Psychosis and Serious Mental Illness (SMI): The Role of Family Factors and Emotional Dysregulation

The present thesis presents two studies with an aim to explore the pathway from psychosis proneness to persistence and persistence to impairment or serious mental illness (SMI) with a specific focus on early childhood experiences and emotional processes that contribute to vulnerability. The first study reports on a meta-aggregative systematic review exploring the lived experiences of Adult-Children of Parents with Mental Illness (Adult-COMPI) across childhood and adulthood. It identified three synthesised findings: (i) Childhood Experiences (trauma, silencing, parentification, coping strategies), (ii) Support in Childhood (from professional services, family, and community), and (iii) the Impact on Adulthood (parenthood, relationships, resilience). The findings suggest that Adult-COMPI represent a nosological “pragmatic subgroup” with distinct psychological difficulties. Identification of Adult-COMPI as a pragmatic subgroup gives the opportunity for effective transdiagnostic early intervention and prevention. The second study examines the role of emotional regulation (ER) in predicting delusional ideation and associated distress, conviction and preoccupation in a general population sample reporting psychotic-like experiences (PLE’s). Using a cross-sectional design, the research found that difficulties in ER and alexithymia significantly predicted delusional experiences. ER accounted for 30% of the relationship between delusional beliefs and psychiatric diagnosis. These findings suggest that emotional dysregulation plays a key role across the psychosis continuum, highlighting the potential benefits of interventions targeting emotional dysregulation. Taken together, these findings suggest that ER difficulties and exposure to parental SMI may represent a common risk linking early developmental adversity to later vulnerability and impairment within psychosis and other mental health difficulties.