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Concomitants of paranoia in the general population

  • D. Freeman (a1), S. McManus (a2), T. Brugha (a3), H. Meltzer (a3), R. Jenkins (a1) and P. Bebbington (a4)...

Paranoia is an unregarded but pervasive attribute of human populations. In this study we carried out the most comprehensive investigation so far of the demographic, economic, social and clinical correlates of self-reported paranoia in the general population.


Data weighted to be nationally representative were analysed from the Adult Psychiatric Morbidity Survey in England (APMS 2007; n=7281).


The prevalence of paranoid thinking in the previous year ranged from 18.6% reporting that people were against them, to 1.8% reporting potential plots to cause them serious harm. At all levels, paranoia was associated with youth, lower intellectual functioning, being single, poverty, poor physical health, poor social functioning, less perceived social support, stress at work, less social cohesion, less calmness, less happiness, suicidal ideation, a great range of other psychiatric symptoms (including anxiety, worry, phobias, post-traumatic stress and insomnia), cannabis use, problem drinking and increased use of treatment and services.


Overall, the results indicate that paranoia has the widest of implications for health, emotional well-being, social functioning and social inclusion. Some of these concomitants may contribute to the emergence of paranoid thinking, while others may result from it.

Corresponding author
*Address for correspondence: D. Freeman, Ph.D., King's College London, Department of Psychology, PO Box 077, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK. (Email:
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Bebbington PE, Nayani T (1995). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research 5, 1120.
Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, Moore R, Corcoran R (2009). The cognitive and affective structure of paranoid delusions. Archives of General Psychiatry 66, 236247.
Ben-Zeev D, Ellington K, Swendsen J, Granholm E (2010). Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophrenia Bulletin. Published online: 28 April 2010. doi:10.1093/schbul/sbq041.
Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner SW, Foa EB (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158162.
Brugha TS, Sturt E, MacCarthy B, Potter J, Wykes T, Bebbington PE (1987). The Interview Measure of Social Relationships: the description and evaluation of a survey instrument for assessing personal social resources. Social Psychiatry and Psychiatric Epidemiology 22, 123128.
Coleman JS (1988). Social capital in the creation of human capital. American Journal of Sociology 94, s95–120.
Combs DR, Michael CO, Penn DL (2006). Paranoia and emotion perception across the continuum. British Journal of Clinical Psychology 45, 1931.
Eaton WW, Kessler LG (eds) (1985). Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Academic Press: Orlando, FL.
Forsell Y, Henderson AS (1998). Epidemiology of paranoid symptoms in an elderly population. British Journal of Psychiatry 172, 429432.
Foster C, Startup H, Potts L, Freeman D (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry 41, 4551.
Freeman D (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review 27, 425457.
Freeman D, Brugha T, Meltzer H, Jenkins R, Stahl D, Bebbington P (2010 a). Persecutory ideation and insomnia: findings from the second British National Survey of Psychiatric Morbidity. Journal of Psychiatric Research. Published online: 28 April 2010. doi:10.1016/j.jpsychires.2010.03.018.
Freeman D, Freeman J (2008). Paranoia: The 21st Century Fear. Oxford University Press: Oxford.
Freeman D, Freeman J, Garety P (2008 a). Overcoming Paranoid and Suspicious Thoughts. Basic Books: New York.
Freeman D, Garety PA, Bebbington PE, Smith B, Rollinson R, Fowler D, Kuipers E, Ray K, Dunn G (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427435.
Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D, Garety PA (2008 b). A virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry 192, 258263.
Freeman D, Pugh K, Vorontsova N, Antley A, Slater M (2010 b). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology 119, 8392.
Freeman D, Pugh K, Vorontsova N, Southgate L (2009). Insomnia and paranoia. Schizophrenia Research 108, 280284.
Harrow M, Jobe T, Astrachan-Fletcher EB (2008). Prognosis of persecutory delusions in schizophrenia: a 20-year longitudinal study. In Persecutory Delusions (ed. Freeman D., Bentall R. and Garety P.), pp. 7390. Oxford University Press: Oxford.
Henquet C, Di Forti M, Murray RM, van Os J (2008). The role of cannabis in inducing paranoia and psychosis. In Persecutory Delusions (ed. Freeman D., Bentall R. and Garety P.), pp. 267280. Oxford University Press: Oxford.
Iancu I, Poreh A, Lehman B, Shamir E, Kotler M (2005). The Positive and Negative Symptoms Questionnaire. Comprehensive Psychiatry 46, 6166.
Jenkins R, Meltzer H, Bebbington P, Brugha T, Farrell M, McManus S, Singleton N (2009). The British Mental Health Survey Programme: achievements and latest findings. Social Psychiatry and Psychiatric Epidemiology 44, 899904.
Johns LC, Cannon M, Singleton N, Murray RM, Farrell M, Brugha T, Bebbington P, Jenkins R, Meltzer H (2004). The prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298305.
Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D (1997). Social capital, income inequality, and mortality. American Journal of Public Health 87, 14911498.
Kendler KS, Campbell J (2009). Interventionist causal models in psychiatry. Psychological Medicine 39, 881887.
Kendler KS, Gallagher TJ, Abelson JM, Kessler RC (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. Archives of General Psychiatry 53, 10221031.
Kish L (1965). Survey Sampling. Wiley & Sons: London.
Krabbendam L, van Os J (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.
Lewis G, Pelosi A, Araya RC, Dunn G (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine 22, 465468.
Lincoln TM, Peter N, Schäfer M, Moritz S (2008). Impact of stress on paranoia: an experimental investigation of moderators and mediators. Psychological Medicine 39, 11291139.
Lindström E, Jedenius E, Levander S (2009). A symptom self-rating scale for schizophrenia (4S). Nordic Journal of Psychiatry 63, 368374.
McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. National Centre for Social Research: London.
Miller GA, Chapman JP (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology 110, 4048.
Moore THM, Zammit S, Lingford-Hughes A, Barnes TE, Jones PB, Burke M, Lewis G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
Morrison PD, Zois V, McKeown DA, Lee TD, Holt DW, Powell JF, Kapur S, Murray RM (2009). The acute effects of synthetic intravenous ▵9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine 39, 16071616.
Myin-Germeys I, van Os J (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.
Nelson HE (1982). The National Adult Reading Test. Nfer-Nelson: Windsor, Berks.
Office for National Statistics (ONS). 2006 mid-year household population estimates (
Pedersen CB, Mortensen PB (2001). Evidence of a dose–response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 10391046
Peralta V, Cuesta MJ (1999). Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders. Schizophrenia Research 38, 1326.
Putnam RD (1995). Bowling alone: America's declining social capital. Journal of Democracy 6, 6578.
Rutten BPF, van Os J, Dominguez M, Krabbendam L (2008). Epidemiology and social factors: findings from the Netherlands Mental Health Survey and Incidence and Incidence Study (NEMESIS). In Persecutory Delusions (ed. Freeman D., Bentall R. and Garety P.), pp. 5371. Oxford University Press: Oxford.
Saunders JB, Aasland OG, Babor TF, Dela Fuente JR, Grant M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption, part II. Addiction 88, 791804.
Scott J, Chant D, Andrews G, McGrath J (2006). Psychotic-like experiences in the general community: the correlates of CIDI psychosis screen items in an Australian sample. Psychological Medicine 36, 231238.
Siegrist J (1996). Adverse health effects of high effort/low-reward conditions. Journal of Occupational Health Psychology 1, 2741.
SPSS (2006). SPSS Base 15.0 User's Guide. SPSS Inc.: Chicago, IL.
Startup H, Freeman D, Garety PA (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy 45, 523537.
Thewissen V, Myin-Germeys I, Bentall R, de Graaf R, Vollebergh W, van Os J (2005). Hearing impairment and psychosis revisited. Schizophrenia Research 76, 99103.
Tyrer P, Nur U, Crawford M, Karlsen S, MacLean C, Rao B, Johnson T (2005). The social functioning questionnaire: a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265275.
Van Os J, Hanssen M, Bijl RV, Ravelli A (2000). Strauss (1969) revisited: a psychosis continuum in the general population. Schizophrenia Research 45, 1120.
Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009). A systematic review and meta-analysis of the psychosis continuum. Psychological Medicine 39, 179195.
Varghese D, Scott J, Welham J, Bor W, Najman J, O'Callaghan M, Williams G, McGrath J (2009). Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophrenia Bulletin. Published online: 17 August 2009. doi:10.1093/schbul/sbp083.
Vázquez-Barquero JL, Lastra I, Nuñez MJC, Castanedo SH, Dunn G (1996). Patterns of positive and negative symptoms in first episode schizophrenia. British Journal of Psychiatry 168, 693701.
Vermissen D, Janssen I, Myin-Germeys I, Mengelers R, a Campo J, van Os J, Krabbendam L (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research 99, 103110.
Ware JE, Kosinski M, Keller SD (1995). A 12-item short-form health survey. Construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220233.
WHO (1992). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Geneva: World Health Organisation.
Zimbardo PG, Andersen SM, Kabat LG (1981). Induced hearing deficit generates experimental paranoia. Science 212, 15291531.
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