The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models

Underdiagnosis of Posttraumatic Stress Disorder Among Outpatients With Personality Disorders in Clinical Practice Despite the Use of a Diagnostic Instrument

While existing literature suggests that posttraumatic stress disorder (PTSD) is frequently undetected in routine clinical practice, the detection rate of PTSD in patients with a personality disorder (PD) has not been investigated. This study examined the point prevalence of PTSD and frequency of trauma-focused treatment in 204 outpatients with a PD. Data were derived from electronic patient files. Compared to the mean weighted prevalence of PTSD in the literature, the Mini International Neuropsychiatric Interview Plus (MINI-Plus) found lower rates of PTSD for the entire sample (29.2%), but not separately for patients with borderline PD (BPD; 33.3%) and patients with other PDs (26.9%). In addition, PTSD diagnoses following intake were less prevalent for PD patients overall (18.6%), BPD patients (27%), and patients with other PDs (13.8%). The present study provides preliminary evidence that PTSD might be underdiagnosed and consequently unmanaged in PD patients in clinical practice, suggesting that the recognition of PTSD among patients with PD needs improvement.

Exploring the prevalence of childhood adversity among university students in the United Kingdom: A systematic review and meta-analysis

OBJECTIVES

The focus of this review was to systematically review and meta-analyse the prevalence of ACEs among university students in the UK.

METHOD

The systematic searching of six electronic databases (conducted February 2024) identified ten relevant articles (peer-reviewed articles of a quantitative nature that included ACE prevalence). PROSPERO reference: CRD42022364799.

RESULTS

Pooled prevalence for number of ACEs endured was 55.4% (95% CI: 32.4% - 78.4%; I2 > 99.5%) for one or more, and 31.6% (7.5% - 55.6%; I2 > 99.5%) for three or more. Pooled prevalence was: 15.9% (7.0% - 24.7%; I2 > 94.5%) for physical abuse; 27.0% (18.1% - 35.9%; I2 > 94.5%) for emotional abuse; 12.1% (5.2% - 19.0%; I2 > 94.5%) for sexual abuse; 8.4% (1.7% - 15.1%; I2 > 95.4%) for physical neglect, and 30.0% (21.5% - 38.5%; I2 > 95.4%) for emotional neglect. Pooled prevalence for household dysfunction categories were: 34.4% (22.8% - 46.0%) for parental separation; 18.4% (10.1% - 26.8%) for domestic violence; 35.2% (23.6% - 46.8%) for mental health difficulties; 21.4% (12.9% - 29.9%) for substance use; and 5.7% (2.3% - 9.1%) for incarceration (I2 > 88.8% for all household dysfunction items). Significant heterogeneity was observed between studies for most categories of adversity, and it was not possible to explain/reduce this variance by removing small numbers of influential/discrepant studies. Further analyses suggested potential influences of measurement tool used, country of data collection, and age and sex of participants.

CONCLUSION

Results demonstrate considerable, largely unaccounted-for, heterogeneity in estimates of the prevalence of ACEs, impeding confidence in any summary statistics. Conclusions must be tentative due to analyses being underpowered given small numbers of papers, as well as potential confounds, meaning results may not be truly representative. However, results do suggest high prevalence rates which warrant further investigation, with appropriate support offered to students.

Childhood trauma associated with psychotic-like experiences among people living with HIV: The chain mediation effect of stigma and resilience

BACKGROUND

Previous research established the associations between childhood trauma and psychosis, but the effects of childhood trauma on psychotic-like experiences (PLEs) among people living with HIV (PLWH) and the potential mediation mechanisms in these associations remain unclear.

OBJECTIVE

This study aimed to investigate the effects of childhood trauma on PLEs, as well as the chain mediation roles of stigma and resilience in this relationship. Furthermore, we explored whether the aforementioned associations differed when hallucinatory experiences (HEs) and delusional experiences (DEs) were separately modeled.

PARTICIPANTS AND SETTING

The sample included 333 outpatients participants (95.2 % males, Mage = 28.24 ± 7.12) living with HIV recruited from Hunan Province, China; and data were collected with a cross-sectional survey.

METHOD

The hypothesized chain mediation models were examined using SPSS PROCESS macro 3.3 software.

RESULTS

Various influencing mechanisms of childhood trauma on HEs and DEs were examined in this study. Our results showed that, (a) childhood trauma directly exerted negative effect on HEs, while the chain mediation effect of stigma and resilience were not statistically significant. Conversely, (b) childhood trauma exerted no direct influence on DEs but rather through the chain mediation effect of stigma and resilience.

CONCLUSIONS

The identification of two different routes between that childhood trauma can have on HEs and DEs highlighted the importance of tailored prevention and intervention among PLWH with a history of childhood trauma.

Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation

BACKGROUND AND HYPOTHESIS

Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

STUDY DESIGN

In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter's Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

STUDY RESULTS

Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

CONCLUSIONS

These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.

Explaining paranoia: cognitive and social processes in the occurrence of extreme mistrust

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.

Effects of the interaction between PTSD and ADHD symptoms on the level of reporting psychotic-like experiences: findings from a non-clinical population

Objective

Psychotic-like experiences (PLEs) are increasingly being recognized as subclinical phenomena that might predict the development of various mental disorders that are not limited to the psychosis spectrum. Accumulating evidence suggests that attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are highly comorbid mental disorders. However, their interactive effect on the occurrence of PLEs has not been investigated so far. Therefore, in the present study we aimed to investigate the effect of interaction between ADHD and PTSD symptoms on the level of psychotic-like experiences (PLEs) in the non-clinical sample.

Methods

The study included 3,000 individuals aged 18-35 years with a negative history of psychiatric treatment. The symptoms of ADHD and PTSD were assessed using self-reports.

Results

There was a significant association of the interaction between ADHD and PTSD with the level of reporting PLEs. This association remained significant after adjustment for age, gender, the level of education, the current vocational situation, lifetime history of problematic substance use, and depressive symptoms. Post-hoc tests demonstrated significantly higher levels of reporting PLEs in participants with positive screening for both ADHD and PTSD compared to other subgroups of participants. Also, individuals with positive screening for one vulnerability (either ADHD or PTSD) reported significantly higher levels of reporting PLEs compared to those with a negative screening for ADHD and PTSD. In turn, no significant differences between individuals reporting one vulnerability, i.e., between those with positive screening for ADHD and those with positive screening for PTSD, were observed.

Conclusion

Findings from the present study imply that both PTSD and ADHD symptoms the interaction effect on the level of reporting PLEs that might be of importance for early intervention strategies. However, observed associations require replication in clinical samples.

What's the impact of voice-hearing experiences on the social relating of young people: A comparison between help-seeking young people who did and did not hear voices

Limited research has explored the specific impact of voice-hearing experiences upon the social relating of adolescents. This study examined the associations of voice-hearing in youth with social relating, and putative explanatory factors. An observational, cross-sectional design using a clinical comparison group was employed to examine historical and concurrent associations with voice-hearing. Thirty-four young people (age 14-18 years) with voice-hearing experiences and 34 young people who did not hear voices were recruited from NHS mental health services. Participants completed measures about social relating and potential explanatory factors. Analyses of covariance were used to examine between-group differences. Voice-hearers scored higher on negative schematic beliefs (self-beliefs, partial η2 = .163, p = .001; other-beliefs, partial η2 = .152, p =. 002) and depressive and anxiety symptoms (partial η2 = .23 and partial η2 = .24, p-s <. 001 respectively). The two groups did not differ significantly on childhood trauma levels (partial η2 = .02, p = .273), however, the voice-hearing group scored lower on premorbid adjustment (partial η2 = .19, p < .001). Hearing voices in help-seeking youth could be an indicator for social relating issues and holding negative schematic beliefs, and may be an indicator for of increased psychopathological complexity. Although poorer premorbid adjustment might indicate an early vulnerability to social relating difficulties, voice-hearing might be an aggravating factor and one that requires treatment.

Mental health hygiene during a health crisis: Exploring factors associated with media-induced secondary trauma in relation to the COVID-19 pandemic

Aims

Given the risk of developing vicarious trauma through news media has increased during the pandemic, we explored risk factors associated with media induced secondary trauma, and its behavioral and psychological implications.

Methods

An international study (N = 1066), with a diverse sample, was administered in July 2020. We used standardized and validated questionnaires to measure news consumption, media-related trauma, compliance, and paranoia.

Results

Greater frequency of news consumption, accessing news via social media and WHO, and believing in conspiracy theories increased likelihood of developing media-induced secondary trauma. News related trauma was associated with greater compliance with safety measures and increased paranoid ideation. Media-trauma however exhibited a greater association with paranoia than compliance.

Conclusion

Findings highlight the need to facilitate a collaborative intervention, with public, media houses, health safety officials, and social scientists to have a deeper understanding of potential psychological costs of news consumption patterns.

Repetitive Negative Thinking as a Central Node Between Psychopathological Domains: a Network Analysis

Repetitive negative thinking (RNT) may be defined as a reiterative, passive and uncontrollable thinking process. RNT has been recognized as a transdiagnostic phenomenon associated with the onset and maintenance of several clinical conditions including depression, generalised anxiety, psychosis and insomnia. We aimed to estimate a network model of mutual associations between RNT and the aforementioned indicators whilst controlling for other well-established transdiagnostic factors (i.e. perceived stress, loneliness). A total of 324 participants (Mage = 25.26 years, SD = 6.89; 69.3% females) completed a cross-sectional survey of self-report questionnaires. A Gaussian graphical model was estimated using the graphical LASSO in combination with the extended Bayesian information criterion. We found a dense network in which RNT exhibited substantial connections with the majority of the psychopathological domains. The centrality indices confirmed that RNT was one of the most important nodes in the network. Moreover, the estimated network showed satisfactory accuracy and stability. Findings emphasized RNT as a potentially good therapeutic target for psychopathology prevention and treatment protocols.

Humiliation and state anxiety as predictors of attenuated psychosis in a community sample

Existing literature suggests that humiliation experiences, coupled with a negative family context, significantly predicts persecutory ideation in non-clinical participants. Whether this may also be linked to attenuated psychotic experiences is unknown. The current study aimed to assess whether familial adversity and humiliation may be related to hallucination-like experiences (HLEs) and other psychotic symptoms, and if state anxiety significantly contributed to these relationships. This cross-sectional study recruited a community sample of 93 adults (38% male; mean age = 27.3 years, standard deviation = 10.8 years), who completed measures of maladaptive familial environments, past and anticipated humiliation experiences, state anxiety and attenuated psychotic symptoms. Correlations and hierarchical regressions tested for direct and indirect relationships amongst study variables. A maladaptive family context, and humiliation (past and anticipated) were positively correlated with HLEs, and facets of attenuated psychotic symptoms. Anxiety uniquely predicted audio-visual and multisensory HLEs. Past humiliation and anxiety jointly predicted cognitive-perceptual disturbance and disorganisation, whereas fear of humiliation and anxiety jointly predicted interpersonal difficulty. Elevated state anxiety, coupled with humiliation, may increase attenuated psychotic symptoms in adulthood. Future research is needed to ascertain if these relationships hold true in clinical cohorts to examine the clinical significance of these data.

Longitudinal symptomatic interactions in long-standing schizophrenia: a novel five-point analysis based on directed acyclic graphs

BACKGROUND

Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. We predicted that the persistence of psychotic symptoms would be driven by the continuing presence of affective disturbance.

METHODS

EuroSC included 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures of psychotic and affective symptoms were repeated four times at 6-month intervals, thereby furnishing five time-points. To examine interactions between symptoms both within and between time-slices, we adopted a novel technique for modelling longitudinal data in psychiatry. This was a form of Bayesian network analysis that involved learning dynamic directed acyclic graphs (DAGs).

RESULTS

Our DAG analysis suggests that the main drivers of symptoms in this long-term sample were delusions and paranoid thinking. These led to affective disturbance, not vice versa as we initially predicted. The enduring relationship between symptoms was unaffected by whether patients were receiving first- or second-generation antipsychotic medication.

CONCLUSIONS

In this cohort of people with chronic schizophrenia treated with medication, symptoms were essentially stable over long periods. However, affective symptoms appeared driven by the persistence of delusions and persecutory thinking, a finding not previously reported. Although our findings as ever remain hostage to unmeasured confounders, these enduring psychotic symptoms might nevertheless be appropriate candidates for directly targeted psychological interventions.

Echoes of shame: a comparison of the characteristics and psychological sequelae of recalled shame experiences across the voice hearing continuum

BACKGROUND

Voice hearing occurs across a number of psychiatric diagnoses and appears to be present on a continuum within the general population. Previous research has highlighted the potential role of past experiences of shame in proneness to voice hearing in the general population.

AIMS

This study aimed to extend this past research and compare people with distressing voices, people with voices but no distress, and a non-voice hearing control group, on various dimensions of shame and shame memory characteristics.

METHOD

In a cross-sectional, online study 39 distressed voice hearers, 31 non-distressed voice hearers and 50 non-voice hearers undertook a shame memory priming task in which they were prompted to recall a memory of a shaming experience from their past. They then completed questionnaires assessing the characteristics of the recalled shame event and the psychological sequalae of this event (i.e. intrusions, hyperarousal, avoidance, the centrality of shame memories, external shame, and self-criticism).

RESULTS

The majority of recalled shame memories involved experiences such as interpersonal criticism or experiences of being devalued. Univariate analyses found no significant differences between the three groups with regard to the shame events that were recalled, but the distressed voice hearer group reported significantly more hyperarousal, intrusions, self-criticism, and external shame in relation to their experience.

CONCLUSIONS

The findings suggest that voice hearers recall similar types of shame experiences to non-voice hearers, but that problematic psychological sequelae of these shame experiences (in the form of intrusive memories, hyperarousal, external shame, and self-criticism) may specifically contribute to distressing voice hearing.

Investigating Specific Associations Between Childhood Victimization Profiles and Positive Psychosis Symptoms: The Mediating Roles of Anxiety, Depression, and Schema

Background

Childhood trauma is a risk factor for psychosis. It is proposed this is due to traumatic events giving rise to psychological mechanisms that are implicated in the development and maintenance of symptoms. Investigation of the psychological mechanisms accounting for relationships between trauma and psychosis will be assisted by focusing on specific trauma profiles, hallucination modalities, and delusion subtypes.

Study Design

In 171 adults with schizophrenia-spectrum diagnoses and high-conviction delusions, associations between childhood trauma classes, and hallucination and delusion factors, were tested using structural equation models (SEMs). Anxiety, depression, and negative schema were examined as potential mediators of trauma class-psychosis symptom factor links.

Study Results

Significant associations were found between the emotional abuse/neglect and poly-victimization classes with persecutory delusions and delusions of influence, that were all mediated through anxiety (β = 1.24-0.23, P = < .05). There was an association between the physical abuse class and grandiose/religious delusions that was not explained by the mediators (β = 1.86, P = < .05). Trauma class was not significantly associated with any hallucination modality (β = 0.004-1.46, P = > .05).

Conclusions

In a sample of people with strongly held delusions, this study demonstrates that childhood victimization is associated with delusions of influence and grandiose beliefs, as well as with persecutory delusions in psychosis. Consistent with previous findings, the potent, mediating role of anxiety supports affective pathway theories and the utility of targeting threat-related processes when treating trauma effects in psychosis.

A Study on the Factors Affecting Anger in Patients With Post-traumatic Stress Disorder

OBJECTIVE

To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

METHODS

We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms.

RESULTS

The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionality/neuroticism scale (odds ratio=1.152, p<0.001).

CONCLUSION

The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.

Gazing the dusty mirror: Joint effect of narcissism and sadism on workplace incivility via indirect effect of paranoia, antagonism, and emotional intelligence

Workplace productivity is badly affected by many negative factors such as narcissism, and sadism. In addition, paranoia and antagonism play an important role in increasing workplace incivility. Through emotional intelligence, such negative behaviors could be addressed by managers and their junior colleagues. The current study aims to investigate the parallel mediating role of paranoia, antagonism, and emotional intelligence on the relationship between narcissism, sadism, and workplace incivility. A survey approach was used. Primary data was collected in PLS-SEM. The population of the study was all faculty members in higher education institutions in the Khyber Pakhtunkhwa (Pakistan) region. A measurement model and structural model were developed. The measurement model demonstrated that convergent and discriminant validities were established. The structural model's findings revealed that narcissism, antagonism, and emotional intelligence were not mediated between narcissism and workplace incivility. Similarly, emotional intelligence did not play any mediating role between sadism and workplace incivility. This implied that emotional intelligence has no role in decreasing or reducing workplace uncivil behavior.

Relationships among subclinical psychotic symptoms in young adults over time

BACKGROUND

Subclinical psychotic symptoms are common in the general population and are often benign. However, those that become distressing or persistent may increase risk for the development of a psychotic disorder. Cognitive models have proposed that certain appraisals of hallucinatory experiences can lead to delusional beliefs, particularly if an individual is experiencing negative mood. However, the dynamic relationships among these symptoms are poorly understood. This study examined the longitudinal relationships among subclincal hallucinations, delusional ideation, and depression in a sample of young adults.

METHODS

677 college students completed baseline questionnaires to assess: delusional ideation (Peters Delusions Inventory), hallucinations (Launay-Slade Hallucinations Scale-Extended), and depression (Beck Depression Inventory). These measures were repeated 7, 13, 19, and 25 months later.

RESULTS

Higher baseline severity of hallucinations was strongly predictive of severity of delusions across all future follow-up timepoints, specifically when baseline depression was high. However, the severity of hallucinations did not change over time, nor were they predicted by baseline delusional ideation.

CONCLUSIONS

These findings support the proposal that hallucinations frequently precede more severe delusional ideation, rather than the reverse sequence, particularly when depressive symptoms are present. Such longitudinal relationships provide clues to the underlying mechanisms of psychosis, highlighting one pathway for intervention.

Role of polygenic and environmental factors in the co-occurrence of depression and psychosis symptoms: a network analysis

Depression and psychosis are often comorbid; they also have overlapping genetic and environmental risk factors, including trauma and area-level exposures. The present study aimed to advance understanding of this comorbidity via a network approach, by (1) identifying bridge nodes that connect clusters of lifetime depression and psychosis symptoms and (2) evaluating the influence of polygenic and environmental risk factors in these symptoms. This study included data from European ancestry participants in UK Biobank, a large population-based sample (N = 77,650). In Step 1, a network model identified bridge nodes between lifetime symptoms of depression and psychosis and functional impairment. In Step 2, genetic and environmental risk factors were incorporated to examine the degree to which symptoms associated with polygenic risk scores for depression and schizophrenia, lifetime exposure to trauma and area-level factors (including deprivation, air pollution and greenspace). Feelings of worthlessness, beliefs in unreal conspiracy against oneself, depression impairment and psychosis impairment emerged as bridges between depression and psychosis symptoms. Polygenic risk scores for depression and schizophrenia were predominantly linked with depression and psychosis impairment, respectively, rather than with specific symptoms. Cumulative trauma emerged as a bridge node associating deprivation with feelings of worthlessness and beliefs in unreal conspiracy, indicating that the experience of trauma is prominently linked with the co-occurrence of depression and psychosis symptoms related to negative views of oneself and others. These key symptoms and risk factors provide insights into the lifetime co-occurrence of depression and psychosis.

Childhood interpersonal trauma and paranoia in psychosis: The role of disorganised attachment and negative schema

Paranoia is associated with significant distress and is associated with childhood trauma. Understanding the mechanisms responsible for this association is important for informing psychological interventions. Theoretical proposals suggest that negative schema and insecure attachment may be important mechanisms in the development of paranoia. Disorganised attachment may be particularly relevant. The current study is the first to examine whether the relationship between childhood interpersonal trauma and paranoia is mediated by disorganised attachment, and the impact of disorganised attachment on negative self and negative other schema. A large online sample of 242 people with self-reported psychosis completed measures of childhood trauma, attachment, self and other schema, paranoia and psychosis symptomatology. Path analysis indicated that childhood interpersonal trauma was associated with disorganised attachment, which in turn was associated with negative self-schema, negative other schema, and paranoia. Negative schema about others, but not self, was associated with paranoia. Disorganised attachment and negative other schema fully mediated the relationship between trauma and paranoia. Negative other schema partially mediated the association between disorganised attachment and paranoia. Results were found when controlling for depression, hallucinations and age. Results suggest that interventions that aim to modify disorganised attachment patterns and negative schema about others can potentially alleviate the impact of trauma on paranoia. Findings provide justification for longitudinal studies to confirm the direction of effects, and intervention studies that aim to manipulate disorganised attachment and negative schema about others and observe the impact of this on paranoia.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy

BACKGROUND

Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences.

METHODS

243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups.

CONCLUSIONS

In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

Pathways linking school bullying and psychotic experiences: Multiple mediation analysis in Chinese adolescents and young adults

It is found that people with psychotic experiences have a 4-fold increased risk of developing a psychotic disorder later in life. Indeed, accumulating evidence has suggested that the association between school bullying and psychotic experiences works linearly. Previous studies are mainly carried out in a Western context, and only seldomly do studies address whether the association exists in the Chinese population and the related psychological and cognitive mechanisms. Therefore, we carried out the current study to address this gap in the literature focusing on the lifelong school bullying experiences of Chinese adolescents and young adults. We examined them in relation to psychotic experiences while assessing the mediating role of self-esteem, the personality trait of neuroticism, and a cognitive bias in thinking called interpretation bias. We found that multiple victimizations were quite common in Hong Kong secondary schools. In addition to a significant association between school bullying and psychotic experiences, we found partial mediating effects of proposed psychological and cognitive mediators in constructed multiple mediation models utilizing bootstrapping approach. Specifically, bullying quantity reflecting the number of victimizations, had its association with psychotic experiences partially mediated by the personality trait of neuroticism. In contrast, bullying duration reflecting the lasting of victimization was associated with psychotic experiences partially mediated by the personality trait of neuroticism and interpretation bias. Our findings enhance our knowledge of mechanisms underpinning the psychosis spectrum development and have implications for school-based intervention programs targeting bullying victims.

Paranoia and negative schema about the self and others: A systematic review and meta-analysis

Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality appraisal of quantitative studies investigating the relationship between negative self and negative other schema and paranoia across the paranoia continuum. A systematic search identified 43 eligible studies; 25 were included in the meta-analysis. Meta-analytic findings demonstrated a medium to large relationship between paranoia and negative self-schema (r = 0.46, 95% CI 0.39 to 0.53) and negative other schema (r = 0.48, 95% CI 0.38 to 0.56). The magnitude of associations was similar across people with and without psychosis. Findings demonstrated that associations between negative self-schema and paranoia were not always statistically significant when controlling for confounding variables, particularly depression. The association between negative other schema and paranoia tended to remain significant when controlling for confounding variables. Findings also demonstrated that negative schema may mediate relationships between adverse experiences in childhood and paranoia. Overall, findings support theoretical proposals that both negative self and negative other schema are associated with paranoia. Longitudinal studies are required to confirm the direction of effects. Findings provide support for incorporating and targeting negative self and negative other schema in psychological formulations and therapeutic work.

The role of self-compassion on the relationship between trauma and hearing voices

Traumatic life events are associated with increased risk of hearing voices and posttraumatic stress (PTS) symptoms have been implicated in this relationship. Studies indicate that increased self-compassion is associated with reduced PTS symptoms and voice-distress. The present study sought to examine whether self-compassion moderated the relationship between PTS symptoms and voice-distress. Self-report and clinician-administered questionnaires were used to measure self-compassion, PTS symptom severity, voice-frequency, and voice-distress in 62 trauma-affected voice-hearers who presented to a community voice-hearing clinic. Correlation analyses revealed that PTS symptom severity was positively correlated with voice-distress, but not voice-frequency, and that self-compassion was negatively correlated with voice-distress and PTS symptom severity. While self-compassion did not moderate the relationship between PTS symptom severity and voice-distress, it was associated with a significant reduction in voice-distress, at all levels of PTS symptom severity. Preliminary findings suggest self-compassion may play an important role in reducing voice-distress and thus warrant further consideration of self-compassion as a target in treatment for help-seeking voice-hearers.

Employee state paranoia: linking abusive supervision with employee voice behavior

Purpose

Utilizing affective event theory (AET), this paper aims to understand the affective reasoning behind choosing to speak up for or against abusive supervision. For this purpose, the authors examine the underlying mechanism of employee state paranoia in the relationship between abusive supervision and promotive and prohibitive voice of employees.

Design/methodology/approach

Data from 307 microfinance bank employees were collected using supervisor–subordinate nested design and time-lag approach. The analysis was performed through partial least square (PLS) structural equation modeling using Smart PLS software.

Findings

The results support the direct relationship of abusive supervision with promotive and prohibitive voice. They also support the mediating relation of paranoia arousal between abusive supervision and promotive voice. However, the results do not support the mediating relationship of paranoia arousal between abusive supervision and prohibitive voice.

Originality/value

In light of the literature drawn from AET and empirical data, this study forwards robust recommendations for theory and practice and may assist future researchers interested in the role of employee paranoia arousal.

Understanding the role of self in auditory verbal hallucinations using a self-discrepancy paradigm

OBJECTIVE

Negative auditory verbal hallucination (AVH) content is a major predictor of distress and typically occurs more frequently than positive or neutral content. Recent research has found that negative views of self are associated with the negative content of AVHs. However, research investigating the role of self in AVH content is in its infancy and warrants further study.

DESIGN

The current study examined correspondence between negative voice content and internalized representations of self, using a self-discrepancy paradigm incorporating multiple domains of self (ideal, ought, and feared). It also considered the impact of depression and anxiety.

METHOD

An adapted self-discrepancy questionnaire was administered to a transdiagnostic clinical sample of 86 current voice-hearers. Participants rated how similar they believed themselves to be (actual self), and how similar their voices would say they are (voice self), to their ideal, ought, and feared self-concepts.

RESULTS

Voice content was related to how the person viewed themselves in relation to their ideal, ought, and feared self-concepts. Additionally, voices reflected negative feared self-concepts, particularly in people with anxiety.

CONCLUSIONS

These findings provide further insight into the phenomenon of hearing voices and have the potential to change the way we approach formulation and treatment of AVHs. In particular, treatment approaches that reduce discrepancies between how one views themselves and their positive and negative self-concepts, or alter the relationship one has with their self-concepts and negative voices, have the potential to reduce the impact of distressing voices.

PRACTITIONER POINTS

Voice experiences can be meaningfully related to how the person views themselves in relation to concepts of their ideal, ought, and feared selves Negative voice content might be understood as reflecting discrepancies from these self-representations, which may have a self-regulatory function in relation to goal-directed behaviour. Identifying how voice content relates to self could be useful in not only challenging the extent of perceived self-discrepancies, but also considering how to enact valued parts of self.

Persecutory ideation and anomalous perceptual experiences in the context of the COVID-19 outbreak in France: what's left one month later?

PURPOSE

Beyond the effects of the coronavirus pandemic on the public's health, the length of lockdown and its possible psychological impacts on populations is heavily debated. However, the consequences of lockdown on psychotic symptoms have been poorly investigated.

METHODS

An online survey was run from April 13 to May 11, 2020; a total of 728 French subjects from the general population were included in the study. We assessed the perceived impact of the COVID-19 outbreak, length of isolation, diagnosis/symptoms/hospitalisation related to the COVID-19 (oneself and family). Paranoid ideations and hallucination-like experiences were assessed via the Paranoia Scale and the Cardiff Anomalous Perceptions Scale, respectively. Self-reported measures of negative affect, loneliness, sleep difficulties, jumping to conclusion bias, repetitive thoughts, among others, were also included.

RESULTS

Final regression model for paranoia indicated that socio-demographic variables (age, sex and education), loneliness, cognitive bias, anxiety, experiential avoidance, repetitive thoughts and hallucinations were associated with paranoia (R² = 0.43). For hallucinations, clinical variables as well as the quality of sleep, behavioural activation, repetitive thoughts, anxiety and paranoia were associated with hallucinations in our sample (R² = 0.27). Neither length of isolation nor the perceived impact of the COVID-19 pandemic were associated with psychotic experiences in the final models.

CONCLUSIONS

No evidence was found for the impact of isolation on psychotic symptoms in the general population in France one month after the lockdown. It nevertheless confirms the preeminent role of several factors previously described in the maintenance and development of psychotic symptoms in the context of a pandemic and lockdown measures.

Does Gender Matter? An Exploratory Study of Cultural Betrayal Trauma and Hallucinations in Latino Undergraduates at a Predominantly White University

Violence victimization, such as physical, sexual, and emotional abuse, has been linked with hallucinations. How abuse-related distress manifests is dependent on a host of factors, including gender, ethnicity, and societal inequality. Cultural betrayal trauma theory may provide insight into hallucinatory experiences for Latinos in the United States, as it is a contextualized framework that identifies societal trauma (e.g., discrimination) as a contributor to the harm of within-group interpersonal violence victimization in minority populations. Though men may experience higher rates of hallucinations, there is little work on gender differences in the predictive power of violence victimization on hallucinations, particularly in Latino populations. Therefore, with cultural betrayal trauma theory as a guide, the purpose of the current exploratory study is to examine gender differences in the association of ethno-cultural betrayal trauma (within-group violence victimization) on tactile, visual, and auditory hallucinations in a sample of Latino undergraduate students at a predominantly White university in the United States. Participants (N = 80) completed online self-report measures on ethno-cultural betrayal trauma and hallucinatory experiences. Sizable proportions of the sample reported experiencing ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations. Controlling for between-group trauma, the link between ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations was moderated by male gender. With cultural betrayal trauma theory as its framework, these preliminary results suggest that gender differences in hallucinatory experiences may be affected by the way trauma-related distress is expressed in Latino undergraduate students in the United States.

Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms

Background : Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and implicit/explicit self-esteem discrepancies in three non-clinical groups with different psychopathological traits and a control group. Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. A dimensional approach with the total sample (n = 208) was also used to complement the information provided by the group approach. Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas compared with the control group. However, the group with a combination of trait-paranoia and depressive symptoms showed the lowest levels of positive self-schemas and self-esteem. Furthermore, this group and the control group displayed implicit/explicit self-esteem discrepancies, although in opposite directions and with different implications. The dimensional approach revealed associations of trait-paranoia and depressive symptoms with poor explicit self-esteem and self-schemas but not with implicit self-esteem. Conclusions: Trait-paranoia participants showed different self-representations depending on whether depressive symptoms were present or not. The interaction between subclinical neurotic and psychotic traits entailed a detrimental self-representation that might increase the risk for psychopathology.

Physical injury and psychotic experiences in 48 low- and middle-income countries

BACKGROUND

Psychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs.

METHOD

Cross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002-2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression.

RESULTS

In fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85-2.31], traffic injury (OR 1.84, 95% CI 1.53-2.21) and other injury (OR 2.09, 95% CI 1.84-2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22-2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle).

CONCLUSIONS

Different types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.

The effect of rumination and distraction on auditory hallucinatory experiences: An analogue experimental study

BACKGROUND AND OBJECTIVES

The cognitive model of voices suggests that negative appraisals of hallucinatory experiences result in responses, such as rumination, which maintain voice-hearing. Our principal aim was to investigate the effect of rumination on the frequency of voice-hearing.

METHODS

A two-group randomised experimental design was employed using a non-clinical sample. A total of 106 participants completed baseline measures of trait rumination, hallucination-proneness, mood and state negative affect, and were presented with a voice-hearing paradigm. False feedback designed to cause a negative interpretation of auditory intrusions was provided and participants were randomly allocated to either a distraction or rumination condition. Participants performed the auditory task for a second time, and the total number of false alarms and distress scores were compared between groups.

RESULTS

A Mann-Whitney U test revealed that the manipulation of rumination was successful (p = 0.007). We did not detect a statistically significant difference between the distraction and rumination groups for total false alarms (p = 0.282) or distress (p = 0.387) scores.

LIMITATIONS

Findings largely relate to a female undergraduate psychology sample.

CONCLUSION

Results of this non-clinical study do not support the hypothesis that rumination leads to an increase in the frequency of voice-hearing on a laboratory task.

Folie a deux in monozygotic twins with childhood trauma: A case report

Folie a deux is a rare syndrome characterized by induction of a delusion in a susceptible person in close proximity with an individual with known delusional disorder. We report a rare case of monozygotic twins with induced delusional disorder in one of the twins. The twins had experienced childhood trauma in the form of emotional neglect and physical abuse by the father. The primary case (Twin A) was diagnosed with delusional disorder and was treated with oral antipsychotic. The secondary case (Twin B) showed resolution of symptoms after separation from twin A. The case highlights the unique presentation of induced delusional symptoms in monozygotic twins and the close association between childhood trauma and psychosis.

Threatening Life Events and Difficulties and Psychotic Disorder

OBJECTIVE

Stressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence.

METHOD

This study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls.

RESULTS

We found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51-4.79]; 2 events OR 4.87 [95% CI 2.34-10.16]; ≥3 events OR 5.27 [95% CI 1.83-15.19]; 1 difficulty OR 3.02 [95% CI 1.79-5.09]; 2 difficulties OR 9.71 [95% CI 4.20-22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18-51.85]).

CONCLUSIONS

Threatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.

PTSD with secondary psychotic features among trauma-affected refugees: The role of torture and depression

This cross-sectional study examined the prevalence of PTSD with secondary psychotic symptoms (PTSD-SP), its comorbidities, and its association with torture and depression in treatment-seeking refugees. Data were pooled from the Danish Database on Refugees with Trauma (DART). The sample represents approximately 90% of trauma-affected refugee-patients (N = 627) attending a Danish psychiatric outpatient clinic from 2008 to 2013. PTSD, secondary psychotic symptoms, and comorbidities were assessed with structured and routine clinical interviews. The association of PTSD-SP with torture and depression was investigated using hierarchical logistic regression. The prevalence of PTSD-SP in treatment-seeking refugees with PTSD was 30%. Among these, 44% fulfilled the criteria for Enduring Personality Change After Catastrophic Experience (EPCACE). Psychotic symptoms comprised hallucinations and persecutory delusions, often reflecting trauma-related themes. Comorbidity with depression was high (79%). Neither torture, nor other war-trauma (ex-combatant, imprisonment, civilian war trauma) predicted PTSD-SP, but comorbid depression did. Depression only explained a small amount of the total PTSD-SP variance. Results indicate that PTSD-SP is common in treatment-seeking refugees. However, its etiology is poorly understood. This highlights the need for further research to improve diagnosis and treatment for this patient group.

Inconsistent trauma reporting is associated with emotional and behavioural problems and psychotic experiences in young people

BACKGROUND

Little is known about the prevalence of inconsistent trauma reporting in community samples and about its associations with psychopathology. This study aimed to assess for the first time the prevalence of inconsistent trauma reporting in a community sample of children/adolescents and to explore associations with both psychotic experiences and with psychopathology more generally.

METHOD

A community-based sample of 86 children/adolescents (baseline mean age 11.5) were interviewed at two time points with data collected in relation to potentially traumatic events through the K-SADS. Emotional and behavioural problems were assessed at follow-up (mean age 15.7) through the Youth Self Report questionnaire while the presence of psychotic experiences was based on expert consensus post interview. Logistic regression models were used to test associations between inconsistent reporting and psychotic experiences at baseline and follow-up, with associations with emotional and behavioral problems at follow-up also assessed.

RESULTS

Overall, 16.3% of adolescents failed to report previously reported potentially traumatic events at follow-up and were therefore defined as inconsistent trauma reporters. Inconsistent reporting was associated with emotional and behavioural problems as assessed by the Youth Self Report with the exception of rule breaking behaviour and with psychotic experiences as assessed on interview.

CONCLUSIONS

Inconsistent trauma reporting is associated with psychotic experiences and emotional and behavioural problems in young people and may represent an important marker for psychopathology in youth.

Childhood Trauma and Psychosis: An Updated Review

There is growing evidence to support the link between childhood trauma and psychosis. Childhood trauma increases the risk for psychosis and affects severity and type of psychotic symptoms, and frequency of comorbid conditions, including depression and substance use. Childhood trauma is linked to more severe functional impairment in individuals with psychosis. There is evidence to support gender differences in the influence of childhood trauma on the course of psychotic illnesses, appearing to be more profound in girls and women. Other biological markers that may explain the link between childhood trauma and psychosis include brain-derived neurotrophic factor and other inflammatory markers.

Childhood adversity and clinical and psychosocial outcomes in psychosis

AIMS

Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes.

METHODS

Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes.

RESULTS

Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82).

CONCLUSIONS

Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.

Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions

Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.

A look into hallucinations: the relationship between visual imagery and hallucinations in Alzheimer's disease

Introduction: We investigated the relationship between visual hallucinations and vividness of visual imagery in patients with Alzheimer's disease (AD). Method: We recruited 28 patients with AD and 30 healthy control participants, matched for age and education. We evaluated proneness towards hallucinations with the Launay-Slade Hallucinations Scale, which includes items assessing visual and auditory hallucinations. We also evaluated vividness of visual imagery with the Vividness of Visual Imagery Questionnaire on which participants had to imagine four images (i.e., imagining the face of a friend, the rising sun, a familiar shop-front, and a country scene) and report the vividness of the images they generated. Results: Analysis demonstrated significant positive correlations between visual hallucinations and vividness of visual imagery in AD patients, however, no significant correlations were observed between auditory hallucinations and vividness of visual imagery in these participants. No significant correlations were observed between hallucinations and vividness of visual imagery in healthy control participants, probably due to the lack of hallucinations in these participants. Discussion: These results demonstrate a selective relationship between the occurrence of visual (but not auditory) hallucinations and the ability to generate vivid visual images in AD.

Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder

OBJECTIVE

Literature suggests that childhood trauma increases vulnerability for schizophrenia-spectrum disorders, including schizotypal personality disorder (SPD). Yet, it remains unexplored whether childhood trauma predicts symptom load and the level of neurocognitive functioning in SPD.

METHOD

We included 225 individuals with SPD and 127 healthy controls. Childhood trauma was evaluated using the Childhood Trauma Questionnaire, and schizotypal traits were assessed using the Schizotypal Personality Questionnaire. Standard neurocognitive assessments covered six cognitive domains.

RESULTS

All types of reported childhood trauma were significantly associated with SPD, in a linear fashion. Severe sexual abuse showed the greatest magnitude of association with higher cognitive-perceptual load (e.g., ideas of reference, odd belief or magical thinking); severe emotional neglect was associated with interpersonal scores (e.g., excessive social anxiety, constricted affect) within the SPD group. SPD individuals who reported severe trauma showed worse cognitive functioning (i.e., working memory, verbal/visual learning and memory, as well as verbal fluency).

CONCLUSIONS

Particular severe childhood trauma types were associated with higher cognitive-perceptual and interpersonal symptoms in SPD, along with worse cognitive functioning. These findings highlight the need for clinicians to enquire about childhood trauma in SPD patients, since unaddressed early adverse experiences may carry long-term negative consequences.

Traumatic life event exposure and psychotic-like experiences: A multiple mediation model of cognitive-based mechanisms

Several cognitive mechanisms have been proposed to account for the relationship between exposure to traumatic life events (TLEs) and the entire psychosis spectrum. However, only few of these mechanisms have been empirically tested and those that have been tested have not considered multiple mechanisms simultaneously. The purpose of this study was to examine whether perceived stress, dissociation, negative self-schemas, negative other-schemas, and/or external locus of control mediated the association between TLEs and psychotic-like experiences (PLEs). An undergraduate sample of 945 individuals completed a battery of self-report questionnaires. We found significant indirect effects from TLE exposure to PLEs through perceived stress, dissociation, external locus of control, negative self-schemas, and negative other-schemas. When controlling for comorbid psychological symptoms, only the indirect effect from TLE exposure to PLEs through dissociation continued to be significant. Targeting stress sensitivity, maladaptive schemas, dissociative tendencies, and externalizing attributional styles may prove useful in the amelioration of risk for various psychopathologies (e.g., mood, psychosis) in the aftermath of TLE exposure. Findings underscore the importance of targeting trauma-related cognitions in the prevention or reduction of psychotic-like experiences or disorders.

Links between psychotic and neurotic symptoms in the general population: an analysis of longitudinal British National Survey data using Directed Acyclic Graphs

BACKGROUND

Non-psychotic affective symptoms are important components of psychotic syndromes. They are frequent and are now thought to influence the emergence of paranoia and hallucinations. Evidence supporting this model of psychosis comes from recent cross-fertilising epidemiological and intervention studies. Epidemiological studies identify plausible targets for intervention but must be interpreted cautiously. Nevertheless, causal inference can be strengthened substantially using modern statistical methods.

METHODS

Directed Acyclic Graphs were used in a dynamic Bayesian network approach to learn the overall dependence structure of chosen variables. DAG-based inference identifies the most likely directional links between multiple variables, thereby locating them in a putative causal cascade. We used initial and 18-month follow-up data from the 2000 British National Psychiatric Morbidity survey (N = 8580 and N = 2406).

RESULTS

We analysed persecutory ideation, hallucinations, a range of affective symptoms and the effects of cannabis and problematic alcohol use. Worry was central to the links between symptoms, with plausible direct effects on insomnia, depressed mood and generalised anxiety, and recent cannabis use. Worry linked the other affective phenomena with paranoia. Hallucinations were connected only to worry and persecutory ideation. General anxiety, worry, sleep problems, and persecutory ideation were strongly self-predicting. Worry and persecutory ideation were connected over the 18-month interval in an apparent feedback loop.

CONCLUSIONS

These results have implications for understanding dynamic processes in psychosis and for targeting psychological interventions. The reciprocal influence of worry and paranoia implies that treating either symptom is likely to ameliorate the other.

Reductions in reported persecutory ideation and psychotic-like experiences during exposure therapy for posttraumatic stress disorder

While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms. Persecutory ideation symptoms, which were most closely related to PTSD Cluster C (avoidance and numbing) symptoms, were reduced post-treatment in the trauma-focused condition relative to WL. Auditory and visual hallucinations-which were most closely associated with PTSD re-experiencing-decreased from baseline to post-treatment assessments for WL and exposure therapy participants. The presence of PLEs at baseline did not predict a reduced PTSD symptom response to treatment. Trauma-focused treatments appear effective in addressing psychotic-like experiences that can emerge in individuals with PTSD.

Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults

AIM

The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization.

METHODS

The study sample consisted of 147 help-seeking adolescents (mean age 17 years) selected after a screening phase (Prodromal Questionnaire) and evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). All participants were specifically asked if they had experienced either psychological bullying or physical bullying, and they completed the Interpersonal Sensitivity Measure (IPSM).

RESULTS

Of the whole sample, 30 (20%) participants had experienced psychological bullying or physical bullying at least once in their life. Performing a multiple regression, bullying victimization was found to be an independent predictor of subtle paranoid ideation and suspiciousness. Interpersonal sensitivity was also found to be an independent predictor of subtle paranoid ideation; in particular, two IPSM subscales, fragile inner-self and separation anxiety, showed a significant correlation with subtle paranoid ideation.

CONCLUSIONS

Our results confirmed that bullying victimization is a negative interpersonal experience associated with paranoid ideation and suspiciousness. However, being overly sensitive and having negative beliefs about the self as fragile and vulnerable to threat also lead to a tendency to attribute experiences as externally caused and, in turn, facilitate the formation and maintenance of paranoid ideation.

Psychotic symptoms in borderline personality disorder: an update

PURPOSE OF REVIEW

The purpose of this article is to review the most recent literature on psychotic symptoms in borderline personality disorder (BPD).

RECENT FINDINGS

Both auditory hallucinations and delusional ideation (especially paranoid delusions) are relatively common in individuals with BPD. It is still difficult to distinguish these and related phenomena in BPD from the corresponding experiences in psychotic disorders and schizophrenia, despite numerous attempts to do so. The terminology introduced to help with this effort has not been particularly useful. The presence of auditory hallucinations may affect the course of BPD negatively. Psychotic symptoms in BPD seem to be significantly related to the context (usually stressful events) and appear or intensify in response to situational crisis. The role of certain co-occurring disorders in increasing the risk of psychotic symptoms in BPD remains uncertain.

SUMMARY

Psychotic symptoms in BPD continue to be poorly understood. Further research should try to ascertain the relationships between hallucinations and delusions on one hand and the processing of trauma, emotion regulation, distress tolerance and interpersonal sensitivity on the other. Ultimately, such endeavor will contribute to developing more effective treatments for BPD.

In and out of schizophrenia: Activation and deactivation of the negative and positive schemas

Theorists, clinicians, and investigators have attempted to find a common source for the negative and positive symptoms of schizophrenia. We propose that a unified theory, based on a common cognitive structure not only has explanatory value, but can serve as a framework for a psychotherapeutic intervention. Specifically, we propose that the cognitive triad - the negative view of the self, others, and the future - is the source of the content for the negative and positive symptoms. We report literature supporting the relationship between each facet of the negative triad and each of the key symptoms: expressive negative symptoms, delusions, and verbal hallucinations. We conclude that the literature supports the validity of the cognitive model of negative and positive symptoms. The cognitive model furthers the understanding of the positive and negative symptoms of schizophrenia, and we describe how this provides a framework for a psychotherapeutic intervention.

Paranoid beliefs and realistic expectations of victimization: Data from the survey of police-public encounters

BACKGROUND

The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence.

METHODS

Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure.

RESULTS

Paranoid beliefs were positively associated with police victimization expectations (β=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (β=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization.

CONCLUSIONS

The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.

The network structure of paranoia in the general population

PURPOSE

Bebbington and colleagues' influential study on 'the structure of paranoia in the general population' used data from the British National Psychiatric Morbidity Survey and latent variable analysis methods. Network analysis is a relatively new approach in psychopathology research that considers mental disorders to be emergent phenomena from causal interactions among symptoms. This study re-analysed the British National Psychiatric Morbidity Survey data using network analysis to examine the network structure of paranoia in the general population.

METHODS

We used a Graphical Least Absolute Shrinkage and Selection Operator (glasso) method that estimated an optimal network structure based on the Extended Bayesian Information Criterion. Network sub-communities were identified by spinglass and EGA algorithms and centrality metrics were calculated per item and per sub-community.

RESULTS

We replicated Bebbington's four component structure of paranoia, identifying 'interpersonal sensitivities', 'mistrust', 'ideas of reference' and 'ideas of persecution' as sub-communities in the network. In line with previous experimental findings, worry was the most central item in the network. However, 'mistrust' and 'ideas of reference' were the most central sub-communities.

CONCLUSIONS

Rather than a strict hierarchy, we argue that the structure of paranoia is best thought of as a heterarchy, where the activation of high-centrality nodes and communities is most likely to lead to steady state paranoia. We also highlight the novel methodological approach used by this study: namely, using network analysis to re-examine a population structure of psychopathology previously identified by latent variable approaches.