The puzzle of paranoia

Vulnerable Self, Poor Understanding of Others' Minds, Threat Anticipation and Cognitive Biases as Triggers for Delusional Experience in Schizophrenia: A Theoretical Model

“…The threat anticipation model (TAM; Fowler, ; Freeman, ; Freeman & Freeman, ; Freeman & Garety, ; Freeman, Garety, & Fowler, ; Freeman, Garety, Kuipers, Fowler, & Bebbington, ; Garety, Kuipers, Fowler, Freeman, & Bebbington, ) suggests that delusions are precipitated by levels of arousal and anxiety that create anomalous internal experiences among vulnerable persons (e.g., thoughts being experienced as voices, depersonalization, perceptual anomalies), which in turn elicit a ‘search for meaning’. In the search for meaning, pre‐existing beliefs about the self, others and the world (e.g., the self as weak, others as threatening and the world as bad) are drawn upon, determining the anticipation of threat that characterizes the persecutory delusions.…”

“…Such negative beliefs about the self may lead to an experience of oneself as a vulnerable target, an easy target for others to mock, exploit or harm. This may be especially likely when a person has a negative appraisal of others, for example, that people are generally bad, selfish or devious (Freeman et al, ).…”

“…We agree with the TAM that this vulnerable sense of self could be linked to a range of factors including history of trauma that predates the emergence of psychosis (Freeman et al, , ). Some research has shown unusually high rates of trauma among patients diagnosed with psychosis as well as links between positive symptoms and the experience of trauma among persons in the general population (Butler, Mueser, Sprock, & Braff, ; Ensink, ; Liotti & Gumley, ; Morrison, Frame, & Larkin, ).…”

Adapted Metacognitive Interpersonal Therapy for Improving Adherence to Intersubjective Contexts in a Person With Schizophrenia

“…According to Freeman and colleagues (Freeman et al, 2005;Freeman, Garety, & Fowler, 2008), negative beliefs about the self and others are associated with negative arousal (anxiety and depression), which may be important in the generation of persecutory delusions. When an individual is ashamed of him or herself and feels anxious, negative arousal is then likely to encourage a representation of the world as threatening and to induce delusional ideation, a process that was visible in Marianna's initial conversations with the therapist.…”

“…Heilbrun and Kors (1991) stressed how social withdrawal can have a role in stoking the delusion-hallucination circle. The more a person with schizophrenia is isolated, the less possible is it for others' feedback to help in revising persecutory thoughts (Freeman et al, 2008).…”