Attachment representations in individuals diagnosed with schizophrenia: A projective study through the bird’s nest drawing

Volkan Demir

doi:10.18621/eurj.1742863

Attachment representations in individuals diagnosed with schizophrenia: A projective study through the bird’s nest drawing

Abstract

Objectives: This study aims to explore the attachment representations of individuals diagnosed with schizophrenia through the Bird’s Nest Drawing, a projective technique. It also seeks to compare the findings with those of individuals without a schizophrenia diagnosis to identify potential differences in attachment-related imagery and narrative themes.

Methods: A total of 100 participants took part in the study: 50 individuals diagnosed with schizophrenia and 50 without any psychiatric diagnosis. Each participant was asked to draw a bird’s nest and write a brief narrative about their drawing. Quantitative data were analyzed using chi-square tests. Qualitative analysis was conducted through thematic evaluation of narratives from 15 randomly selected participants from each group.

Results: Quantitative analysis showed statistically significant group differences in several aspects of the drawings, including the presence of parent bird and chick/egg, use of appropriately colored figures, frequent use of green, and whether the nest touched a surface. Qualitative analysis revealed that narratives of individuals with schizophrenia included themes of loneliness, mistrust, unmet basic needs, and disconnection from the nest. Conversely, narratives of individuals without schizophrenia reflected familial closeness, caregiving, and emotional security.

Conclusions: The results suggest that individuals with schizophrenia project attachment-related difficulties - such as distrust, disconnection, and impaired bonding - more prominently in both their drawings and written narratives. The BND test appears to be a meaningful tool for exploring attachment dynamics at the projective level in clinical populations.

Keywords

Ethical Statement

This study was approved by the Istanbul Kent University Social and Human Sciences Ethics Committee (Decision No: 2025/06; date: 01.07.2025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.

References

1. Ainsworth MDS, Blehar MC, Waters E, Wall S. Editors. Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum, 1978.
2. Bowlby J. Attachment and Loss, Vol. 1: Attachment. Basic Books, 1969.
3. Cassidy J, Shaver PR. Handbook of Attachment: Theory, Research, and Clinical Applications. 2nd ed.. Guilford Press, 2008.
4. Mikulincer M, Shaver PR. Attachment in Adulthood: Structure, Dynamics, and Change. Guilford Press, 2007.
5. Dozier M, Stovall-McClough KC, Albus KE. Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of Attachment. Guilford Press, 2008: pp. 718–744.
6. Liotti G. Trauma, dissociation, and disorganized attachment: three strands of a single braid. Psychotherapy. 2004;41(4):472-486. doi: 10.1037/0033-3204.41.4.472.
7. Berry K, Barrowclough C, Wearden A. A review of the role of adult attachment style in psychosis: unexplored issues and questions for further research. Clin Psychol Rev. 2007;27(4):458-475. doi: 10.1016/j.cpr.2006.09.006.
8. Mikulincer M, Shaver PR. An attachment perspective on psychopathology. World Psychiatry. 2012;11(1):11-15. doi: 10.1016/j.wpsyc.2012.01.003.

9. Karakuş G, Kocal Y, Sert D. [Schizophrenia: Etiology, Clinical Features and Treatment]. Arşiv Kaynak Tarama Dergisi. 2017;26(2): 251-267. doi: 10.17827/aktd.303574. [Article in Turkish]
10. Summakoğlu D, Ertuğrul B. [Schizophrenia and its treatment]. Lectio Scientific. 2018;2(1):43-61. [Article in Turkish]
11. Bifulco A, Kwon J, Jacobs C, Moran PM, Bunn A, Beer N. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2006;41(10):796-805. doi: 10.1007/s00127-006-0101-z.
12. Read J, Gumley A. Can attachment theory help explain the relationship between childhood adversity and psychosis? In Telling Stories? Routledge, 2019: p. 51-94.
13. Nilsson A. Differentiation between patients with schizophrenia and borderline disorders in the Percept-genetic Object-Relation Test, PORT. Br J Med Psychol. 1995;68(4):287-309. doi: 10.1111/j.2044-8341.1995.tb01837.x.
14. Kaiser DH. Indications of attachment security in a drawing task. Arts Psychother.1996;23(4):333-340.
15. Demirbağ B. Kuş Yuvası Çizim Testinin Türkçeye Uyarlanması, Geçerlik ve Güvenirlik Çalışması. Yüksek Lisans Tezi, Ankara: Gazi Üniversitesi, 2016.
16. Akba Ö, Demir V. Analyzing Attachment Representations and Aggression Tendencies of Individuals Diagnosed with Psychosomatic Skin Disease through Drawing Method. Psikiyatride Güncel Yaklaşımlar. 2024;16(Suppl 1): 303-316. doi: 10.18863/pgy.1509412.
17. Gül K, Demir V. [Investigation of Attachment Representations and Personality Traits of Individuals with Alcohol and Substance Use Disorder by Drawing Pictures: Projective Research]. Bağımlılık Dergisi. 2025;26(1):47-58. doi: 10.51982/bagimli.1502012. [Article in Turkish]
18. Yıldırım A, Şimşek H. Sosyal bilimlerde nitel araştırma yöntemleri (11. baskı). Seçkin Yayıncılık, 2018.
19. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inform. 2004;22(2):63-75. doi: 10.3233/EFI-2004-22.
20. Miles MB, Huberman AM, Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed. Calif.: SAGE Publications, 1994.
21. Dişçi R. Temel ve Klinik Biyoistatistik. İstanbul Medikal Yayıncılık, 2008.
22. Akoğlu B. Resim ve Çocuğun İç Dünyasına Yolculuk. İstanbul, Nobel Akademik Yayıncılık, 2023.
23. Ebrinç S, Çetin M, Başoğlu C, et al. [Research of family functionality, social support and expression of emotion in schizophrenic patients and their families]. Anadolu Psikiyatri Derg. 2001;2(1):5-14. [Article in Turkish]
24. Karancı AN. Şizofren hasta yakınlarının dünyası: Nedensel atıflar, yükler ve umutlar. Şizofreni Yazıları. 2000;1(1): 6-12.
25. Tüzer V, Zincir S, Başterzi AD, Aydemir Ç, Kısa C, Göka E. [Assessment of Expressed Emotion and Family Environment in Schizophrenic Patients]. Klinik Psikiyatri. 2003;6(4):189-197. [Article in Turkish]
26. Francis D, Kaiser D, Deaver SP. Representations of Attachment Security in the Bird's Nest Drawings of Clients with Substance Abuse Disorders. Art The. 2003;20(3):125-137. doi: 10.1080/07421656.2003.10129571.
27. Shen H, Wang SH, Zhang Y, et al. Color painting predicts clinical symptoms in chronic schizophrenia patients via deep learning. BMC Psychiatry. 2021;21(1):522. doi: 10.1186/s12888-021-03452-3.
28. Uzun S, Aslan Ç. Schizophrenia Patients’ Perceptions of Belongingness and Expectations from Society. Reserach Square. 2023. doi: 10.21203/rs.3.rs-2703461/v1.
29. Barut JK, Dietrich MS, Zanoni PA, Ridner SH. Sense of Belonging and Hope in the Lives of Persons with Schizophrenia. Arch Psychiatr Nurs. 2016;30(2):178-184. doi: 10.1016/j.apnu.2015.08.009.
30. Handler L, Thomas AD. Drawings in assessment and psychotherapy. New York: Routledge/Taylor & Francis Group, 2014.
31. Aydın AB. Yetişkin bireylerde erken dönem uyum bozucu şemalar ve bağlanma stilleri ile ayrılık kaygısı arasındaki ilişkinin incelenmesi. Yüksek lisans tezi. İstanbul Gelişim Üniversitesi, 2020.
32. Conradi HJ, Boertien SD, Cavus H, Verschuere B. Examining psychopathy from an attachment perspective: The role of fear of rejection and abandonment. J Forensic Psychiatry Psychol. 2016, 27(1): 92-109. doi: 10.1080/14789949.2015.1077264.
33. Kaneda A, Yasui-Furukori N, Saito M, et al. Characteristics of the tree-drawing test in chronic schizophrenia. Psychiatry Clin Neurosci. 2010;64(2):141-148. doi: 10.1111/j.1440-1819.2010.02071.x.
34. Teneycke T, Hoshino J, Sharpe D. The bridge drawing: An exploration of psychosis. Arts Psychother. 2009;36(5):297-303. doi: 10.1016/j.aip.2009.07.003.
35. Iqbal S, Shah AA, Iqbal M. Emotional indicators across Pakistani schizophrenic and normal individuals based on Draw a Person Test. Pak J Soc Clin Psychol. 2013;11(1): 59-65.

Details

Primary Language

English

Subjects

Psychiatry

Journal Section

Research Article

Authors

Volkan Demir ^*
0000-0002-8148-8647
Türkiye

Early Pub Date

August 26, 2025

Publication Date

September 4, 2025

Submission Date

July 15, 2025

Acceptance Date

August 24, 2025

Published in Issue

Year 2025 Volume: 11 Number: 5

DOI

https://doi.org/10.18621/eurj.1742863

IZ

https://izlik.org/JA22DN84US

Cite

RIS / Bibtex

AMA

1.Demir V. Attachment representations in individuals diagnosed with schizophrenia: A projective study through the bird’s nest drawing. Eur Res J. 2025;11(5):989-1000. doi:10.18621/eurj.1742863

Cited By

Attachment representations in individuals diagnosed with schizophrenia: A projective study through the bird’s nest drawing

The European Research Journal

https://doi.org/10.18621/eurj.1742863