Paranoia and instability of self-esteem in adolescents
Introduction
Paranoid ideas in general, and specifically persecutory ideas, which refer to incorrect beliefs that one is under the threat of someone or something, are the most common type of delusions or abnormal beliefs (e.g., Garety & Hemsley, 1987). Research aimed at furthering our understanding of the (psychological) factors involved in the development and maintenance of paranoia is of pivotal importance (Bentall et al., 2001, Freeman et al., 2002). It has become increasingly clear that paranoid ideation is a common experience in the general population, favouring a continuum approach to (paranoid) delusions (e.g., van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2009). Research on paranoid ideation in non-clinical samples may therefore advance our understanding of paranoia in general, and of the factors involved in the development and maintenance of paranoid/persecutory delusions more particularly (e.g., Combs and Penn, 2004, Freeman et al., 2005). The study of attenuated psychotic symptoms (in this case paranoid persecutory ideation) is also important in light of the international movement for an early detection of psychosis during adolescence, since an early intervention could delay or abort the conversion to schizophrenia spectrum disorders (e.g., Welham et al., 2009); but not necessarily (Dhossche, Ferdinand, Van der Ende, Hofstra, & Verhulst, 2002), as symptoms are common in adolescents but sometimes transient, and psychosis must always be viewed within a context in which multiple factors (e.g., genetic and social) operate in combination (van Os et al., 2009).
The idea that self-esteem (SE) is in some way implicated in the development of paranoid beliefs has been repeatedly advanced in the literature (e.g., Colby, 1977). Research on SE in paranoia, however, has yielded inconsistent findings. Some studies found that paranoia is associated with low SE, both in non-clinical groups (e.g., Combs and Penn, 2004, Ellett et al., 2003), and in patients with persecutory delusions (Drake et al., 2004). Yet other studies showed that SE levels in paranoid patients are relatively high or normal (e.g., Lyon, Kaney, & Bentall, 1994).
Bentall et al. (2001) suggested that a potential explanation for this inconsistency is that prior studies focused on global level of SE, without taking into account the temporal instability of SE. If one assumes that SE in paranoia is relatively unstable over time, then this can explain the mixed results of previous studies. It would also mean that SE instability might play a more important role in paranoia than global level of SE (Bentall et al., 2001). Interestingly, two recent studies provided just such evidence. Thewissen et al. (2006) found that SE instability was associated with the presence of paranoid symptoms in a general population sample (age range: 18–64). Similar findings were reported by Thewissen, Bentall, Lecomte, and van Os (2008) who showed that paranoia was associated with higher instability of SE in a group of individuals, ages 18–77, ranging across the continuum in level of paranoia.
The association between paranoia and unstable SE fits with one of the predictions of Bentall et al., 2001, Thewissen et al., 2006, Thewissen et al., 2008, according to which paranoid ideas are the consequence of attempts to protect oneself from negative thoughts and feelings about the self. Consequently, the idea is that paranoia, or the conviction that disappointments and negative events in one’s life are caused by intentional actions of others (i.e. attributing threatening events to the actions of other people), serves a self-defensive function. Given that such defensive attempts can be expected to often be ineffective, it is predicted that SE will typically be highly unstable in individuals scoring high on paranoia (Thewissen et al., 2006, Thewissen et al., 2008), which was precisely the pattern observed in both studies.
The aim of the present study was to further investigate the relationship between paranoia and SE instability in a sample of (mainly mid-)adolescents. As mentioned, so far only two studies looked at this relationship. In the first study (Thewissen et al., 2006) paranoia was defined as the presence/absence of paranoid symptoms, using a diagnostic interview. In our study we used a dimensional measure of paranoia. One such scale is the Paranoia Scale (PS; Fenigstein & Vanable, 1992), which is without any doubt the most widely used paranoia scale in clinical and non-clinical individuals. The PS was also used in the second study that examined instability of self-esteem in relation to paranoia (Thewissen et al., 2008). However, a good many of the items in the PS are not clearly persecutory (see Freeman et al., 2005). As such, the PS, rather than being a measure of persecutory ideation specifically, is an instrument assessing general paranoid ideation, including other components of paranoia (e.g., ideas of reference) in addition to persecutory ideas (McKay, Langdon, & Coltheart, 2005, p. 234). Also, the PS only provides an estimate of the degree to which respondents find these items applicable to them, but not of the degree of conviction and distress of paranoid thoughts. Therefore, Freeman and colleagues (2005) developed the Paranoia Checklist (PCL), which consists of items of a more clinical nature, all of them clearly persecutory. Moreover, the PCL not only assesses the frequency of persecutory paranoid thoughts, but also the degree of conviction and the level of associated distress. In the present study, we included both the PS (to compare our findings to those of Thewissen and colleagues) and the PCL (to extend prior findings to a multidimensional measure of paranoia consisting of items that are more clearly persecutory and closer to paranoid ideation of a clinical nature).
The golden standard to measure SE instability is the calculation of within-participant standard deviation scores of SE over repeated assessments (see e.g., Kernis, Cornell, Sun, Berry, & Harlow, 1993) as for example implemented in Thewissen et al. (2006). However, given that it is not always possible to assess participants’ level of SE repeatedly, researchers have advanced scales to measure SE instability with a single assessment (e.g., Kernis et al., 1992, Rosenberg, 1965). In light of various limitations (e.g., complex wording of items and/or instructions) of those scales (see e.g., Chabrol, Rousseau, & Callahan, 2006), we developed a new self-report scale directly assessing instability of SE, keeping the wording of items as simple and unambiguous as possible: The SE Instability Scale (SEIS). Preliminary validation showed that the SEIS has promising psychometrics (see below).
In summarizing, the primary aim of the present study was to examine the relationship between paranoia and SE instability in a group of mid-adolescents. Our study attempts to extend prior research in the following ways. First, it is the first to study the relationship between paranoia and SE instability using the PCL. This will allow us to examine with which dimension of paranoid ideation SE instability is mostly associated. Second, the current study is the first to use a self-report measure to assess SE instability in relation to paranoia. Third, participants in our study were all mid-adolescents, an age group that has typically been excluded in prior work on the relation between SE (instability) and paranoia, but is highly relevant given the typical decline of global SE from childhood to adolescence (e.g., Robins, Trzesniewski, Tracy, Gosling, & Potter, 2002) and the typical onset of schizophrenia from mid-adolescence to the mid-20s. Finally, because one and the same lab conducted the only two studies reporting evidence for the relationship between paranoia and SE instability, it would be useful to see this pattern of results replicated by an independent group of researchers.
As a secondary aim, we examined to what extent global SE level is associated with paranoia, as this remains an issue of considerable debate. We were especially interested to see whether (global) level of SE would still be significantly associated with paranoia, once SE instability is taken into account. A third and final aim was the preliminary psychometric evaluation of the newly developed Dutch translation of the original English PCL.
Section snippets
Participants
One hundred and thirty one students (92 women) from the last two years of secondary school participated voluntarily. Eighty-five (65%) were recruited from the ‘Katholieke Centrumscholen Sint-Truiden’; forty-six (35%) were recruited from the ‘Sancta-Maria Instituut Aarschot’. The mean age was 16.54 years (SD = 0.72; range: 15–19, with 90% aged 16–17).
Materials
The Paranoia Scale (PS; Fenigstein & Vanable, 1992) is a 20-item self-report scale measuring paranoia. Items are rated on a 5-point scale, ranging from not at all applicable to extremely applicable. Good psychometric properties are reported (Fenigstein & Vanable, 1992). Cronbach’s alpha in the present sample was 0.89.
The Paranoia Checklist (PCL; Freeman et al., 2005) is an 18-item self-report scale to investigate paranoid thoughts. All items are rated on three 5-point scales for frequency,
Psychometric evaluation of the Dutch Paranoia Checklist
Cronbach’s alpha was 0.82, 0.88, and 0.91 for the Frequency, Conviction, and Distress subscales, respectively, indicating satisfactory reliability. Like the original PCL, there was convergent validity of the Dutch PCL with the PS: higher scores on the PS correlated with PCL-Frequency, r(126) = 0.71, Conviction, r(126) = 0.66, and Distress, r(123) = 0.40, (all ps < 0.001). Descriptive statistics can be found in Table 1.
Is paranoia associated with SE instability?
We performed four hierarchical (blockwise entry) regression analyses with SE
Discussion
The present study aimed to examine the association between paranoia and both SE and instability of SE in a non-clinical sample of mid-adolescents. At least one important impetus for a recent increased interest for this topic came from Bentall et al.’s (2001) model according to which paranoid delusions are developed defensively, for the maintenance of SE. However, research findings with respect to this relation between SE and paranoia are mixed. Paranoia has been found to be associated with both
Acknowledgements
Filip Raes and Dinska Van Gucht, Department of Psychology, University of Leuven, Belgium.
We thank Alexia Grauls for her assistance in conducting this study, and Daniel Freeman for helpful comments on an earlier draft.
Correspondence concerning this article should be addressed to Filip Raes, Department of Psychology, University of Leuven, Tiensestraat 102, B-3000 Leuven, Belgium. Electronic mail may be sent to [email protected].
References (24)
- et al.
Persecutory delusions: A review and theoretical integration
Clinical Psychology Review
(2001) - et al.
The role of subclinical paranoia on social perception and behavior
Schizophrenia Research
(2004) - et al.
Paranoia, persecutory delusions and attributional biases
Psychiatry Research
(2005) - et al.
Beck depression inventory
(1996) - et al.
Preliminary results of a scale assessing instability of self-esteem
Canadian Journal of Behavioural Science
(2006) Appraisal of four psychological theories of paranoid phenomena
Journal of Abnormal Psychology
(1977)- et al.
Diagnostic outcome of self-reported hallucinations in a community sample of adolescents
Psychological Medicine
(2002) - et al.
The evolution of insight, paranoia and depression during early schizophrenia
Psychological Medicine
(2004) - et al.
Paranoia in a nonclinical population of college students
Journal of Nervous and Mental Disease
(2003) - et al.
Paranoia and self-consciousness
Journal of Personality and Social Psychology
(1992)
Psychometric properties of the Dutch Rosenberg self-esteem scale
Psychologica Belgica
Psychological investigation of the structure of paranoia in a non-clinical population
British Journal of Psychiatry
Cited by (13)
The association of self-esteem variability with diurnal cortisol patterns in a sample of adult workers
2023, Biological PsychologyCognitive and social cognitive deficits in paranoia
2019, Social Cognition in PsychosisCognitive, affective, and social factors maintaining paranoia in adolescents with mental health problems: A longitudinal study
2017, Psychiatry ResearchCitation Excerpt :Items refer to general feelings about the self and are rated on a 0–4 scale (0 = strongly disagree, 3 = strongly agree), with lower scores indicating lower self-esteem. The RSES has good internal consistency (α = 0.86; Sinclair et al., 2010) and has been used in adolescents with paranoia (Raes and Van Gucht, 2009). Finally, the social competence, academic competence, and physical appearance subscales of the Self-Perception Profile (SPP; Harter, 2012) were used to measure adolescent self-concepts.
The relevance of self-esteem and self-schemas to persecutory delusions: A systematic review
2013, Comprehensive PsychiatryCitation Excerpt :Consistent with the results from patients' samples, the three nonclinical studies also found evidence for the relevance of instability of self-esteem to paranoia proneness [20,79,80]. Raes and Van Gucht [80] found higher self-reported fluctuations in self-esteem to be associated with higher paranoid ideation. Moreover, Thewissen [20] assessed self-esteem three times over a period of two years and found higher fluctuations in self-esteem to be accompanied by higher levels of subclinical paranoia.
Self-attacking and self-reassurance in persecutory delusions: A comparison of healthy, depressed and paranoid individuals
2013, Psychiatry ResearchCitation Excerpt :Moreover, one particular strength of the ASR model is that it predicts a reciprocal link between self-esteem instability and extreme attributions (Kernis et al., 1993), of which persecutory delusions might be considered a paradigmatic example. The results of recent cross-sectional, longitudinal and experience-sampling research support this prediction, in that paranoia has been linked to both low self-esteem and fluctuations in self-esteem (Thewissen et al., 2007; Thewissen et al., 2008a; Raes and Van Gucht, 2009; Thewissen et al., 2011), although a recent analysis of an older dataset did not replicate this (Palmier-Claus et al., 2011). Other work has demonstrated that perceived deservedness of persecution is also highly variable in persecutory delusions, a finding that is again consistent with a dynamic conceptualisation of self-esteem in paranoia (Melo et al., 2006).
Evaluating a Values-Based Intervention for Adolescence with High Nonclinical Paranoia: A Schools-Based Randomised Control Trial
2022, Cognitive Therapy and Research