Paranoia and Social Anxiety: Predicting Aggressive Behavior.

Aggression is a transdiagnostic behavior that is associated with poor clinical outcomes. As such, it is important to understand factors that contribute to various manifestations of aggressive behavior. Recent research has revealed a subtype of individuals with social anxiety disorder (SAD) who tend to display relatively high amounts of aggression and experience more severe social anxiety and dysfunction compared to individuals in the prototypical SAD group. The current study used a status threat manipulation along with behavioral indices of aggression to examine the impact of paranoia and social anxiety symptom severity on aggression in a sample of undergraduates with social anxiety (N = 220). Analyses indicated that paranoia uniquely predicted indirect aggression whereas an interaction between social status threat, paranoia, and social anxiety severity uniquely predicted direct aggression. These findings suggest that paranoia may be a particularly important contributor to aggression among individuals with social anxiety.

Digitally Enhanced Psychological Assessment and Treatment of Paranoia: A Systematic Review.

BACKGROUND: Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision and are increasingly being integrated into healthcare. This systematic review evaluated feasibility, acceptability, and effectiveness of digitally enhanced psychological assessments and treatments for paranoia across the paranoia continuum (PROSPERO: CRD42023393257). METHODS: Databases PsychINFO, EMBASE, MEDLINE and Web of Science were searched until 12 June 2023; the Effective Public Health Practice Project (EPHPP) quality assessment tool evaluated studies; and a narrative synthesis was conducted. RESULTS: Twenty-seven studies met inclusion criteria (n = 3457, 23 assessment and 4 treatment, 2005-2023, most in Europe). Technologies included virtual reality (VR, n = 23), experience sampling methodology (ESM, n = 2), an app (n = 1) and a combination of VR and ESM (n = 1). Assessments involved monitoring paranoia under various virtual conditions or in everyday life. Treatments were generally integrated with Cognitive Behaviour Therapy (CBT), which involved using VR to test out threat beliefs and drop safety behaviours or using an app to support slowing down paranoid thinking. EPHPP ratings were strong (n = 8), moderate (n = 12) and weak (n = 7). CONCLUSIONS: Digitally enhanced assessments and treatments showed promising acceptability, feasibility and treatment effectiveness. Limitations of studies include small sample sizes, lack of comparison groups and long-term data and limited randomised controlled trials. Results support the potential future integration of VR in the assessment of paranoia and show promise for treatments such as CBT, although further clinical trials are required. Investigation of other technologies is limited.

Postictal psychiatric symptoms: A neurophysiological study.

OBJECTIVE: Postictal psychiatric symptoms (PPS) are a relatively common but understudied phenomenon in epilepsy. The mechanisms by which seizures contribute to worsening in psychiatric symptoms are unclear. We aimed to identify PPS prospectively during and after admission to the epilepsy monitoring unit (EMU) in order to characterize the postictal physiologic changes leading to PPS. METHODS: We prospectively enrolled patients admitted to the EMU and administered repeat psychometric questionnaires during and after their hospital stay in order to assess for postictal exacerbations in four symptom complexes: anger/hostility, anxiety, depression, and paranoia. Electroclinical and electrographic seizures were identified from the EEG recordings, and seizure durations were measured. The severity of postictal slowing was calculated as the proportion of postictal theta/delta activity in the postictal EEG relative to the preictal EEG using the Hilbert transform. RESULTS: Among 33 participants, 8 demonstrated significant increases in at least one of the four symptoms (the PPS+ group) within three days following the first seizure. The most common PPS was anger/hostility, experienced by 7/8 participants with PPS. Among the 8 PPS+ participants, four experienced more than one PPS. As compared to those without PPS (the PPS- group), the PPS+ group demonstrated a greater degree of postictal EEG slowing at 10 min (p = 0.022) and 20 min (p = 0.05) following seizure termination. They also experienced significantly more seizures during the study period (p = 0.005). There was no difference in seizure duration between groups. SIGNIFICANCE: Postictal psychiatric symptoms including anger/hostility, anxiety, depression, and paranoia may be more common than recognized. In particular, postictal increases in anger and irritability may be particularly common. We provide physiological evidence of a biological mechanism as well as a demonstration of the use of quantitative electroencephalography toward a better understanding of postictal neurophysiology.

Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans.

Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean ± SD = 10.91 ± 7.12 versus 8.21 ± 7.17 and Mean ± SD = 10.18 ± 10.03 versus 6.35 ± 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (ß = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.

Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature.

PURPOSE: Insecure attachment may constitute a vulnerability factor for psychosis, and dissociation may be a key mechanism in the development of auditory hallucinations specifically. While there is good evidence for the role of these processes in isolation, it is unclear whether dissociation accounts for the association between insecure attachment and psychosis. This systematic review takes a theory-driven approach to examine proposed causal relationships across the clinical and nonclinical literature. METHODS: We searched five databases (PubMeD, Web of Science, PsycINFO, CINAHL and ETHOS) for published and unpublished research examining attachment, dissociation and psychosis. Two independent reviewers extracted the data and assessed the quality of all included studies. RESULTS: We identified 242 potential articles and included 13 in the final review (2096 participants). We found that (1) disorganised attachment was consistently associated with dissociation and inconsistently associated with voices and paranoia, (2) dissociation was associated with voices and paranoia, and these links were stronger in clinical samples, and (3) dissociation played a role in the impact of insecure attachment on voice hearing and paranoia in clinical groups. CONCLUSIONS: This is the first review to synthesise the research examining attachment, dissociation, and psychosis. The evidence is consistent with proposed causal hypotheses and raises conceptual and measurement issues, for example, the need to clarify the relative contributions of different insecure attachment styles, and utilise behavioural/observational measures to strengthen study designs. Most importantly, we need experimental and longitudinal studies to confirm causal links and targets for treatment.

[Recent developments in the modeling and psychological management of persecutory ideation]. / Actualités récentes dans la modélisation et la prise en charge psychologique des idées de persécution.

Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.

Conspiracy mentality, subclinical paranoia, and political conservatism are associated with perceived status threat.

Status threat (i.e., concern that one's dominant social group will be undermined by outsiders) is a significant factor in current United States politics. While demographic factors such as race (e.g., Whiteness) and political affiliation (e.g., conservatism) tend to be associated with heightened levels of status threat, its psychological facets have yet to be fully characterized. Informed by a "paranoid" model of American politics, we explored a suite of possible psychological and demographic associates of perceived status threat, including race/ethnicity, political conservatism, analytic thinking, magical ideation, subclinical paranoia, and conspiracy mentality. In a small, quota sample drawn from the United States (N = 300), we found that conspiracy mentality, subclinical paranoia, conservatism, and age were each positively (and uniquely) associated with status threat. In addition to replicating past work linking conservatism to status threat, this study identifies subclinical paranoia and conspiracy mentality as novel psychological associates of status threat. These findings pave the way for future research regarding how and why status threat concerns may become exaggerated in certain individuals, possibly to the detriment of personal and societal wellbeing.

Experimental studies of paranoid thinking in clinical and nonclinical populations: a systematic review and meta-analysis.

Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that attempt to induce, manipulate or measure paranoid thinking in both clinical and nonclinical populations, which is important to understand causal mechanisms and advance psychological interventions. Our aim was to conduct a systematic review and meta-analysis of experimental studies (non-sleep, non-drug paradigms) on psychometrically assessed paranoia in clinical and nonclinical populations. The review was conducted using PRISMA guidelines. Six databases (PsycINFO, PubMed, EMBASE, Web of Science, Medline and AMED) were searched for peer-reviewed experimental studies using within and between-subject designs to investigate paranoia in clinical and nonclinical populations. Effect sizes for each study were calculated using Hedge's g and were integrated using a random effect meta-analysis model. Thirty studies were included in the review (total n = 3898), which used 13 experimental paradigms to induce paranoia; 10 studies set out to explicitly induce paranoia, and 20 studies induced a range of other states. Effect sizes for individual studies ranged from 0.03 to 1.55. Meta-analysis found a significant summary effect of 0.51 [95% confidence interval 0.37-0.66, p < 0.001], indicating a medium effect of experimental paradigms on paranoia. Paranoia can be induced and investigated using a wide range of experimental paradigms, which can inform decision-making about which paradigms to use in future studies, and is consistent with cognitive, continuum and evolutionary models of paranoia.

Psychopathological mediators between insecure attachment and psychotic features in a non-clinical sample: the role of depression and interpersonal sensitivity.

INTRODUCTION: Attachment styles represent a personality pattern critical to psychological health, with insecure attachment being a central factor in developing psychopathological characteristics of psychosis. However, its downstream psychopathological pathways remain unclear. This study aimed to investigate the putative psychopathological mediators in the relationship between insecure attachment and psychotic features in a non-clinical sample of university students. METHODS: We recruited two non-clinical samples for a total of 978 subjects, 324 males and 654 females, and administered the Relationship Questionnaire (RQ) to assess attachment styles and the Symptom Check-List 90 (SCL-90) to assess psychopathological symptoms. Moreover, the Paranoia and Psychoticism subscales of SCL-90 were combined and used as a measure of Psychosis (PSY). A mediation analysis model was carried out to establish the relationship among variables. RESULTS: Mediation analysis showed a total effect from RQ-Preoccupied and RQ-Fearful to PSY, respectively, 0.31 and 0.28. Direct effects from the SCL-90-R factor candidate mediator to PSY ranged from 0.51 for somatization to 0.72 for depression and 0.72 for interpersonal sensitivity. Indirect effects ranged from 0.08 for RQ-Preoccupied via hostility to 0.21 for RQ-Preoccupied via depression. DISCUSSION: Our results show that the effect of insecure attachment on psychosis features is differentially mediated by some psychopathological dimensions, being depression and interpersonal sensitivity the most relevant ones. PSY feature, therefore, is predicted by other specific symptoms in the psychological context of insecure primary relationships. CONCLUSIONS: From a preventive and clinical point of view, our results could be relevant in informing the early-stage psychological treatment of pre-psychotic states and, in general, people experiencing sub-threshold psychotic symptoms.

The murder of the surgeon Antonio Parrozzani and the relationship between sexual disorders and paranoid thinking.

In this study we aimed to describe the relationship between sexual disorders and paranoid thinking describing the historical case of murder of the famous surgeon Antonio Parrozzani and the pathological personality of his murderer. Parrozzani was killed by Francesco Mancini, his patient in the past. Mancini was obsessed by his sexual problems due to hypothetical injuries after an inguinal hernia surgery, made by Parrozzani. Following treatment, the murderer likely lived his surgery as a traumatic event and developed a paranoid thinking against the surgeon, breaking out with the dramatic homicide. Parrozzani's case highlights the strong relationship between paranoia and sexuality, and likewise this relationship can be considered as a prodromic factor for a psychotic onset. Moreover, this case, supported by two psychiatric assessments of murderer, remembers once again the association between violence and paranoia. Therefore, clinicians should take into account the danger of the possible presence of paranoid obsession together with sexual problems, to prevent psychosis onset or violent acts related to paranoid delusions.

Sexual abuse and psychotic phenomena: a directed acyclic graph analysis of affective symptoms using English national psychiatric survey data.

BACKGROUND: Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect. METHOD: We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 (N = 5954) and 2014 (N = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality. RESULTS: In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms. CONCLUSIONS: Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis.

Cognitive flexibility and emotion regulation: Dual layers of resilience against the emergence of paranoia.

Cognitive inflexibility has been linked to difficulties in revising paranoid beliefs, whereas cognitive flexibility may protect against the development and maintenance of paranoid beliefs by allowing for troubleshooting in light of available evidence. While less discussed in the context of paranoia research, better regulation of affective states may reduce the likelihood of biased beliefs developing in the first place, reducing the burden on belief updating mechanisms. The present study hypothesized that high cognitive flexibility and strong emotion regulation ability may act as a reciprocal protective shield against the risk associated with lower ability in the other domain. Participants were recruited from the general population (N = 221) to complete the Ambiguous Interpretation Inflexibility Task, as well as self-report measures for paranoia and emotion regulation ability. The results show an interaction between cognitive flexibility and emotion regulation ability as related to less severe paranoia. Better emotion regulation ability is associated with lower paranoia in individuals with lower cognitive flexibility, whereas higher cognitive flexibility is associated with less severe paranoia in individuals with greater emotion regulation difficulties. These findings highlight the importance of emotion regulation in early interventions of paranoia, especially how emotion regulation relates to known cognitive vulnerabilities such as inflexibility.

Self-compassion as a mediator of the relationship between childhood sexual abuse and psychotic symptoms in clinical and non-clinical groups.

BACKGROUND: Previous research has shown a link between childhood sexual abuse (CSA) and more severe symptoms of psychosis. There is also evidence that self-compassion is a key mechanism linking adverse childhood experiences and mental health problems such as post-traumatic stress disorder and depression, but no research has examined these links in psychosis. METHODS: We analysed existing cross-sectional data, including 55 individuals with psychosis and 166 individuals from the general population. Participants completed standardized measures of CSA, self-compassion, paranoia, positive psychotic symptoms and distress linked to psychosis. RESULTS: The clinical group had higher scores on CSA and all psychosis measures, but we found no differences in self-compassion between the groups. Higher levels of CSA correlated with lower self-compassion and higher paranoia and positive symptoms in both groups. CSA also correlated with distress linked to psychosis in the non-clinical group. Lower self-compassion mediated the association between higher levels of CSA and more severe paranoia in both groups. In the non-clinical group, lower self-compassion also mediated the association between greater CSA and more positive psychotic symptoms and more severe distress. CONCLUSIONS: This is the first study to show that self-compassion mediates the link between CSA and both paranoia and psychotic symptoms in adulthood. Self-compassion may therefore be an important transdiagnostic candidate target in therapy to mitigate the impact of early adversity on paranoia in both clinical and non-clinical groups. Limitations include the small clinical sample and inclusion of a cannabis-using non-clinical sample, though recent cannabis use did not impact self-compassion levels.

Rethinking paranoid ideation and reasoning: A pilot study based on the argumentative theory of reasoning.

BACKGROUND AND OBJECTIVES: Cognitive theories assume an imbalance of intuitive and analytical reasoning in paranoid ideation. The argumentative theory of reasoning offers an approach on the primary function of reasoning and its flaws. It assumes social exchange as main purpose of reasoning. We applied this theory to delusion research and tested experimentally whether social exchange in the form of production and evaluation of arguments influences subsequent reflective reasoning. Additionally, we examined whether the social network and the frequency/preference for discussions are associated with distorted reflective reasoning and paranoid ideation. METHODS: 327 participants completed the Social Network Index (SNI), the Paranoia Checklist (PCL), and the Cognitive Reflection Test-2 (CRT2). Moreover, preference and frequency of discussions were assessed. In the discussion group (N = 165), participants produced arguments and evaluated counterarguments on two socially relevant topics. The control group (N = 162) watched a nature video instead. RESULTS: The discussion group showed lower distorted reflective reasoning than the control group. Discussion preference and/or frequency was associated with frequency and disturbance of paranoid thoughts, as well as overall paranoid ideation. LIMITATIONS: Due to the online format environmental factors could not be held constant and no intrasubject comparison of the CRT2 could be computed in the trial. Furthermore, the sample mainly consisted of psychology students. CONCLUSION: The results contribute to the understanding of distorted reflective reasoning and provides preliminary evidence that the argumentative theory of reasoning may offer a promising perspective for delusion research.

Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies.

BACKGROUND AND OBJECTIVES: Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS: We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS: Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS: The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS: Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.

"Green et al. Paranoid Thoughts Scale-revised": Structural invariance and clinical utility of a brief version in schizophrenia.

OBJECTIVE: Persecutory ideas are highly frequent in psychotic disorders and particularly in schizophrenia. Although several measures exist to assess persecutory ideas in both clinical and non-clinical samples, there is a need for brief and psychometrically sound measures to capture the multidimensional aspects of paranoia in people diagnosed with schizophrenia. Our aim was to validate a brief version of the revised Green et al., Paranoid Thoughts Scale (R-GPTS) in schizophrenia in order to minimize time-consuming assessment. METHODS: 100 individuals with schizophrenia and 72 non-clinical controls were recruited. We used the GPTS-8, a brief 8-item version of the R-GPTS recently developed and validated in the French general population. Psychometric properties of the scale were investigated including its factor structure, internal consistency, and convergent/divergent validities. RESULTS: Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the GPTS-8. The GPTS-8 was positively and moderately correlated with the Positive and Negative Syndrome Scale (PANSS) suspiciousness item indicating good internal consistency. Concerning divergent validity, no correlations were found between the GPTS-8 and the Montreal cognitive assessment (MoCA). Importantly patients with schizophrenia reported higher scores on the GTPS-8 than controls demonstrating its clinical validity. CONCLUSIONS: The French GPTS 8-item brief scale-8 retains the psychometric strengths of the R-GPTS in schizophrenia with relevant clinical validity. The GPTS-8 can consequently be used as a short and quick measure of paranoid ideations in individuals with a diagnosis of schizophrenia.

[To the problem of somatic-hypochondriac paranoia]. / K probleme somaticheskoi-ipokhondricheskoi paranoii.

OBJECTIVE: To unite within the framework of a single clinical entity (based on the model of hypochondriacal paranoia) phenomena of the somatopsychotic and hypochondriacal range, which, in accordance with modern systematics, are classified as various categories of psychosomatic, affective disorders and personality disorders. MATERIAL AND METHODS: The sample for analysis consisted of 29 patients (with the diagnosis of delusional disorder (ICD-10; F22.0 in ICD-10), 10 men (34.5%) and 19 women (64.5%), the average age was 42.9±19.9 years; men - 10 nab. (34.5%), women - 19 nab. (64.5%). The average duration of the disease iswas 9.4±8.5 years. The psychopathological method was used as the main one. RESULTS: The article forms an alternative concept of somatic paranoia based on the model of hypochondriacal paranoia. The fundamental difference between the construct of somatic paranoia is an obligate connection between somatopsychic and ideational disorders. Somatopsychic (coenesthesiopathic) symptoms do not exist as an independent (equivalent to the structure of somatic clinical syndromes) dimensions and are formed exclusively with the participation of ideational phenomena. CONCLUSION: In accordance with the presented concept, coenesthesiopathic symptoms within the framework of somatic paranoia act as a somatic equivalent of delusional disorders.

A preliminary study examining terminology used by individuals with lived experience describing beliefs about being targeted or harmed by others.

While recent studies have prompted re-evaluation of the term "schizophrenia," few have examined the use of terms to describe persecutory ideation (PI) or paranoia. This study examines the preferences and terms used by a cross-diagnostic population of individuals (N = 184) with lived experience using an online survey. Participants most commonly described their PI in terms of the perceived source of threat, followed by clinical language, most commonly variants of "paranoia" and "anxiety." Of five selected terms assessed quantitatively - "anxiety," "paranoia," "persecutory thoughts," "suspiciousness," and "threat thoughts" - participants were more likely to report that "anxiety" aligned with their experience of PI, followed by "suspiciousness." Endorsement of terms more specific to PI was associated with self-report PI severity, while a preference for "anxiety" over other terms was both associated with less severe PI and lower scores on a measure of stigma. These results suggest that the heterogeneity of terms used by individuals with lived experience support a person-centered approach to language describing such experiences.

Temporal pathways from attachment insecurity to paranoia in a heterogeneous clinical sample: An experience sampling study.

INTRODUCTION: There has been growing interest in the role of attachment mechanisms in the onset and maintenance of paranoia. The latest systematic reviews of mixed samples of healthy individuals and psychiatric patients have revealed that increased trait attachment anxiety and avoidance are associated with experiencing paranoia, with trait attachment anxiety showing a stronger association. Few studies have examined attachment and paranoia in naturalistic conditions via the Experience Sampling Method. OBJECTIVES: The present study examined whether experiences of attachment anxiety and avoidance fluctuate in the flow of daily life, and whether a within-person change in both attachment states precedes the experience of momentary paranoia, and negative and positive emotions. METHODS: Thirty-seven clinical participants and twenty-six healthy controls were studied over six consecutive days using the Experience Sampling Method (ESM). An experience-in-close-relationships questionnaire (ECR-R 16 SF) was used to capture trait attachment dimensions. Several ESM items were used to capture momentary negative and positive affect, paranoia and attachment insecurity states. RESULTS: The findings revealed that fluctuations in both attachment insecurity states were significantly higher in the clinical group. A prior elevated attachment anxiety and avoidance was followed by an increase in negative affect in the next moment and elevated attachment avoidance was additionally followed by a decrease in positive affect and an increase in paranoia. CONCLUSION: Our findings reveal the specific temporal associations between momentary attachment insecurity states as predictors of change in emotions/affects and paranoia, along with evidence that state attachment avoidance has a superior impact on momentary affect and paranoia compared to state attachment anxiety. These results contrast with those of recent cross-sectional studies.

The felt-presence experience: from cognition to the clinic.

The felt presence experience is the basic feeling that someone else is present in the immediate environment, without clear sensory evidence. Ranging from benevolent to distressing, personified to ambiguous, felt presence has been observed in neurological case studies and within psychosis and paranoia, associated with sleep paralysis and anxiety, and recorded within endurance sports and spiritualist communities. In this Review, we summarise the philosophical, phenomenological, clinical, and non-clinical correlates of felt presence, as well as current approaches that use psychometric, cognitive, and neurophysiological methods. We present current mechanistic explanations for felt presence, suggest a unifying cognitive framework for the phenomenon, and discuss outstanding questions for the field. Felt presence offers a sublime opportunity to understand the cognitive neuroscience of own-body awareness and social agency detection, as an intuitive, but poorly understood, experience in health and disorder.