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In pragmatic language, there is an intentional distinction between the literal meaning of what is said, and what the speaker actually means. Previous neuroimaging investigations of pragmatic language have contrasted it with literal language; however, such contrasts may have been confounded by the higher levels of ambiguity in pragmatic language. Here, we used functional magnetic resonance imaging (fMRI) to compare pragmatic sentences (specifically requiring the interpretation of nonliteral meaning in the form of hints) with unintentionally ambiguous scenarios. Analysis showed that ambiguous language activated brain areas recognized to play a role in generating a theory of mind (ToM) that have previously been argued to support understanding of pragmatic language, specifically medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and temporoparietal junction (TPJ). In contrast, the pragmatic scenarios drew on anterior temporal, superior parietal lobule, in addition to precuneus. While no effect of gender was found for unintentionally ambiguous stimuli, females showed greater activity than males within mPFC and inferior frontal gyrus (IFG) for pragmatic scenarios – regions thought to be involved in cognitive and affective empathy, respectively. Findings suggest that while areas underpinning ToM are sufficient to support meaning derivation in the context of ambiguity, reasoning about pragmatic intent is more reliant on access to self-referential memory.

Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis.

Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis.