Body image concerns in patients with persecutory delusions

Abstract

Background Persecutory fears build on feelings of vulnerability that arise from negative views of the self. Body image concerns have the potential to be a powerful driver of feelings of vulnerability. Body image concerns are likely raised in patients with psychosis given the frequent weight gain. We examined for the first-time body esteem – the self-evaluation of appearance – in relation to symptom and psychological correlates in patients with current persecutory delusions. Methods One-hundred and fifteen patients with persecutory delusions in the context of non-affective psychosis completed assessments of body image, self-esteem, body mass index (BMI), psychiatric symptoms and well-being. Body esteem was also assessed in 200 individuals from the general population. Results Levels of body esteem were much lower in patients with psychosis than non-clinical controls (d = 1.2, p < 0.001). In patients, body esteem was lower in women than men, and in the overweight or obese BMI categories than the normal weight range. Body image concerns were associated with higher levels of depression (r = −0.55, p < 0.001), negative self-beliefs (r = −0.52, p < 0.001), paranoia (r = −0.25, p = 0.006) and hallucinations (r = −0.21, p = 0.025). Body image concerns were associated with lower levels of psychological wellbeing (r = 0.41, p < 0.001), positive self-beliefs (r = 0.40, p < 0.001), quality of life (r = 0.23, p = 0.015) and overall health (r = 0.31, p = 0.001). Conclusions Patients with current persecutory delusions have low body esteem. Body image concerns are associated with poorer physical and mental health, including more severe psychotic experiences. Improving body image for patients with psychosis is a plausible target of intervention, with the potential to result in a wide range of benefits.

Intersections of paranoia and the body in the general population

“…Hypothesis 2 was also supported in that paranoia, but not persecutory ideation, significantly contributed to the prediction of dysmorphic concerns, alongside sex and negative emotional states. In light of previous theorisations that negative body image contributes to heightened paranoia (Waite and Freeman, 2017; Waite et al, 2022), our current findings have demonstrated bidirectional links in showing that the converse is also true. This represents a novel alternate mechanism by which paranoid thoughts may be generalised to one’s bodily experiences, and highlights a possible aetiological pathway deserving of clinical attention and future enquiry.…”

“…Hypothesis 1 was supported; paranoia, persecutory ideation and perceptual aberration were all significantly positively correlated with dysmorphic concerns. This finding represents an extension of Waite et al (2022) and Waite and Freeman (2017) in that the impact of various psychosis facets was shown to encompass dysmorphic concerns, beyond weight. Further positive correlations between dysmorphic concerns with magical ideation as well as private body consciousness with magical and persecutory ideation, and public body consciousness with magical ideation and paranoia, denote that other psychosis facets exerted selective influences on multidimensional body image.…”

“…In schizophrenia, hallucinatory experiences are known to co-exist with and mutually reinforce paranoia and other delusions (Shinn et al, 2013). A recent investigation involving individuals with a psychotic disorder ( N = 115) demonstrated that body image concerns were significantly positively associated with paranoia, involving self-referential and persecutory aspects, as well as anomalous perceptual experiences (Waite et al, 2022). Unusual sensory experiences and magical thinking are also shared by a segment of the general population (e.g.…”

“…Given how paranoia and body image concerns exist on a continuum, ranging from negligible to pathological with significant variability in between, a clear understanding of how these constructs intersect along this spectrum is important. It has been theorised that negative body image may contribute to heightened paranoia (Waite and Freeman, 2017; Waite et al, 2022), yet it is equally plausible these relationships are bidirectional. Another possible mechanism could be that those prone to paranoid thoughts in their daily interactions, may generalise these to their own bodily experiences, especially in the presence of other unusual thinking styles or anomalous perceptual events, exacerbated by negative emotional states.…”

“…The inclusion of body consciousness was appropriate, given the population under study, where body image concerns on the clinical spectrum may not be as prominent. The current study therefore aimed to extend on Waite et al (2022) and Waite and Freeman (2017) by: (i) employing validated, comprehensive assessments of multidimensional body image, beyond weight concerns, and (ii) incorporating added psychosis dimensions, involving perceptual aberration and magical ideation. With regards to dysmorphic concerns, we specifically sought to corroborate a significant association with paranoia as well as delineate the contributions of paranoia versus persecutory ideation (see 2.2.6), given notable endorsement of persecutory (and self-referential) delusions in body dysmorphic disorder (Rossell et al, 2020; Toh et al, 2017).…”