Deficits in theory of mind and social anxiety as independent paths to paranoid features in schizophrenia

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Abstract

Research suggests paranoia among persons with schizophrenia may be the result of a number of different psychological processes including deficits in theory of mind (ToM) and social anxiety. To test this hypothesis, this study sought to determine whether a group of highly paranoid persons with and without a ToM deficit could be detected and whether the group with paranoia and better ToM might have high levels of social anxiety. To explore this, a cluster analysis was performed on a group of 102 adults with schizophrenia spectrum disorders in a non-acute phase of illness on the basis of ratings of paranoid features using the Positive and Negative Syndrome Scale and levels of ToM deficit using a factor score which summarized four different ToM assessments. Four groups were produced: High Paranoia/Poor ToM (n = 14); Low Paranoia/Good ToM (n = 22); Low Paranoia/Low Middle ToM (n = 29); and High Paranoia/High Middle ToM (n = 23). Groups were then compared on self report of social anxiety. As predicted, the group with levels of high paranoid features and relatively better ToM performance had significantly higher levels of social anxiety than all other groups.

Section snippets

Participants

Participants were 76 adult men and 12 women with SCID (Spitzer, Williams, Gibbon, & First, 1994) confirmed DSM-IV diagnoses of schizophrenia (n = 51) or schizoaffective disorder (n = 37) engaged in outpatient treatment in a VA Medical Center (n = 72) or a Community Mental Health Center (n = 16). The mean age and education were 49.72 (SD = 3.38) and 12.79 (SD = 1.75). The median number of psychiatric hospitalizations was five. All were in a non-acute phase of illness as defined by no hospitalizations or

Results

To determine whether a factor score could be produced representing overall capacity for ToM a principal components analysis was performed considering all four ToM measures. This revealed one factor with an Eigen value > one (2.26) accounting for 57% of the variance. Next, to determine whether we could detect groups with equivalently high and low levels of suspiciousness, both with and without relative impairments, the PANSS suspiciousness item was normalized and a K-Means cluster analysis was

Discussion

In the current study, we explored the possibility that two constructs may lead either separately or in combination with one another to paranoia in schizophrenia: ToM deficits which make others' motives inscrutable and social anxiety which leads to the expectation of rejection and behavior guided by malicious intent. In particular, we sought to detect two groups of persons with paranoia, one with deficits in ToM and one with especially high levels of social anxiety but not necessarily poor ToM

Role of Funding Source

Portions of this study were funded by the VA Rehabilitation Research and Development Service. This body played no role in study design; the collection, analysis and interpretation of data, in the writing of the report; and in the decision to submit the paper for publication.

Contributors

Lysaker, Olesek, Salvatore, Grant, Buck, Nicolo, Procacci and Dimaggios were involved in literature searches. Lysaker undertook the statistical analyses. Lysaker wrote the complete first draft and all authors subsequently made meaningful contributions to the writing. All authors contributed to and have approved the final manuscript.

Conflict of Interest

There are no conflicts of interest.

Acknowledgements

Research was funded in part by the Veterans Administration Rehabilitation Research and Development Service.

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