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Delusion types, such as paranoia and grandiosity, will share contributory factors, but they are also expected to have associated features that set them apart ( 17, 18). Grandiosity is present in the general population, although prevalence rates vary widely based on sample (8–65%) ( 16, 17). Grandiose ideation reflects the belief that one has special powers, abilities, or purpose. Paranoia is one type of delusion another is grandiosity. Studying paranoia in the general population has the notable advantage of enabling larger sample sizes, which can, for example, provide the power to test differential associations. Studying milder variants of paranoia can inform the understanding of clinical disorder. Greater endorsement of paranoid thinking has been associated with increased suicidal ideation, greater substance use, poor social functioning, and lower levels of happiness ( 15). Even at sub-clinical levels, paranoia is clinically relevant. Approximately 10% of individuals without a psychotic disorder endorse the belief that others have been trying to harm them or their interests ( 13) and 10–20% of individuals endorse paranoid thoughts with strong conviction and significant distress ( 14).
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Paranoia is common in the general population ( 12). Persecutory delusions are the extreme end of a paranoia continuum that describes unfounded ideas that others intend you harm ( 11). Critically, treatments targeting worry, negative self-beliefs and insomnia improve persecutory delusion severity in patients with schizophrenia ( 5– 9), bolstering evidence that they are causal factors of persecutory ideation ( 10). Sleep disturbance also contributes to persecutory ideation by increasing negative affect, mood dysregulation, and anomalous internal states. Negative self-beliefs increase feelings of inferiority and vulnerability to harm from others. Worry brings the threat belief to mind and keeps it there, reducing exploration of alternative perspectives and increasing psychological distress.
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This model suggests a number of factors that contribute to persecutory delusion onset and maintenance ( 5). The threat anticipation model, a targeted cognitive-behavioral model of persecutory delusions, has been proposed in order to inform treatment development ( 4). Defining appropriate and specific cognitive-behavioral models of psychiatric symptoms is therefore an important step toward effective and individualized treatments. Meta-analysis indicates that studies targeting specific contributory factors (e.g., self-esteem, worry) may demonstrate greater effects on the improvement of delusion severity than a broader, formulation-driven cognitive-behavioral therapy for psychosis (CBTp) approach ( 3). The study of delusions has benefited from this approach. Increasingly, research is focused on leveraging cognitive-behavioral models to identify appropriate treatment targets ( 1, 2). This suggests a degree of specificity of contributory factors to different types of delusional thinking, supporting the pursuit of specific psychological models and treatments for each delusion type.ĭeveloping precise psychological models of mental experiences is critical for advancing treatment. We extend these findings by demonstrating that these contributory factors, particularly worry and negative self-beliefs, are associated with paranoid ideation to a greater extent than grandiosity. We replicate previous reports that worry, negative self-beliefs and sleep quality are associated with paranoid ideation in the general population. Relationships with sleep quality were similar. Grandiosity demonstrated significantly weaker relationships with worry and negative self-beliefs. Paranoia was significantly associated with worry, negative self-belief, and sleep quality. Correlations were compared using Fisher's r-to-z transform to examine whether the magnitude of relationships differed by delusion type. Paranoid and grandiose delusional ideation was assessed using the Peters Delusions Inventory (PDI-21) and correlated with self-reported worry ( n = 228), negative self-beliefs ( n = 485), and sleep quality ( n = 655). Data were used from 814 adults from the Nathan Kline Institute-Rockland (NKI-Rockland) study, a general population dataset. We tested the specificity of these contributory factors to paranoia compared to grandiosity, a different type of delusional ideation. Worry, negative self-beliefs, and sleep disturbance have been identified as contributory factors to the onset, maintenance, and severity of paranoia.
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