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Social behaviors in persons with and without persecutory delusions
Schizophrenia Research 80 (2005) 361 – 362 www.elsevier.com/locate/schres
Letter to the Editors
Social behaviors in persons with and without persecutory delusions Dear Editors, Paranoia has been associated with a variety of cognitive and attributional biases that appear to be specific for threatening stimuli (Garety and Freeman, 1999; Penn et al., 1997). However, there has been little examination of the behavioral characteristics associated with paranoia, which have been linked to problems in social functioning (Haynes, 1986; Kramer, 1998). In a previous study, we demonstrated that sub-clinical paranoia was associated with several behavioral correlates indicative of mistrust, such as greater social distance from others, an increased time to read consent forms, and more negative perceptions of a neutral behaving examiner (Combs and Penn, 2004). Consistent with continuum-based models of paranoia, it is possible that similar behaviors would be exhibited by persons with more severe levels of paranoia, such as persecutory delusions (Bentall et al., 1988; Martin and Penn, 2001; Salinas et al., 2002). This study represents an extension of our previous work to include persons with and without persecutory delusions. Similar to sub-clinical samples, we predicted that persons with persecutory delusions would show greater social distance from a neutral acting examiner, take longer to read consent forms, and ask more questions during the study. Two groups of participants with and without persecutory delusions were recruited from a forensic inpatient facility in Oklahoma. Participants with persecutory delusions (n = 26) had Brief Psychiatric Rating Scale (BPRS) suspiciousness scores of 5 or greater (M = 5.4 SD = .50; Martin and Penn, 2002). 0920-9964/$ - see front matter D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2005.04.015
Participants without persecutory delusions (n = 26) had suspiciousness scores of less than 4 and were not currently delusional (M = 2.5 SD = 1.2). Participants also completed the Personality Assessment Inventory persecutory ideation subscale and the Wide Range Achievement Test-III reading subtest. Participants with persecutory delusions were younger, more symptomatic, had better reading skills, and had been in treatment for fewer weeks than the comparison group. The standardization and details of the behavioral measures used in the study can be found in our earlier work (Combs and Penn, 2004). Social distance, time to read the consent form, and the number of questions asked during the consent process were recorded unobtrusively by the examiner. Participants with persecutory delusions showed higher scores on the PAI persecutory ideation subscale, which further supported the presence of paranoid ideation (see Table 1). On the behavioral measures, persons with persecutory delusions sat farther away from the examiner than participants
Table 1 Summary of paranoia and behavioral measures Variable
PAI persecutory ideation scale Social distance (inches) Consent reading time (in seconds) Questions asked (#)
Persecutory delusions (+)
Persecutory delusions ( )
Mean (SD)
Mean (SD)
Effect size Cohen’s f
11.9 (4.6)TT
6.8 (3.3)
0.64
38.0 (9.7)TT
32.0 (6.2)
0.36
359.0 (229)T
250.0 (114)
0.30
1.3 (1.2)
0.18
2.0 (2.1)
PAI=Personality Assessment Inventory. T p V .05. TT p V .01.
362
Letter to the Editors
without persecutory delusions, F(48) = 6.2, p = .01, and took longer to read the consent form, F (50) = 4.6, p = .03. However, there was no difference on the number of questions asked during the consent process, F(49) = 1.5, ns. Age, BPRS score, reading ability, and length of treatment did not affect the results when entered as covariates. Social behaviors are an important, yet understudied aspect of paranoia. We are encouraged that the results of this study were consistent with those found in sub-clinical samples (Combs and Penn, 2004). Paranoid ideation has been linked to poor social skills and negative social interactions with others and it is possible that the increased social distance found in this study, albeit relatively small, may contribute to problems in social functioning (Haynes, 1986; Ritzler, 1981). This relationship would have been strengthened by obtaining independent ratings of social skill as part of the study. We also found evidence for a link between mistrust and slower consent read times, which remained significant even after controlling for psychiatric symptoms and reading ability. Surprisingly, there was no difference on number of questions asked during the consent process, which may reflect the social avoidance found in paranoia (Haynes, 1986). Future research should begin to examine the link between these behaviors and social interactions.
References Bentall, R., Jackson, H.F., Pilgrim, D., 1988. Abandoning the concept of schizophrenia: some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology 27, 156 – 169.
Combs, D.R., Penn, D.L., 2004. The role of sub-clinical paranoia on social perception and behavior. Schizophrenia Research 69, 93 – 104. Garety, P.A., Freeman, D., 1999. Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology 38, 113 – 154. Haynes, S.N., 1986. A behavioral model of paranoid behaviors. Behavior Therapy 17, 266 – 287. Kramer, R.M., 1998. Paranoid cognition in social systems: thinking and acting in the shadow of doubt. Personality and Social Psychology Review 2, 251 – 275. Martin, J.A., Penn, D.L., 2001. Social cognition and sub-clinical paranoid ideation. British Journal of Clinical Psychology 40, 261 – 265. Martin, J.A., Penn, D.L., 2002. Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions. Schizophrenia Bulletin 28, 131 – 141. Penn, D.L., Corrigan, P.W., Bentall, R.P., Racenstein, J.M., Newman, L., 1997. Social cognition in schizophrenia. Psychological Bulletin 121, 114 – 132. Salinas, J.A., Paul, J.A., Newbill, L., 2002. Is paranoid status prognostic of good outcomes? It depends. Journal of Consulting and Clinical Psychology 70, 1029 – 1039. Ritzler, B.A., 1981. Paranoia—Prognosis and treatment: a review. Schizophrenia Bulletin 4, 710 – 728.
Norene W. Gay Oklahoma Forensic Center, Vinita, OK, United States Dennis R. Combs Department of Psychology, Lorton Hall, Room 308, University of Tulsa, 600 South College Ave., Tulsa, OK 74104, United States E-mail address: [email protected]. Corresponding author. Tel.: +1 918 631 2751; fax: +1 918 631 2833. 13 February 2005
Letter to the Editors
Social behaviors in persons with and without persecutory delusions Dear Editors, Paranoia has been associated with a variety of cognitive and attributional biases that appear to be specific for threatening stimuli (Garety and Freeman, 1999; Penn et al., 1997). However, there has been little examination of the behavioral characteristics associated with paranoia, which have been linked to problems in social functioning (Haynes, 1986; Kramer, 1998). In a previous study, we demonstrated that sub-clinical paranoia was associated with several behavioral correlates indicative of mistrust, such as greater social distance from others, an increased time to read consent forms, and more negative perceptions of a neutral behaving examiner (Combs and Penn, 2004). Consistent with continuum-based models of paranoia, it is possible that similar behaviors would be exhibited by persons with more severe levels of paranoia, such as persecutory delusions (Bentall et al., 1988; Martin and Penn, 2001; Salinas et al., 2002). This study represents an extension of our previous work to include persons with and without persecutory delusions. Similar to sub-clinical samples, we predicted that persons with persecutory delusions would show greater social distance from a neutral acting examiner, take longer to read consent forms, and ask more questions during the study. Two groups of participants with and without persecutory delusions were recruited from a forensic inpatient facility in Oklahoma. Participants with persecutory delusions (n = 26) had Brief Psychiatric Rating Scale (BPRS) suspiciousness scores of 5 or greater (M = 5.4 SD = .50; Martin and Penn, 2002). 0920-9964/$ - see front matter D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2005.04.015
Participants without persecutory delusions (n = 26) had suspiciousness scores of less than 4 and were not currently delusional (M = 2.5 SD = 1.2). Participants also completed the Personality Assessment Inventory persecutory ideation subscale and the Wide Range Achievement Test-III reading subtest. Participants with persecutory delusions were younger, more symptomatic, had better reading skills, and had been in treatment for fewer weeks than the comparison group. The standardization and details of the behavioral measures used in the study can be found in our earlier work (Combs and Penn, 2004). Social distance, time to read the consent form, and the number of questions asked during the consent process were recorded unobtrusively by the examiner. Participants with persecutory delusions showed higher scores on the PAI persecutory ideation subscale, which further supported the presence of paranoid ideation (see Table 1). On the behavioral measures, persons with persecutory delusions sat farther away from the examiner than participants
Table 1 Summary of paranoia and behavioral measures Variable
PAI persecutory ideation scale Social distance (inches) Consent reading time (in seconds) Questions asked (#)
Persecutory delusions (+)
Persecutory delusions ( )
Mean (SD)
Mean (SD)
Effect size Cohen’s f
11.9 (4.6)TT
6.8 (3.3)
0.64
38.0 (9.7)TT
32.0 (6.2)
0.36
359.0 (229)T
250.0 (114)
0.30
1.3 (1.2)
0.18
2.0 (2.1)
PAI=Personality Assessment Inventory. T p V .05. TT p V .01.
362
Letter to the Editors
without persecutory delusions, F(48) = 6.2, p = .01, and took longer to read the consent form, F (50) = 4.6, p = .03. However, there was no difference on the number of questions asked during the consent process, F(49) = 1.5, ns. Age, BPRS score, reading ability, and length of treatment did not affect the results when entered as covariates. Social behaviors are an important, yet understudied aspect of paranoia. We are encouraged that the results of this study were consistent with those found in sub-clinical samples (Combs and Penn, 2004). Paranoid ideation has been linked to poor social skills and negative social interactions with others and it is possible that the increased social distance found in this study, albeit relatively small, may contribute to problems in social functioning (Haynes, 1986; Ritzler, 1981). This relationship would have been strengthened by obtaining independent ratings of social skill as part of the study. We also found evidence for a link between mistrust and slower consent read times, which remained significant even after controlling for psychiatric symptoms and reading ability. Surprisingly, there was no difference on number of questions asked during the consent process, which may reflect the social avoidance found in paranoia (Haynes, 1986). Future research should begin to examine the link between these behaviors and social interactions.
References Bentall, R., Jackson, H.F., Pilgrim, D., 1988. Abandoning the concept of schizophrenia: some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology 27, 156 – 169.
Combs, D.R., Penn, D.L., 2004. The role of sub-clinical paranoia on social perception and behavior. Schizophrenia Research 69, 93 – 104. Garety, P.A., Freeman, D., 1999. Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology 38, 113 – 154. Haynes, S.N., 1986. A behavioral model of paranoid behaviors. Behavior Therapy 17, 266 – 287. Kramer, R.M., 1998. Paranoid cognition in social systems: thinking and acting in the shadow of doubt. Personality and Social Psychology Review 2, 251 – 275. Martin, J.A., Penn, D.L., 2001. Social cognition and sub-clinical paranoid ideation. British Journal of Clinical Psychology 40, 261 – 265. Martin, J.A., Penn, D.L., 2002. Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions. Schizophrenia Bulletin 28, 131 – 141. Penn, D.L., Corrigan, P.W., Bentall, R.P., Racenstein, J.M., Newman, L., 1997. Social cognition in schizophrenia. Psychological Bulletin 121, 114 – 132. Salinas, J.A., Paul, J.A., Newbill, L., 2002. Is paranoid status prognostic of good outcomes? It depends. Journal of Consulting and Clinical Psychology 70, 1029 – 1039. Ritzler, B.A., 1981. Paranoia—Prognosis and treatment: a review. Schizophrenia Bulletin 4, 710 – 728.
Norene W. Gay Oklahoma Forensic Center, Vinita, OK, United States Dennis R. Combs Department of Psychology, Lorton Hall, Room 308, University of Tulsa, 600 South College Ave., Tulsa, OK 74104, United States E-mail address: [email protected]. Corresponding author. Tel.: +1 918 631 2751; fax: +1 918 631 2833. 13 February 2005