Journal List > Korean J Schizophr Res > v.17(2) > 1122197

Korean J Schizophr Res. 2014 Oct;17(2):63-71. Korean.
Published online Oct 27, 2014.
Copyright © 2014 Korean Society for Schizophrenia Research
Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia : Its Association with Paranoia
Nam Wook Kim, MD,1,2 Yun Young Song, MD,1,3 Jin Young Park, MD, PhD,1,2 Seo Yeon Baek, BA,1 Jee In Kang, MD, PhD,1,2 Eun Lee, MD, PhD,1,2 and Suk Kyoon An, MD, PhD1,2
1Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
2Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
3Department of Psychiatry, Seoul National Hospital, Seoul, Korea.

Address for correspondence: Suk Kyoon An, Department of Psychiatry, Yonsei University College of Medicine, 119 Gyeonchung-daero 1926beon-gii, Gwangju 464-110, Korea. Tel: 031-760-9404, Fax: 031-761-7582, Email:
Received Jun 28, 2014; Revised Aug 19, 2014; Accepted Aug 25, 2014.



Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attributional bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia.


101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spielberg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery.


Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p<0.001, adjusted R2=0.61].


The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.

Keywords: Paranoia; Schizophrenia; Ultra-high risk for psychosis; Neurocognition; Emotional dysregulation; Attributional bias


Table 1
Demographic and clinical characteristics of participants
Click for larger image

Table 2
Intercorrelation between paranoia scale and other variables
Click for larger image

Table 3
Multiple linear regression analysis of paranoia score with other variables
Click for larger image

1. Freeman D, Garety PA. Comments on the content of persecutory delusions: does the definition need clarification? Br J Clin Psychol 2000;39(Pt 4):407–414.
2. Fenigstein A, Vanable PA. Paranoia and self-consciousness. J Pers Soc Psychol 1992;62:129–138.
3. Freeman D, Garety PA, Bebbington PE, Smith B, Rollinson R, Fowler D, et al. Psychological investigation of the structure of paranoia in a non-clinical population. Br J Psychiatry 2005;186:427–435.
4. Freeman D. Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 2007;27:425–457.
5. Combs DR, Penn DL, Fenigstein A. Ethnic differences in subclinical paranoia: an expansion of norms of the paranoia scale. Cultur Divers Ethnic Minor Psychol 2002;8:248–256.
6. Combs DR, Michael CO, Penn DL. Paranoia and emotion perception across the continuum. Br J Clin Psychol 2006;45:19–31.
7. van Os J, Verdoux H. Diagnosis and classification of schizophrenia: categories versus dimensions, distributions versus disease. Epidemiol Schizophr 2003:364–410.
8. Cutting J, Cutting J. In: Principles of psychopathology: Two worlds, two minds, two hemispheres. Oxford University Press Oxford; 1997.
9. Wessely S, Buchanan A, Reed A, Cutting J, Everitt B, Garety P, et al. Acting on delusions. I: Prevalence. Br J Psychiatry 1993;163:69–76.
10. Castle DJ, Phelan M, Wessely S, Murray RM. Which patients with non-affective functional psychosis are not admitted at first psychiatric contact? Br J Psychiatry 1994;165:101–106.
11. Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE. A cognitive model of persecutory delusions. Br J Clin Psychol 2002;41:331–347.
12. Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, et al. The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Arch Gen Psychiatry 2009;66:236–247.
13. Freeman D, Garety PA. Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behav Cognitive Psychother 1999;27:47–62.
14. Drake RJ, Pickles A, Bentall RP, Kinderman P, Haddock G, Tarrier N, et al. The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med 2004;34:285–292.
15. Combs D, Penn D. Social cognition in paranoia. In: Freeman D, Bentall R, Garety P, editors. Persecutory delusions: Assessment, theory and treatment. 2008. pp. 175-204.
16. Penn DL, Corrigan PW, Bentall RP, Racenstein JM, Newman L. Social cognition in schizophrenia. Psychol Bull 1997;121:114–132.
17. Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P. Persecutory delusions: a review and theoretical integration. Clin Psychol Rev 2001;21:1143–1192.
18. Van Dael F, Versmissen D, Janssen I, Myin-Germeys I, van Os J, Krabbendam L. Data gathering: biased in psychosis? Schizophr Bull 2006;32:341–351.
19. Kee KS, Kern RS, Green MF. Perception of emotion and neurocognitive functioning in schizophrenia: what's the link? Psychiatry Res 1998;81:57–65.
20. Garety PA, Hemsley DR, Wessely S. Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. J Nerv Ment Dis 1991;179:194–201.
21. Garety PA, Freeman D, Jolley S, Dunn G, Bebbington PE, Fowler DG, et al. Reasoning, emotions, and delusional conviction in psychosis. J Abnorm Psychol 2005;114:373–384.
22. Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008;65:28–37.
23. Yung AR, Nelson B, Stanford C, Simmons MB, Cosgrave EM, Killackey E, et al. Validation of "prodromal" criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophrenia Research 2008;105:10–17.
24. Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, et al. Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study. Schizophr Bull 2009;35:894–908.
25. First M, Spitzer R, Gibbon M, Williams J. In: Structured clinical interview for DSM-IV axis I disorders-non-patient edition (SCID-I/NP, version 2.0). New York: Biometrics Research Department; 1996.
26. First M, Spitzer R, Gibbon M, Williams J. In: Structured clinical interview for DSM-IV Axis I disorders-patient edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute; 1995.
27. Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, et al. Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull 2003;29:703–715.
28. Jung MH, Jang JH, Kang DH, Choi JS, Shin NY, Kim HS, et al. The reliability and validity of the korean version of the structured interview for prodromal syndrome. Psychiatry Investig 2010;7:257–263.
29. Lee HJ, Won HT. A Study of the Reliability and the Validity of the Paranoia Scale. Korean J Clin Psychol 1995;14:83–94.
30. Smári J, Stefánsson S, Thorgilsson H. Paranoia, self-consciousness, and social cognition in schizophrenics. Cognitive Ther Res 1994;18:387–399.
31. Rosenberg M. In: Society and the adolescent self-image. rev: Wesleyan University Press; 1989.
32. Jeon BJ. Self-esteem: A test of its measurability. Yonsei Nonchong 1974;11:107–129.
33. Beck AT, Steer R, Brown G. In: Beck depression inventory. San Antonio, TX: The psychological corporation; 1996.
34. Lee YH, Song JY. A Study of the Reliability and the Validity of the BDI, SDS, and MMPI-D Scales. Korean J Clin Psychol 1991;10:98–113.
35. Spielberger CD, Gorsuch RL, Vagg PR, Jacobs GA. In: Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.
36. Kim KR, Park JY, Song DH, Koo HK, An SK. Neurocognitive performance in subjects at ultrahigh risk for schizophrenia: a comparison with first-episode schizophrenia. Compr Psychiatry 2011;52:33–40.
37. Nuechterlein KH, Edell WS, Norris M, Dawson ME. Attentional vulnerability indicators, thought disorder, and negative symptoms. Schizophr Bull 1986;12:408–426.
38. An SK, Lee SY, Kim KR, Park JY, Kang JI, Lee R. In: Deficits in Verbal and Spatial Working Memory Performance in People with Clinical High-risk for Psychosis and Schizophrenia Patients in Critical Period. Japan: The First Asian Workshop on Schizophrenia Research Osaka; 2009. pp. 136.
39. Rey A. In: L'examen clinique en psychologie. Paris: Presses Universitaires de France; 1964.
40. Delis D, Kramer J, Kaplan E, Ober B. CVLT, California Verbal Learning Test Manual (Version 1). In: Harcourt Brace. San Antonio: The Psychological Corporation; 1987.
41. Heaton R, Chelune G, Talley JL, Kay G, Curtiss G. In: Wisconsin card sort test manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources; 1993.
42. Golden C. In: Stroop Color and Word Test: A Manual for Clinical and Experimental UsesStoelting. Chicago, IL: 1978.
43. Benton A, Spreen O. In: Neurosensory Center Comprehensive Examination for Aphasia. British Columbia: Victoria: Neuropsychology Laboratory, University of Victoria; 1969.
44. Ruff RM, Light RH, Evans RW. The Ruff Figural Fluency Test: a normative study with adults. Dev Neuropsychol 1987;3:37–51.
45. Reitan RM. In: Manual for administration of neuropsychological test batteries for adults and children: Neuropsychology Laboratory. Indiana University medical Center: 1979.
46. Combs DR, Penn DL, Wicher M, Waldheter E. The Ambiguous Intentions Hostility Questionnaire (AIHQ): a new measure for evaluating hostile social-cognitive biases in paranoia. Cogn Neuropsychiatry 2007;12:128–143.
47. Chang H, An SK. Development of Korean Version of the Ambiguous Intentions Hostility Questionnaire (K-AIHQ). J Korean Neuropsychiatr Assoc 2009;48:29–35.
48. Combs DR, Penn DL, Michael CO, Basso MR, Wiedeman R, Siebenmorgan M, et al. Perceptions of hostility by persons with and without persecutory delusions. Cogn Neuropsychiatry 2009;14:30–52.
49. Yi JS, Ahn YM, Shin HK, An SK, Kim KS, Kim YS. Reliability and Validity of the Korean Version of the Positive and Negative Syndrome Scale. J Korean Neuropsychiatr Assoc 2001;40:1090–1105.
50. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.
51. Freeman D, Garety PA. In: Paranoia: the psychology of persecutory delusions. Hove, East Sussex: New York: Psychology Press; 2004.
52. Freeman D, Dunn G, Garety PA, Bebbington P, Slater M, Kuipers E, et al. The psychology of persecutory ideation I: a questionnaire survey. J Nerv Ment Dis 2005;193:302–308.
53. Freeman D, Garety PA. Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behav Res Ther 2003;41:923–947.
54. Garety PA, Freeman D. Cognitive approaches to delusions: a critical review of theories and evidence. Br J Clin Psychol 1999;38(Pt 2):113–154.
55. Bentall RP, Kinderman P, Kaney S. The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behav Res Ther 1994;32:331–341.
56. Frith CD. In: The cognitive neuropsychology of schizophrenia. Psychology Press; 1992.
57. Ellett L, Lopes B, Chadwick P. Paranoia in a nonclinical population of college students. J Nerv Ment Dis 2003;191:425–430.
58. Whaley AL. Paranoia in African-American men receiving inpatient psychiatric treatment. J Am Acad Psychiatry Law 2004;32:282–290.
59. Combs DR, Penn DL. The role of subclinical paranoia on social perception and behavior. Schizophr Res 2004;69:93–104.
60. Garety P, Joyce E, Jolley S, Emsley R, Waller H, Kuipers E, et al. Neuropsychological functioning and jumping to conclusions in delusions. Schizophrenia research 2013;150:570–574.
61. Langdon R, Corner T, McLaren J, Ward PB, Coltheart M. Externalizing and personalizing biases in persecutory delusions: the relationship with poor insight and theory-of-mind. Behav Res Ther 2006;44:699–713.
62. Gilbert DT, Pelham BW, Krull DS. On cognitive busyness: When person perceivers meet persons perceived. J Pers Soc Psychol 1988;54:733.
63. Kinderman P, Dunbar R, Bentall RP. Theory-of-mind deficits and causal attributions. Br J Psychol 1998;89:191–204.
64. Baudouin JY, Martin F, Tiberghien G, Verlut I, Franck N. Selective attention to facial emotion and identity in schizophrenia. Neuropsychologia 2002;40:503–511.
65. Bryson G, Bell M, Lysaker P. Affect recognition in schizophrenia: a function of global impairment or a specific cognitive deficit. Psychiatry Res 1997;71:105–113.
66. Tarrier N, Wykes T. Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behav Res Ther 2004;42:1377–1401.
67. Turkington D, Kingdon D, Weiden PJ. Cognitive behavior therapy for schizophrenia. Am J Psychiatry 2006;163:365–373.
Similar articles

Relations of Self-Esteem with Paranoia in Healthy Controls, Individuals at Ultra-High Risk for Psychosis and with Recent Onset Schizophrenia

Ultra-High Risk for Psychosis : Clinical Characteristics and Diagnosis

Structural Brain Alterations in Individuals at Ultra-high Risk for Psychosis: A Review of Magnetic Resonance Imaging Studies and Future Directions

Working Memory Deficits in Ultra-High Risk for Psychosis and Schizophrenia

Pilot Study on Resting-State Functional Connectivity under the Effects of Familial Loading in People at Ultra-High Risk for Psychosis