relationship between attachment insecurity and negative symptoms of psychosis have produced conflicting findings. Using meta-analytic techniques, the current study sought to systematically appraise the relationship between attachment insecurity dimensions, total negative symptoms and domains of negative symptoms. METHODS: A systematic review of literature published on electronic databases (PubMed, Ovid MEDLINE, EMBASE, PsycINFO) up to October 2025. RESULTS: Twenty-two studies met inclusion criteria (n = 6507; mean age 27.76 years; 35.1% male) and comprised clinical samples (k = 14) and non-clinical samples (k = 9). Five studies achieved a low risk of bias score. A small, significant average association was found between negative symptoms and attachment anxiety in clinical and non-clinical samples. A small, significant average association was found between attachment avoidance and negative symptoms in clinical samples, while a moderate-sized, significant average association was found in non-clinical samples. Differing strengths of association were found between attachment dimensions and each of the negative symptom domains. CONCLUSION: Future research should use measures that adhere to the NIMH consensus definition and should also explore the impact of attachment insecurity on individual negative symptoms. PRISMA/PROSPERO: This review was conducted in line with PRISMA guidance. The review protocol was registered on Prospero on the 16 August 2022. https://www.crd.york.ac.uk/PROSPERO/view/CRD42022353927.

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