Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation.

OBJECTIVES. The evidence to date for a causal role of emotions in the generation of paranoid symptoms is scarce, mainly because of a lack of studies investigating the longitudinal association between emotional processes and paranoia. The primary aim of this study was to investigate whether momentary emotional experiences (anxiety, depression, anger/irritability) and self-esteem predicted the onset and duration of a paranoid episode. We also studied whether levels of emotional experiences and self-esteem were respectively higher and lower during a paranoid episode. DESIGN. A 1-week, prospective momentary assessment study. METHODS. Data were collected using the experience sampling method, a structured self-assessment diary technique. The sample consisted of 158 individuals who ranged across the paranoia continuum. Participants with a psychotic disorder were recruited from in-patient and out-patient mental health services. Participants without psychotic disorder were sampled from the general population. RESULTS. Specific aspects of emotional experience were implicated in the onset and persistence of paranoid episodes. Both an increase in anxiety and a decrease in self-esteem predicted the onset of paranoid episodes. Cross-sectionally, paranoid episodes were associated with high levels of all negative emotions and low level of self-esteem. Initial intensity of paranoia and depression was associated with longer, and anger/irritability with shorter duration of paranoid episodes. CONCLUSIONS. Paranoid delusionality is driven by negative emotions and reductions in self-esteem, rather than serving an immediate defensive function against these emotions and low self-esteem. Clinicians need to be aware of the central role of emotion-related processes and especially self-esteem in paranoid thinking.