A Structural Model of Positive Symptoms of Schizophrenia Disorder Based on Object Relations, Reality Testing, and Family Functioning

Schizophrenia is a disorder that, despite affecting a small percentage of the population, causes enormous damage. Numerous researchers believe that schizophrenia is rooted in the interaction of genetic, biopsychosocial, and family factors and the pathology of their parents. Ego functions are among the components that essentially affect explaining the psychoanalysis model of schizophrenia. Thematic and fact–checking relationships are among the functions of the ego, i.e., considered important in psychopathology. In addition to the theoretical approaches of psychodynamics, what is currently emphasized as an important research finding, is the role of relationships and family environment as characteristics affecting the incidence of schizophrenia. There exist multiple research gaps in identifying the relationship between the severity of the positive symptoms of schizophrenia based on object relations and family functioning; therefore, the present study aimed to investigate the mediating role of reality testing in the relationship between object relations and family functioning, and the positive symptoms of schizophrenia.

The present correlational study employed structural equation modeling. The statistical population of this study consisted of all patients with schizophrenia and their families referring to 505 Hospital in Tehran City, Iran, in 2019. According to the inclusion criteria of the study (all patients with schizophrenia who were diagnosed by psychiatrists with the positive and negative symptoms of schizophrenia; were visited in the outpatient ward, in the period of relative recovery; feeling the need for low therapeutic intervention; patients with an age range of 20 to 50 years; patientschr('39') willingness to participate in the study), 250 patients were selected by convenience sampling method. The required data were collected using the Bell Object Relations and Reality Testing Inventory (Bell et al., 1986), the Family Functioning Scale (Epstein et al., 1983), and the Schizophrenia Positive and Negative Symptoms Scale (Kay et al., 1987). The obtained data were analyzed using structural equation modeling in SPSS and AMOS. The significance level of the tests in this study was set at 0.05.

The present research findings suggested that the total path coefficient (total direct & indirect path coefficient) between object relations and the severity of positive symptoms (β=0.68, p<0.001) was positive and significant. Besides, the total path coefficient between family functioning and the severity of positive symptoms (β=0.44, p<0.001) was positive and significant; the direct path coefficient between object relations and the severity of positive symptoms (p<0.001, β=0.23) was positive and significant. Moreover, the path coefficients between family functioning and the severity of positive symptoms (p<0.001, β=0.44), as well as between object relations and reality testing (p<0.001, β=0.22) were positive and significant. Additionally, path coefficients between family function and reality testing (p<0.001, β=–0.24) and realism on the severity of positive symptoms (p<0.001, β=–0.29) were negative and significant. Finally, the indirect path coefficient between object relations and the severity of positive symptoms (p<0.001, β=0.45) was positive and significant. The calculated goodness–of–fit indices of the relationships between positive symptom severity, object relations, reality testing, and family functioning suggested that reality testing mediated the relationship between object relations and family functioning, and the positive symptoms of schizophrenia (AGFI=0.89, RMSEA=0.066).

Based on the current study findings, reality testing played a mediating role in the relationship between object relations and family functioning, and the severity of the positive symptoms of schizophrenia.