Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 49
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Broyd, Samantha J. Michie, Patricia T. Bruggemann, Jason van Hell, Hendrika H. Greenwood, Lisa-marie Croft, Rodney J. Todd, Juanita Lenroot, Rhoshel and Solowij, Nadia 2016. Schizotypy and auditory mismatch negativity in a non-clinical sample of young adults. Psychiatry Research: Neuroimaging, Vol. 254, p. 83.

    Cederlöf, Martin Kuja-Halkola, Ralf Larsson, Henrik Sjölander, Arvid Östberg, Per Lundström, Sebastian Kelleher, Ian and Lichtenstein, Paul 2016. A longitudinal study of adolescent psychotic experiences and later development of substance use disorder and suicidal behavior. Schizophrenia Research,

    David, Anthony S. and Ajnakina, Olesya 2016. Psychosis as a continuous phenotype in the general population: the thin line between normality and pathology. World Psychiatry, Vol. 15, Issue. 2, p. 129.

    Landin-Romero, R. McKenna, P.J. Romaguera, A. Álvarez-Moya, E. Sarró, S. Aguirre, C. Sarri, C. Compte, A. Bosque, C. Salvador, R. and Pomarol-Clotet, E. 2016. Examining the continuum of psychosis: Frequency and characteristics of psychotic-like symptoms in relatives and non-relatives of patients with schizophrenia. Schizophrenia Research,

    Morris, Sarah E. Vaidyanathan, Uma and Cuthbert, Bruce N. 2016. The Neuropsychopathology of Schizophrenia.

    Peters, Emmanuelle Ward, Thomas Jackson, Mike Morgan, Craig Charalambides, Monica McGuire, Philip Woodruff, Peter Jacobsen, Pamela Chadwick, Paul and Garety, Philippa A. 2016. Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care”. World Psychiatry, Vol. 15, Issue. 1, p. 41.

    Ross, Robert M. Hartig, Bjoern and McKay, Ryan 2016. Analytic cognitive style predicts paranormal explanations of anomalous experiences but not the experiences themselves: Implications for cognitive theories of delusions. Journal of Behavior Therapy and Experimental Psychiatry,

    Ruffell, Tamatha Azis, Matilda Hassanali, Nedah Ames, Catherine Browning, Sophie Bracegirdle, Karen Corrigall, Richard Laurens, Kristin R. Hirsch, Colette Kuipers, Elizabeth Maddox, Lucy and Jolley, Suzanne 2016. Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions. European Child & Adolescent Psychiatry, Vol. 25, Issue. 3, p. 311.

    Shevlin, Mark McElroy, Eoin Bentall, Richard P. Reininghaus, Ulrich and Murphy, Jamie 2016. The Psychosis Continuum: Testing a Bifactor Model of Psychosis in a General Population Sample. Schizophrenia Bulletin, p. sbw067.

    Abu-Akel, A. M. Wood, S. J. Hansen, P. C. and Apperly, I. A. 2015. Perspective-taking abilities in the balance between autism tendencies and psychosis proneness. Proceedings of the Royal Society B: Biological Sciences, Vol. 282, Issue. 1808, p. 20150563.

    Badcock, Johanna C. Mahfouda, Simone and Maybery, Murray T. 2015. Hallucinations and inhibitory functioning in healthy young adults with high and low levels of hypomanic personality traits. Cognitive Neuropsychiatry, Vol. 20, Issue. 3, p. 254.

    Brett, C.M.C. Peters, E.R. and McGuire, P.K. 2015. Which psychotic experiences are associated with a need for clinical care?. European Psychiatry, Vol. 30, Issue. 5, p. 648.

    Córdova-Palomera, Aldo Calati, Raffaella Arias, Bárbara Ibáñez, Manuel-Ignacio Moya, Jorge Ortet, Generós Crespo-Facorro, Benedicto and Fañanás, Lourdes 2015. Season of birth and subclinical psychosis: Systematic review and meta-analysis of new and existing data. Psychiatry Research, Vol. 225, Issue. 3, p. 227.

    DeRosse, Pamela and Karlsgodt, Katherine H. 2015. Examining the Psychosis Continuum. Current Behavioral Neuroscience Reports, Vol. 2, Issue. 2, p. 80.

    Ettinger, U. Mohr, C. Gooding, D. C. Cohen, A. S. Rapp, A. Haenschel, C. and Park, S. 2015. Cognition and Brain Function in Schizotypy: A Selective Review. Schizophrenia Bulletin, Vol. 41, Issue. suppl 2, p. S417.

    Falcone, M. A. Murray, R. M. Wiffen, B. D. R. O'Connor, J. A. Russo, M. Kolliakou, A. Stilo, S. Taylor, H. Gardner-Sood, P. Paparelli, A. Jichi, F. Di Forti, M. David, A. S. Freeman, D. and Jolley, S. 2015. Jumping to Conclusions, Neuropsychological Functioning, and Delusional Beliefs in First Episode Psychosis. Schizophrenia Bulletin, Vol. 41, Issue. 2, p. 411.

    Lien, Yin-Ju Kao, Yu-Chen Liu, Yia-Ping Chang, Hsin-An Tzeng, Nian-Sheng Lu, Chien-Wen Lin, Shwu-Jon and Loh, Ching-Hui 2015. Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample. Social Psychiatry and Psychiatric Epidemiology, Vol. 50, Issue. 2, p. 289.

    Modenato, C. and Draganski, B. 2015. The concept of schizotypy — A computational anatomy perspective. Schizophrenia Research: Cognition, Vol. 2, Issue. 2, p. 89.

    Papassotiropoulos, Andreas and de Quervain, Dominique J.-F. 2015. Failed drug discovery in psychiatry: time for human genome-guided solutions. Trends in Cognitive Sciences, Vol. 19, Issue. 4, p. 183.

    Simon, Joe J. Cordeiro, Sheila A. Weber, Marc-André Friederich, Hans-Christoph Wolf, Robert C. Weisbrod, Matthias and Kaiser, Stefan 2015. Reward System Dysfunction as a Neural Substrate of Symptom Expression Across the General Population and Patients With Schizophrenia. Schizophrenia Bulletin, Vol. 41, Issue. 6, p. 1370.


Why we need more debate on whether psychotic symptoms lie on a continuum with normality

  • A. S. David (a1)
  • DOI:
  • Published online: 11 February 2010

The notion that psychotic symptoms lie on a continuum with normality has become an accepted dogma. It is supported by several lines of empirical evidence, fits in with the orientation of modern services and has a ‘moral’ appeal. However, there is confusion as to the nature of the continuum or continua under discussion. According to the author, commentators on this topic do not often distinguish between the variability and severity of the phenomena themselves, within or between individuals, versus the distribution of symptoms or risk factors in a population. The implications of these two types of continua differ. Furthermore, the evidence for continua of delusional beliefs and hallucinations can be challenged on a number of grounds, both methodological and conceptual. To some extent, whether phenomena are viewed as continua or categories depends on the intentions of the observer. Finding the distinctive characteristics of psychotic phenomena in people with clinical disorders, in addition to their origins in ‘normal’ cognitive processes, is a worthwhile goal.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Why we need more debate on whether psychotic symptoms lie on a continuum with normality
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Why we need more debate on whether psychotic symptoms lie on a continuum with normality
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Why we need more debate on whether psychotic symptoms lie on a continuum with normality
      Available formats
Corresponding author
*Address for correspondence: A. S. David, M.D., FRCP, FRCPsych., M.Sc., Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College, Denmark Hill, London SE5 8AF, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

GA Claridge (1994). A single indicator of risk for schizophrenia. Probable fact or likely myth? Schizophrenia Bulletin 20, 151168.

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

PA Garety , DR Hemsley (1987). Characteristics of delusional experience. European Archives of Psychiatry and Clinical Neuroscience 236, 294298.

J Horwood , G Salvi , K Thomas , L Duffy , D Gunnell , C Hollis , G Lewis , P Menezes , A Thompson , D Wolke , S Zammit , G Harrison (2008). IQ and non-clinical psychotic symptoms in 12-year-olds: results from the ALSPAC birth cohort. British Journal of Psychiatry 193, 185191.

LC Johns , J van Os (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 11251141.

RC Kessler (2002). The categorical versus dimensional assessment controversy in the sociology of mental illness. Journal of Health and Social Behavior 43, 171188.

KR Laurens , S Hodgins , B Maughan , RM Murray , ML Rutter , EA Taylor (2007). Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years. Schizophrenia Research 90, 130146.

TM Lincoln (2007). Relevant dimensions of delusions: continuing the continuum versus category debate. Schizophrenia Research 93, 211220.

TM Lincoln , E Keller (2008). Delusions and hallucinations in students compared to the general population. Psychology and Psychotherapy 81, 231235.

RJ Linscott , J van Os (2010). Systematic reviews of categorical and continuum models of psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI and DSM-VII. Annual Review of Clinical Psychology 6, 14.114.29.

PD McGorry (2005). Early intervention in psychotic disorders: beyond debate to solving problems. British Journal of Psychiatry 187, s108s110.

PE Meehl (1962). Schizotaxia, schizotypy, schizophrenia. American Psychology 17, 827838.

R Mojtabai , D Malaspina , E Susser (2003). The concept of population prevention: application to schizophrenia. Schizophrenia Bulletin 29, 791801.

R Mullen (2003). Delusions: the continuum versus category debate. Australia and New Zealand Journal of Psychiatry 37, 505511.

ER Peters , SA Joseph , S Day , PA Garety (2004). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophrenia Bulletin 30, 10051022.

ER Peters , SA Joseph , PA Garety (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin 25, 553576.

R Poulton , A Caspi , TE Moffitt , M Cannon , R Murray , HL Harrington (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.

G Rose (1992). The Strategy of Preventive Medicine. Oxford University Press: Oxford.

AE Simon , K Cattapan-Ludewig , K Gruber , J Ouertani , A Zimmer , B Roth , E Isler , D Umbricht (2009). Subclinical hallucinations in adolescent outpatients: an outcome study. Schizophrenia Research 108, 265271.

B Stanton , AS David (2000). First person accounts of delusions. Psychiatric Bulletin 24, 333336.

JS Strauss (1969). Hallucinations and delusions as points on continua function. Archive of General Psychiatry 21, 581586.

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

H Verdoux , S Maurice-Tison , B Gay , J van Os , R Salamon , ML Bourgeois (1998). A survey of delusional ideation in primary-care patients. Psychological Medicine 28, 127134.

H Verdoux , J van Os (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research 54, 5965.

AR Yung , LJ Phillips , HP Yuen , SM Francey , CA McFarlane , M Hallgren , PD McGorry (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 2132.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *