Paranoia in patients attending child and adolescent mental health services.

Jessica C Bird,Felicity Waite,Hannah J Stratford,Ashley-Louise Teale,Lydia Carr,Daniel Freeman,Antony C James,Christina Shearn,Emma C Fergusson,Miriam Kirkham

doi:10.1177/0004867420981416

Abstract

Objective:Paranoia may be particularly prevalent during adolescence, building on the heightened social vulnerabilities at this age. Excessive mistrust may be corrosive for adolescent social relationships, especially in the context of mental health disorders. We set out to examine the prevalence, symptom associations, and persistence of paranoia in a cohort of young people attending child and adolescent mental health services.Method:A total of 301 patients (11–17 years old) completed measures of paranoia, affect, peer difficulties and behavioural problems. Clinicians also rated each participant’s psychiatric symptoms. Patterns of association were examined using linear regressions and network analyses. In total, 105 patients repeated the measures several months later.Results:Most of the adolescents had affective disorders (n = 195), self-harm/suicidality (n = 82), or neurodevelopmental conditions (n = 125). Few had suspected psychosis (n = 7). Rates of paranoia were approximately double compared with previous reports from the general population. In this patient sample, 35% had at least elevated paranoia, 15% had at least moderate paranoia, and 6% had high paranoia. Paranoia had moderate associations with clinician-rated peer difficulties, self-harm, and trauma, and small associations with clinician-rated social anxiety, depression, generalised anxiety, and educational problems. Network analyses showed paranoia had the strongest unique relationship with peer difficulties. Paths from peer difficulties to anxiety, self-harm, post-traumatic stress disorder symptoms, and behavioural problems were all via paranoia. Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network. Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time.Conclusion:Paranoia is relatively common and persistent across a range of clinical presentations in youth. When paranoia occurs alongside emotional problems, important peer interactions may be adversely affected. Wider consideration of paranoia in adolescent patients is needed.

Highlights

Paranoia – the unfounded idea that others deliberately intend harm – is one of the most prominent symptoms of psychotic disorders
Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network
Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time

Summary

Introduction

Paranoia – the unfounded idea that others deliberately intend harm – is one of the most prominent symptoms of psychotic disorders. The clinical reality is that paranoia is rarely specific to psychosis, with evidence it occurs across a range of disorders (D’Agostino et al, 2019; Freeman et al, 2019a). There is growing evidence that paranoia builds upon concerns about the self (e.g. social vulnerability, low self-esteem) and psychological processes (e.g. threat anticipation, worry) central to many emotional disorders (Freeman, 2016). Paranoia in adolescents is associated with a range of psychological difficulties including affective symptoms, peer difficulties, behavioural problems, and poor sleep (Bird et al, 2019; Taylor et al, 2015; Wigman et al, 2011; Zavos et al, 2014). There has been extremely little detailed research on paranoia in clinical populations of youth

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Conclusion