Key Points
- Repeated trauma doesn’t directly cause psychosis – it sets off a chain reaction involving insecure attachment and dissociation.
- Disorganized attachment (feeling torn between seeking closeness and fearing it) can amplify dissociation, making reality feel fragmented.
- Dissociation—like the mind hitting an “emergency eject button”—was strongly linked to hallucinations and delusions.
- Social rank, once thought important, played little role in these pathways.
- Findings highlight the need for therapies that target trauma, attachment wounds, and dissociation in psychosis care.
A mind caught between safety and fear
Imagine being a child whose caregiver is both your shelter and your storm.
You run to them for safety, only to feel fear in their arms.
That push–pull confusion doesn’t vanish – it leaves deep tracks in the mind.
For some, those tracks may one day curve toward psychosis.
A new clinical study explored exactly how trauma leaves such lasting fingerprints on mental health.
Instead of assuming trauma directly causes psychosis, researchers asked: what hidden steps link the two?
Following the trail from trauma to psychosis
The team worked with 71 people receiving care for psychosis-related diagnoses.
Rather than scanning brains in a lab or running large population surveys, they sat down with real patients, gathering detailed histories.
Participants completed structured interviews and questionnaires about traumatic events, patterns of attachment, feelings of social rank, and dissociative experiences.
Symptoms like hallucinations and delusions were also carefully rated.
By running advanced statistical models, the researchers tested whether trauma leads straight to psychosis – or whether it flows through a chain of psychological processes first.
Trauma doesn’t march straight to psychosis
Surprisingly, trauma on its own wasn’t enough to predict psychosis symptoms.
It was only repeated trauma, events that struck more than once, that showed a strong link.
Like water dripping on stone, recurrence seemed to carve deeper grooves into the psyche.
But even then, the story wasn’t simple cause and effect.
Trauma’s influence faded once the researchers accounted for attachment and dissociation.
Something else was carrying the weight.
Attachment as a cracked compass
Attachment is our inner compass for relationships, shaped in early caregiving.
Secure attachment points toward trust and safety.
Insecure forms – anxious, avoidant, and especially disorganized attachment – spin the needle wildly.
Disorganized attachment is like trying to use a compass that both points north and south at once.
It often develops when caregivers are simultaneously comforting and frightening.
In this study, trauma strongly predicted disorganized attachment.
Dissociation: the mind’s emergency exit
Enter dissociation. Think of it as the mind pulling a fire alarm to escape overwhelming distress.
People may feel detached from their bodies (depersonalization), sense the world as unreal (derealization), or wall off painful memories.
The study found dissociation was the bridge between trauma, attachment, and psychosis.
When trauma led to disorganized attachment, this in turn increased dissociation – which then made hallucinations and delusions more likely.
It wasn’t trauma itself whispering strange voices or distorting reality. It was trauma’s ripple through attachment and dissociation.
Social rank—less central than expected
Researchers also looked at social rank – how people see themselves in relation to others, whether as insiders or outsiders, dominant or subordinate.
Past theories suggested low social rank might feed paranoia or voice-hearing.
Yet in this clinical sample, social rank didn’t significantly predict psychosis once other factors were considered.
The authors suggest shame – a close cousin of social rank – may be the missing piece for future research.
Why it matters
For years, psychosis was seen as a brain disease disconnected from lived experience. This study adds to a growing body of evidence showing trauma plays a powerful, though indirect, role.
The key message: trauma reshapes how people connect and cope, and these changes make psychosis more likely.
For clinicians, the findings underline the need to address attachment wounds and dissociation directly – not just treat psychotic symptoms.
Compassion-focused therapy, attachment-based imagery, and trauma-informed CBT are promising routes.
For individuals and families, the takeaway is equally vital: psychosis isn’t simply “out of the blue.”
It often emerges from deep patterns of surviving overwhelming experiences.
Healing, then, is not just about dampening symptoms – it’s about rebuilding safety, trust, and connection.
Reference
Grady, S., Crowley, N., Scott, S., Ndukwe, C. I., Donohoe, R., & Gaynor, K. (2025). Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample. British Journal of Clinical Psychology, 64(2), 385–402. https://doi.org/10.1111/bjc.12511
