Though bodily self-disturbances are well documented in schizophrenia, interoceptive functioning (i.e., the perception of the internal state of the body) remains poorly understood in this population. In fact, only two studies to date have empirically measured interoceptive ability in schizophrenia. Both studies documented a deficit in interoceptive accuracy (i.e., objective performance on a heartbeat detection task), and one noted differences in interoceptive sensibility (i.e., subjective experience of interoception) in this population. To our knowledge, interoceptive awareness (i.e., metacognitive awareness of one's interoceptive ability) has never been measured in schizophrenia and the link between interoceptive functioning and schizotypy remains unexplored.The present study addresses this gap by investigating the three dimensions of interoception in individuals with schizophrenia and matched controls (Experiment 1, N=58) and in relation to schizotypal traits (Experiment 2, N=109).Consistent with the literature, Experiment 1 documented a deficit in interoceptive accuracy and differences in interoceptive sensibility in individuals with schizophrenia. For the first time, our study revealed intact interoceptive awareness in individuals with schizophrenia.Against our expectations, we found no link between schizotypy and interoceptive functioning in Experiment 2.Our novel findings bear important clinical implications as insight into one's interoceptive limitations (i.e., intact interoceptive awareness) might promote treatment seeking behavior in schizophrenia. The lack of association between interoceptive ability and schizotypy in non-helpseeking youths suggests that changes in interoception may only arise with the onset of psychosis.

Background As theorized by Abraham Maslow, a fundamental need of all humans is to seek a sense of belonging through meaningful social relationships. This universal process drives social identification, the incorporation of these important relationships into one’s own identity. Over the past several decades, social identity has been implicated in various studies of mental health for the protective role that it plays (Haslam et al. 2015). Paranoia is a core symptom of the schizotypy spectrum, a dynamic continuum that ranges from healthy personality traits to chronic schizophrenia. Paranoia is related to social identity in that it is thought to disrupt the ability to establish trusting social relationships. Over time, the association between social identification and paranoia has been indirectly investigated through various psychosocial factors such as self-esteem, which is thought to be directly influenced by social identity. Previous research has shown that a decrease in self-esteem precedes an immediate increase in paranoia (Myin-Germeys et al., 2008). Despite these findings, few studies have investigated whether social identification is associated with paranoia and the mechanisms by which this effect may emerge. The primary goal of this study was to investigate whether self-esteem mediates the effect of social identity on paranoia in a nonclinical sample. Based on scant previous studies (Bentall et al., 2017), this study hypothesized that self-esteem would mediate the pathway from social identity to paranoia. Methods The sample consisted of 168 Spanish nonclinical youngsters (mean age=28.01), belonging to the ongoing Barcelona Longitudinal Investigation of Schizotypy Study (BLISS). From a large pool of unselected college students, a selected subsample oversampled for schizotypy scores continues regular follow-up assessments. Social identity was measured using the Multidimensional Scale of Perceived Social Support (MSPSS; Landeta & Calvete, 2002), self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965), and paranoia was measured using the “suspiciousness” subscale of the Schizotypal Personality Questionnaire (SPQ; Raine, 1991). A simple mediation analysis of social identity and paranoia via self-esteem was conducted to examine the indirect effect of social identity on paranoia via self-esteem. Results Pearson’s correlations showed that social identity was correlated to self-esteem (r=0.311; p<0.001) and paranoia (r=-0.323; p<0.001). Likewise, self-esteem and paranoia were also correlated (r=-0.344; p<0.001). Mediation analyses showed that there was a significant indirect effect of social identity on paranoia via self-esteem (estimated IE=-0.0117, SE=0.0045, LLCI=-0.0230, ULCI=-0.0047). Discussion The finding that self-esteem mediates the pathway from social identity to paranoia provides an important connection between previous literature that has studied these relationships indirectly. This study concludes that meaningful social relationships may protect against paranoia and it highlights the relevance of tanking into account self-esteem in explaining the association between social identity and paranoia. Thus, it may provide a framework in which various forms of social interventions can be used to prevent and treat paranoid ideation. However, further steps are being taken to further establish this finding. It will be useful to look at various samples, both clinical and nonclinical, along the schizotypy spectrum in order to further investigate the mechanism of action underlying this environmental and psychological interaction.

Though bodily self-disturbances are well documented in schizophrenia, interoceptive functioning (i.e., the perception of the internal state of the body) remains poorly understood in this population. In fact, only two studies to date have empirically measured interoceptive ability in schizophrenia. Both studies documented a deficit in interoceptive accuracy (i.e., objective performance on a heartbeat detection task), and one noted differences in interoceptive sensibility (i.e., subjective experience of interoception) in this population. To our knowledge, interoceptive awareness (i.e., metacognitive awareness of one’s interoceptive ability) has never been measured in schizophrenia and the link between interoceptive functioning and schizotypy remains unexplored. The present study addresses this gap by investigating the three dimensions of interoception in individuals with schizophrenia and matched controls (Experiment 1, N=58) and across the schizotypy spectrum (Experiment 2, N=109). Consistent with the literature, Experiment 1 documented a deficit in interoceptive accuracy and differences in interoceptive sensibility in individuals with schizophrenia. For the first time, our study revealed intact interoceptive awareness in individuals with schizophrenia. Against our expectations, we found no link between schizotypy and interoceptive functioning in Experiment 2. Our novel findings bear important clinical implications as insight into one’s interoceptive limitations (i.e., intact interoceptive awareness) might promote treatment seeking behavior in schizophrenia. The lack of association between interoceptive ability and schizotypy in non-help-seeking youths suggests that changes in interoception may only arise with the onset of psychosis.

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