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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)
  • DOI:
  • Published online: 24 August 2010

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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RP Bentall , G Rowse , N Shryane , P Kinderman , R Howard , N Blackwood , R Moore , R Corcoran (2009). The cognitive and affective structure of paranoid delusions. Archives of General Psychiatry 66, 236247.

JS Coleman (1988). Social capital in the creation of human capital. American Journal of Sociology 94, s95–120.

DR Combs , CO Michael , DL Penn (2006). Paranoia and emotion perception across the continuum. British Journal of Clinical Psychology 45, 1931.

WW Eaton , LG Kessler (eds) (1985). Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Academic Press: Orlando, FL.

Y Forsell , AS Henderson (1998). Epidemiology of paranoid symptoms in an elderly population. British Journal of Psychiatry 172, 429432.

C Foster , H Startup , L Potts , D Freeman (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry 41, 4551.

D Freeman (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review 27, 425457.

D Freeman , T Brugha , H Meltzer , R Jenkins , D Stahl , P Bebbington (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.

D Freeman , PA Garety , PE Bebbington , B Smith , R Rollinson , D Fowler , E Kuipers , K Ray , G Dunn (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427435.

D Freeman , K Pugh , A Antley , M Slater , P Bebbington , M Gittins , G Dunn , E Kuipers , D Fowler , PA Garety (2008 b). A virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry 192, 258263.

D Freeman , K Pugh , N Vorontsova , A Antley , M Slater (2010 b). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology 119, 8392.

D Freeman , K Pugh , N Vorontsova , L Southgate (2009). Insomnia and paranoia. Schizophrenia Research 108, 280284.

M Harrow , T Jobe , EB Astrachan-Fletcher (2008). Prognosis of persecutory delusions in schizophrenia: a 20-year longitudinal study. In Persecutory Delusions (ed. D. Freeman , R. Bentall and P. Garety ), pp. 7390. Oxford University Press: Oxford.

C Henquet , M Di Forti , RM Murray , J van Os (2008). The role of cannabis in inducing paranoia and psychosis. In Persecutory Delusions (ed. D. Freeman , R. Bentall and P. Garety ), pp. 267280. Oxford University Press: Oxford.

I Iancu , A Poreh , B Lehman , E Shamir , M Kotler (2005). The Positive and Negative Symptoms Questionnaire. Comprehensive Psychiatry 46, 6166.

R Jenkins , H Meltzer , P Bebbington , T Brugha , M Farrell , S McManus , N Singleton (2009). The British Mental Health Survey Programme: achievements and latest findings. Social Psychiatry and Psychiatric Epidemiology 44, 899904.

LC Johns , M Cannon , N Singleton , RM Murray , M Farrell , T Brugha , P Bebbington , R Jenkins , H Meltzer (2004). The prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298305.

I Kawachi , BP Kennedy , K Lochner , D Prothrow-Stith (1997). Social capital, income inequality, and mortality. American Journal of Public Health 87, 14911498.

KS Kendler , TJ Gallagher , JM Abelson , RC Kessler (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.

L Krabbendam , J van Os (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.

E Lindström , E Jedenius , S Levander (2009). A symptom self-rating scale for schizophrenia (4S). Nordic Journal of Psychiatry 63, 368374.

GA Miller , JP Chapman (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology 110, 4048.

THM Moore , S Zammit , A Lingford-Hughes , TE Barnes , PB Jones , M Burke , G Lewis (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.

I Myin-Germeys , J van Os (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.

CB Pedersen , PB Mortensen (2001). Evidence of a dose–response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 10391046

V Peralta , MJ Cuesta (1999). Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders. Schizophrenia Research 38, 1326.

RD Putnam (1995). Bowling alone: America's declining social capital. Journal of Democracy 6, 6578.

BPF Rutten , J van Os , M Dominguez , L Krabbendam (2008). Epidemiology and social factors: findings from the Netherlands Mental Health Survey and Incidence and Incidence Study (NEMESIS). In Persecutory Delusions (ed. D. Freeman , R. Bentall and P. Garety ), pp. 5371. Oxford University Press: Oxford.

JB Saunders , OG Aasland , TF Babor , JR Dela Fuente , M Grant (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.

J Siegrist (1996). Adverse health effects of high effort/low-reward conditions. Journal of Occupational Health Psychology 1, 2741.

H Startup , D Freeman , PA Garety (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy 45, 523537.

V Thewissen , I Myin-Germeys , R Bentall , R de Graaf , W Vollebergh , J van Os (2005). Hearing impairment and psychosis revisited. Schizophrenia Research 76, 99103.

P Tyrer , U Nur , M Crawford , S Karlsen , C MacLean , B Rao , T Johnson (2005). The social functioning questionnaire: a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265275.

J Van Os , M Hanssen , RV Bijl , A Ravelli (2000). Strauss (1969) revisited: a psychosis continuum in the general population. Schizophrenia Research 45, 1120.

D Vermissen , I Janssen , I Myin-Germeys , R Mengelers , J a Campo , J van Os , L Krabbendam (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research 99, 103110.

JL Vázquez-Barquero , I Lastra , MJC Nuñez , SH Castanedo , G Dunn (1996). Patterns of positive and negative symptoms in first episode schizophrenia. British Journal of Psychiatry 168, 693701.

JE Ware , M Kosinski , SD Keller (1995). A 12-item short-form health survey. Construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220233.

PG Zimbardo , SM Andersen , LG Kabat (1981). Induced hearing deficit generates experimental paranoia. Science 212, 15291531.

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