Explaining Paranoia: Cognitive and Social Processes in the Occurrence of Extreme Mistrust

Overview

Journal BMJ Ment Health

Specialties Psychiatry
Psychology

Date 2023 Nov 9

PMID 37945313

Authors

Daniel Freeman

Bao Sheng Loe

Affiliations

Soon will be listed here.

Abstract

Background: Paranoia-incorrectly thinking that others are deliberating trying to harm you-causes distress, undermines social interactions and leads to withdrawal. It presents across multiple psychiatric diagnoses.

Objective: The primary aim was to determine the extent that cognitive and social processes may explain paranoia. The secondary aim was to identify explanatory factors that distinguished paranoia and social anxiety.

Methods: 10 382 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, participated in a non-probability survey. All participants completed a paranoia measure and assessments of cognitive and social processes. Structural equation modelling was conducted.

Findings: 2586 (24.9%) participants described being mistrustful of other people. 1756 (16.9%) participants wanted help to trust more. 66.7% of variance in paranoia was explained by a model comprising (in descending order of importance): within-situation defence behaviours, negative images, negative self-beliefs, discrimination, dissociation, aberrant salience, anxiety sensitivity, agoraphobic distress, worry, less social support, agoraphobic avoidance, less analytical reasoning and alcohol use. All explanatory factors were associated with paranoia and social anxiety. Ten factors were more closely associated with paranoia than social anxiety, including discrimination, hallucinations, negative images, aberrant salience and alcohol use. Nine factors were more closely associated with social anxiety, including less positive self-belief, an external locus of control, worry and less analytical reasoning.

Conclusions: Multiple causes are likely to be involved in paranoia. Cognitive and social processes may explain a high degree of paranoia.

Clinical Implications: Multiple clear targets for intervention to reduce paranoia are identified.

Citing Articles

A randomised controlled test in virtual reality of the effects on paranoid thoughts of virtual humans' facial animation and expression.

Wei S, Freeman D, Harris V, Rovira A Sci Rep. 2024; 14(1):17102.

PMID: 39048648 PMC: 11269571. DOI: 10.1038/s41598-024-67534-4.

Understanding and Treating Persecutory Delusions.

Freeman D Schizophr Bull. 2024; 50(2):233-235.

PMID: 38309718 PMC: 10919765. DOI: 10.1093/schbul/sbae012.

References

Connor K, Davidson J, Churchill L, Sherwood A, Foa E, Weisler R . Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry. 2000; 176:379-86. DOI: 10.1192/bjp.176.4.379. View

Freeman D, Rosebrock L, Loe B, Saidel S, Freeman J, Waite F . The Oxford Positive Self Scale: psychometric development of an assessment of cognitions associated with psychological well-being. Psychol Med. 2023; 53(15):7161-7169. PMC: 10719672. DOI: 10.1017/S0033291723000624. View

Freeman D, Garety P, Bebbington P, Smith B, Rollinson R, Fowler D . Psychological investigation of the structure of paranoia in a non-clinical population. Br J Psychiatry. 2005; 186:427-35. DOI: 10.1192/bjp.186.5.427. View

Mirowsky J, Ross C . Paranoia and the structure of powerlessness. Am Sociol Rev. 1983; 48(2):228-39. View

Bell V, Halligan P, Ellis H . The Cardiff Anomalous Perceptions Scale (CAPS): a new validated measure of anomalous perceptual experience. Schizophr Bull. 2005; 32(2):366-77. PMC: 2632213. DOI: 10.1093/schbul/sbj014. View

Bentall R, Wickham S, Shevlin M, Varese F . Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 the Adult Psychiatric Morbidity Survey. Schizophr Bull. 2012; 38(4):734-40. PMC: 3406525. DOI: 10.1093/schbul/sbs049. View

Felix E, Sharkey J, Green J, Furlong M, Tanigawa D . Getting precise and pragmatic about the assessment of bullying: the development of the California Bullying Victimization Scale. Aggress Behav. 2011; 37(3):234-47. DOI: 10.1002/ab.20389. View

Freeman D, Gittins M, Pugh K, Antley A, Slater M, Dunn G . What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychol Med. 2008; 38(8):1121-32. PMC: 2830058. DOI: 10.1017/S0033291708003589. View

Freeman D, Dunn G, Murray R, Evans N, Lister R, Antley A . How cannabis causes paranoia: using the intravenous administration of ∆9-tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia. Schizophr Bull. 2014; 41(2):391-9. PMC: 4332941. DOI: 10.1093/schbul/sbu098. View

10.

Reeve S, Emsley R, Sheaves B, Freeman D . Disrupting Sleep: The Effects of Sleep Loss on Psychotic Experiences Tested in an Experimental Study With Mediation Analysis. Schizophr Bull. 2017; 44(3):662-671. PMC: 5890488. DOI: 10.1093/schbul/sbx103. View

11.

cernis E, Beierl E, Molodynski A, Ehlers A, Freeman D . A new perspective and assessment measure for common dissociative experiences: 'Felt Sense of Anomaly'. PLoS One. 2021; 16(2):e0247037. PMC: 7904139. DOI: 10.1371/journal.pone.0247037. View

12.

Freeman D, Emsley R, Diamond R, Collett N, Bold E, Chadwick E . Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial. Lancet Psychiatry. 2021; 8(8):696-707. PMC: 8311296. DOI: 10.1016/S2215-0366(21)00158-9. View

13.

Freeman D, Bird J, Loe B, Kingdon D, Startup H, Clark D . The Dunn Worry Questionnaire and the Paranoia Worries Questionnaire: new assessments of worry. Psychol Med. 2019; 50(5):771-780. PMC: 7168652. DOI: 10.1017/S0033291719000588. View

14.

Gracie A, Freeman D, Green S, Garety P, Kuipers E, Hardy A . The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatr Scand. 2007; 116(4):280-9. DOI: 10.1111/j.1600-0447.2007.01011.x. View

15.

Schulze K, Freeman D, Green C, Kuipers E . Intrusive mental imagery in patients with persecutory delusions. Behav Res Ther. 2012; 51(1):7-14. DOI: 10.1016/j.brat.2012.10.002. View

16.

Bird J, Fergusson E, Kirkham M, Shearn C, Teale A, Carr L . Paranoia in patients attending child and adolescent mental health services. Aust N Z J Psychiatry. 2021; 55(12):1166-1177. PMC: 8649424. DOI: 10.1177/0004867420981416. View

17.

Bush K, Kivlahan D, McDonell M, Fihn S, Bradley K . The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998; 158(16):1789-95. DOI: 10.1001/archinte.158.16.1789. View

18.

Fowler D, Freeman D, Smith B, Kuipers E, Bebbington P, Bashforth H . The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychol Med. 2006; 36(6):749-59. DOI: 10.1017/S0033291706007355. View

19.

Cicero D, Kerns J, McCarthy D . The Aberrant Salience Inventory: a new measure of psychosis proneness. Psychol Assess. 2010; 22(3):688-701. DOI: 10.1037/a0019913. View

20.

Pacini R, Epstein S . The relation of rational and experiential information processing styles to personality, basic beliefs, and the ratio-bias phenomenon. J Pers Soc Psychol. 1999; 76(6):972-87. DOI: 10.1037//0022-3514.76.6.972. View