Keynote Address: The Psychology of Paranoid Delusions

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Length: 1 hour 12 minutes

Richard P. Bentall, PhD

Persecutory (paranoid) delusions are one of the most common symptoms of psychosis, present in up to 90% of first-episode schizophrenia patients. However, lesser severe forms of paranoid thinking are common in the lives of ordinary people. Nevertheless, there seem to be some important differences between the paranoid thinking of patients with psychosis and that of ordinary people. Specifically, patients with paranoia most often experience 'poor-me' beliefs in which they feel themselves to be innocent victims of undeserved persecution whereas paranoid non-patients typically have 'bad-me' beliefs in which self-esteem is low and in which they feel that persecution is deserved.

Research showing that paranoid symptoms often occur against a background of insecure attachment and experiences of chronic victimisation suggests that they co-opt normal psychological mechanisms involved in the anticipation and avoidance of social threat. At the neurophysiological level, these mechanisms may involve dopamine circuits in the basal ganglia. At the psychological level, the evolution of paranoia during the lifetime of the individual from 'bad-me' during the prodromal phase to 'poor-me' during an acute psychotic crisis can be understood in terms of the development of internal working models (or schemas) about the self and others, and also defensive self-regulatory processes which become important in the transition from bad-me to poor-me paranoia. Hence, research on paranoia provides a bridge between biological and psychological approaches to psychosis, and between cognitive-behavioural and more psychodynamic models of symptom development. The clinical implications of these observations will be discussed if time allows.

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