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Author for correspondence: Dr Lucia R. Valmaggia, E-mail: [email protected]
Introduction
Paranoid ideation, the unfounded belief that others have hostile intentions and want to cause personal harm (Garety & Freeman, 2013) is a core feature of psychosis, prevalent in over 70% of those presenting with the first episode of psychosis (Coid et al. 2013). Paranoid ideation is likely caused by the misinterpretation of internal arousal and states (Freeman et al. 2005a, b, c) and it has also been observed in people suffering from other mental health disorders like anxiety disorders, particularly social anxiety disorder (Gilbert et al. 2005; Michail & Birchwood, 2009), depression (Wigman et al. 2012; Fusar-Poli et al. 2014), and dementia (Selbæk et al. 2013). However, previous research suggests that paranoid thinking is not a distinct emotional state common to those with mental health difficulties, but that it is exponentially distributed in the population; meaning ‘that many individuals have few paranoid thoughts, and few individuals have many’ (Freeman et al. 2005a, b, c). Paranoia occurs on a single dimension, with social evaluative concerns on one end of the continuum and persecutory delusions on the other (Freeman et al. 2005a, b, c). Findings from general population-based studies indicate that as many as 30% of people regularly have paranoid thoughts, and about 5% have experienced persecutory thinking (Johns et al. 2004; Freeman et al. 2011; Bebbington et al. 2013); albeit in only in a minority this is persistent enough to prompt help-seeking (Freeman et al. 2011).
Furthermore, there is strong evidence that factors associated with paranoid thinking are the same among clinical and non-clinical populations; for example attachment disruptions (Pickering et al. 2008), childhood trauma (Reininghaus et al. 2016), particularly bullying (Bentall et al. 2012; Valmaggia et al. 2015a, b), and growing up in an urban environment (Freeman et al. 2015) have all been found to increase the risk for paranoid ideation. Overall, paranoia has been associated with lower physical and psychological well-being, mood, and social inclusion; causing significant levels of distress, disability, and reductions in psychological functioning (Gilbert et al. 2005; Freeman et al. 2011; Freeman & Garety, 2014).
Perceptions of the self, have long been hypothesised to be one...