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Cognitive Processes in Delusional Disorders

  • Christopher Fear (a1), Helen Sharp (a2) and David Healy (a2)



Studies of schizophrenics with persecutory delusions have shown cognitive biases in subjects who are deluded. It has been suggested that their delusions defend against depression. This study challenges the assumption that delusional disorder (DD) patients are covertly depressed.


Clinical and demographic data and responses to questionnaires designed to assess schizotypy, depression, dysfunctional attitudes, attributional and attention biases were collected from 29 patients satisfying DSM–III–R criteria for DD. These were compared with 20 matched normal controls and results from published studies of schizophrenics.


DD subjects did not show abnormal levels of overt or covert depression or schizotypy. They showed high levels of dysfunctional attitudes (P < 0.0001), a distinctive attributional style (P = 0.01), and increased attention to threat-related stimuli (P = 0.01).


DD is a distinct disorder predicated upon sensitivity to threat and biases of attention and attribution. These findings may have implications for the cognitive therapy of these disorders.


Corresponding author

Dr Healy, Hergest Unit, Ysbyty Gwynedd, Bangor, Gwynedd, LL57 2PW


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American Psychiatric Association (1987) Diagnostic and Statistical Manual for Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Beck, A. T. & Beamesderfer, A. (1974) Assessment of depression: The depression inventory. In Psychological Measurements in Psychopharmacology (ed Pichot, P.). Basel: Karger.
Bentall, R. P. (1994) Cognitive biases and abnormal beliefs: towards a model of persecutory delusions. In The Neuropsychology of Schizophrenia (eds David, A. S. & Cutting, J.), pp. 337360. London: Erlbaum.
Bentall, R. P. & Kaney, S. (1989) Content specific information processing and persecutory delusions: An investigation using the emotional Stroop task. British Journal of Medical Psychology, 62, 355364.
Candido, C. L. & Romney, D. M. (1990) Attributional style in paranoid vs. depressed patients. British Journal of Medical Psychology, 63, 355363.
Chadwick, P. D. J. & Lowe, C. F. (1994) A cognitive approach to measuring and modifying delusions. Behaviour Research & Therapy, 32, 355367.
Eckblad, M. & Chapman, L. J. (1983) Magical ideation as an indicator of schizotypy. Journal of Consulting and Clinical Psychology, 51, 215225.
Fear, C. F. (1995) Cognitive processes in obsessive–compulsive and delusional disorders. Unpublished MD thesis, University of Liverpool.
Healy, D. & Williams, J. M. G. (1988) Dysrhythmia, dysphoria and depression. Psychological Bulletin, 103, 163210.
Kaney, S. & Bentall, R. P. (1989) Persecutory delusions and attributional style. British Journal of Medical Psychology, 62, 191198.
Kinderman, P., Kaney, S., Morley, S., et al (1992) Paranoia and the defensive attributional style: Deluded and depressed patients' attributions about their attributions. British Journal of Medical Psychology, 65, 371383.
Nelson, H. E. (1982) National Adult Reading Test (NART). London: Nfer-Nelson.
Peterson, C., Semmel, A., Von Baeyer, C., et al (1982) The attributional style questionnaire. Cognitive Research and Therapy, 6, 287298.
Ross, L. & Anderson, C. A. (1982) Shortcomings in the attribution process: On the origins and maintenance of erroneous social assessments. In Judgement Under Uncertainty: Heuristics and Biases (eds Kahneman, D., Slovic, P. & Tversky, A.), pp. 129152. Cambridge: Cambridge University Press.
Ullman⊘, L. P. & Krasner, L. (1969) A Psychological Approach to Abnormal Behaviour. Englewood Cliffs: Prentice Hall.
Weissman, A. N. (1979) The dysfunctional attitude scale: A validation study. Dissertation Abstracts International, 40, 13891390.
Wessely, S., Buchanan, A., Reed, A., et al (1993) Acting on delusions. I: prevalence. British Journal of Psychiatry, 163, 6976.
Williams, J. M. G., Healy, D., Teasdale, J. D., et al (1990) Dysfunctional attitudes and vulnerability to persistent depression. Psychological Medicine, 20, 375381.

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Cognitive Processes in Delusional Disorders

  • Christopher Fear (a1), Helen Sharp (a2) and David Healy (a2)


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Cognitive Processes in Delusional Disorders

  • Christopher Fear (a1), Helen Sharp (a2) and David Healy (a2)
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