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The structure of paranoia in the general population

  • Paul E. Bebbington (a1), Orla McBride (a2), Craig Steel (a3), Elizabeth Kuipers (a4), Mirjana Radovanoviĉ (a5), Traolach Brugha (a6), Rachel Jenkins (a7), Howard I. Meltzer (a6) and Daniel Freeman (a8)...



Psychotic phenomena appear to form a continuum with normal experience and beliefs, and may build on common emotional interpersonal concerns.


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.


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.


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.


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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Corresponding author

Professor Paul E. Bebbington, UCL Mental Health Sciences Unit, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK. Email:


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The structure of paranoia in the general population

  • Paul E. Bebbington (a1), Orla McBride (a2), Craig Steel (a3), Elizabeth Kuipers (a4), Mirjana Radovanoviĉ (a5), Traolach Brugha (a6), Rachel Jenkins (a7), Howard I. Meltzer (a6) and Daniel Freeman (a8)...
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Filtering by door opening?

Matthew J.A. Cordiner, CT3 Psychiatry
01 July 2013

I read the article by Bebbington et al with great interest, with the findings reflecting much of what I experience at the frontline of psychiatric practice. However, I cannot help but feel that a door-to-door survey may well have automatically excluded many of those who harbour moresevere paranoid thoughts, potentially skewing the results. I would suggestthat it takes a great deal of trust to open your door to a stranger purporting to be carrying out research, let alone engage with the interview process itself. Thus perhaps those surveyed may well represent those with the most trusting and least suspicious nature, rather than a true reflection of society in general. I wonder if the authors feel that this could have had an impact on their findings?

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