The structure of paranoia in the general population
Open accessAbstract
Background: Psychotic phenomena appear to form a continuum with normal experience and beliefs, and may build on common emotional interpersonal concerns. Aims: We tested predictions that paranoid ideation is exponentially distributed and hierarchically arranged in the general population, and that persecutory ideas build on more common cognitions of mistrust, interpersonal sensitivity and ideas of reference. Method: Items were chosen from the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) questionnaire and the Psychosis Screening Questionnaire in the second British National Survey of Psychiatric Morbidity (n = 8580), to test a putative hierarchy of paranoid development using confirmatory factor analysis, latent class analysis and factor mixture modelling analysis. Results: Different types of paranoid ideation ranged in frequency from less than 2% to nearly 30%. Total scores on these items followed an almost perfect exponential distribution (r = 0.99). Our four a priori first-order factors were corroborated (interpersonal sensitivity; mistrust;ideas of reference; ideas of persecution). These mapped onto four classes of individual respondents:a rare, severe, persecutory class with high endorsement of all item factors, including persecutory ideation; a quasi-normal class with infrequent endorsement of interpersonal sensitivity, mistrust and ideas of reference, and no ideas of persecution; and two intermediate classes, characterised respectively by relatively high endorsement of items relating to mistrust and to ideas of reference. Conclusions: The paranoia continuum has implications for the aetiology, mechanisms and treatment of psychotic disorders, while confirming the lack of a clear distinction from normal experiences and processes.
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Persecutory delusions are the extreme end of a spectrum of paranoia in the general population.
“They are the extreme end of a spectrum of paranoia in the general population.”
From A counterweight model for understanding and treating persecutory delusions. (2025) · cites this paper as Bebbington et al., 2013
Many people have a few paranoid thoughts, and a few people have many paranoid thoughts.
“Many people have a few paranoid thoughts, and a few people have many paranoid thoughts (Bebbington et al., 2013; Freeman et al., 2005; Neidhart, Mohnke, Vogel, & Walter, 2024).”
From A counterweight model for understanding and treating persecutory delusions. (2025) · cites this paper as Bebbington et al., 2013
Mistrust is a likely additional factor in the relationship between insecure attachment and paranoia.
“Mistrust is a likely candidate for this relationship, as it is a subcomponent of the paranoia spectrum often present in subclinical populations (Bebbington et al., 2013; Bell & O’Driscoll, 2018), and insecure attachment styles are associated with reduced interpersonal trust (Fett et al., 2016; Mikulincer, 1995, 1998).”
From Mistrust and negative self‐esteem: Two paths from attachment styles to paranoia. (2021) · cites this paper as Bebbington et al., 2013
Mistrust is a subcomponent of the paranoia spectrum often present in subclinical populations.
“Mistrust is a likely candidate for this relationship, as it is a subcomponent of the paranoia spectrum often present in subclinical populations (Bebbington et al., 2013; Bell & O’Driscoll, 2018)”
From Mistrust and negative self‐esteem: Two paths from attachment styles to paranoia. (2021) · cites this paper as Bebbington et al., 2013
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- Authors
- Bebbington, P. E., McBride, O., Steel, C., Kuipers, E., Radovanoviĉ, M., Brugha, T., Jenkins, R., Meltzer, H. I., & Freeman, D.
- Affiliations
- University College London (GB)
- University of Ulster (GB)
- University of Reading (GB)
- King's College London (GB)
- University Psychiatric Hospital (SI)
- University of Leicester (GB)
- Warneford Hospital (GB)
- Corresponding author
- Bebbington, Paul E.
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-06
- Volume
- 202
- Issue
- 6
- Pages
- 419-427
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2158853806
- Cited by
- 302
- References
- 54
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 40 · 2023: 32 · 2022: 25 · 2021: 28 · 2020: 24 · 2019: 20 · 2018: 28 · 2017: 30 · 2016: 16 · 2015: 4 · 2014: 9 · 2013: 3
- FWCI
- 7.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10103)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- paranoia, paranoid ideation, ideas of reference, distrust, interpersonal sensitivity, exponential distribution, latent class structure, psychosis continuum, general population
- MeSH terms
- Culture, United Kingdom, Humans, Paranoid Disorders, Surveys and Questionnaires, Statistics as Topic, Thinking
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