Adolescent Paranoia: Prevalence, Structure, and Causal Mechanisms

Abstract

Background Adolescence can be a challenging time, characterized by self-consciousness, heightened regard for peer acceptance, and fear of rejection. Interpersonal concerns are amplified by unpredictable social interactions, both online and offline. This developmental and social context is potentially conducive to the emergence of paranoia. However, research on paranoia during adolescence is scarce. Method Our aim was to examine the prevalence, structure, and probabilistic causal mechanisms of adolescent paranoia. A representative school cohort of 801 adolescents (11–15 y) completed measures of paranoia and a range of affective, cognitive, and social factors. A Bayesian approach with Directed Acyclic Graphs (DAGs) was used to assess the causal interactions with paranoia. Results Paranoid thoughts were very common, followed a continuous distribution, and were hierarchically structured. There was an overall paranoia factor, with sub-factors of social fears, physical threat fears, and conspiracy concerns. With all other variables controlled, DAG analysis identified paranoia had dependent relationships with negative affect, peer difficulties, bullying, and cognitive-affective responses to social media. The causal directions could not be fully determined, but it was more likely that negative affect contributed to paranoia and paranoia impacted peer relationships. Problematic social media use did not causally influence paranoia. Conclusions There is a continuum of paranoia in adolescence and occasional suspicions are common at this age. Anxiety and depression are closely connected with paranoia and may causally contribute to its development. Paranoia may negatively impact adolescent peer relationships. The clinical significance of paranoia in adolescents accessing mental health services must now be established.

The assessment of paranoia in young people: Item and test properties of the Bird Checklist of Adolescent Paranoia

“…The B-CAP has concurrent validity with other measures of paranoia, with data from Bird et al (2019) showing a correlation of r=0.84 (p<0.001) with the paranoia subscale of the Specific Psychotic Experiences Questionnaire (SPEQ; Ronald et al 2014) and r=0.68 (p<0.001) with the Social Mistrust Scale (SMS; Wong et al 2014). Although all paranoia measures are limited in their ability to determine whether thoughts are truly unfounded, we have shown that B-CAP scores are moderate correlated (r=0.41, p<0.001) with participant ratings on a visual analogue scale (VAS) that they are 'more fearful of others than they should be' (Bird et al 2019). This was significantly larger than the small correlation of r=0.25 between the same VAS rating and bullying scores (z=5.35, p<0.001).…”

The assessment of paranoia in young people: Item and test properties of the Bird Checklist of Adolescent Paranoia

“…The final 18 items were selected from a broader item pool following exploratory and confirmatory factor analysis. The final hierarchical model of a second-order paranoia factor and three sub-factors of social harm, conspiracy ideas, and physical threat showed excellent fit statistics (Bird et al 2019).…”

“…Participants from the general population were recruited from a secondary school in Leicestershire, United Kingdom, as reported in Bird et al (2019). All pupils aged 11-15 years were invited to take part using opt-out parental consent and pupils who provided written assent completed the questionnaire as part of the larger study pack within a 60-minute lesson.…”

“…The B-CAP is an 18-item scale, developed by our research team (Bird et al 2019), assessing the frequency of paranoid thoughts in the last two weeks on a 6-point scale (0=Never, 5=All the time).…”

“…Most existing measures are primarily designed for adult populations with language that may be less appropriate for adolescents. We recently presented an initial validation of a new dimensional measure of paranoid thoughts specifically for youth: The Bird Checklist of Adolescent Paranoia (B-CAP; Bird et al 2019). We now extend this initial validation to evaluate the item and test properties of the B-CAP using item response theory (IRT), whilst also arguing for the wider application of IRT to the measurement of psychotic experiences in youth.…”