Abstract
Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N = 401, study 2, N = 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia.
Highlights
Paranoia, defined as the unfounded fear that others intend to cause you harm, is a common and distressing experience reported by many individuals with psychosis (Freeman and Garety, 2000)
Age was correlated with several of our predictors including sleep quality, alexithymia and perceptual anomalies, we included it as a co-variate in further analysis
This was confirmed by a series of Mann-Whitney U tests, which revealed no significant differences between the samples in study 1 and 2 on anxiety, depression, positive affect, negative affect, sleep quality, alexithymia or perceptual anomalies (p > 0.05)
Summary
Paranoia, defined as the unfounded fear that others intend to cause you harm, is a common and distressing experience reported by many individuals with psychosis (Freeman and Garety, 2000). Paranoid thinking is not confined to psychosis, and is reported by up to 30% of the general population (Freeman et al, 2005, Freeman, 2007). At the non-clinical level, sleep loss in healthy individuals leads to an increase in paranoid thoughts (Kahn-Greene et al, 2007; Reeve et al, 2017). Results found links between a number of sleep disorder symptoms such as insomnia, nightmare frequency and nightmare distress and PLE's including paranoia (Sheaves et al, 2016). Insomnia was associated with an approximately two to threefold increase in paranoid thinking (Freeman et al, 2010). Insomnia was a significant predictor of new incidence of paranoid thoughts, suggestive of insomnia having a causal role (Freeman et al, 2012)
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