Inconsistencies in Paranoid Functioning, Premorbid Adjustment, and Chronicity: Question of Diagnostic Criteria

Abstract

Despite the widely held belief that paranoid behavior is associated with good premorbid adjustment, low chronicity, and high current functioning in psychiatric inpatients, inconsistencies in the literature suggest that supportive evidence may be an artifact of the measurement model commonly used to index paranoid status. In a sample of 497 nonorganic inpatients selected from 19 treatment units, paranoid behavior, when measured by a dimensional/cumulative model, was not found to indicate higher functioning and associated relationships, but simply to reflect a narrower class of problem behavior. Only when paranoid status was defined using a traditional model based on the predominance of the defining class of behavior did paranoid subjects demonstrate better premorbid adjustment, lower chronicity, and higher levels of functioning than nonparanoid subjects. Serious problems exist in the use of information obtained from traditional predominance/class models for either theoretical or practical purposes.

Statistical Support for Subtypes in Posttraumatic Stress Disorder: The How and Why of Subtype Analysis

“…For example, Sorensen et al [63] evaluated the relative merits of a dimensional versus subtype approach to paranoia. For example, Sorensen et al [63] evaluated the relative merits of a dimensional versus subtype approach to paranoia.…”

“…Finally, it is also certainly the case that using a variable dimensionally versus dichotomously might yield differing or even opposite results. For example, Sorensen et al [63] evaluated the relative merits of a dimensional versus subtype approach to paranoia. He found that when paranoia was measured dimensionally, those with more paranoid symptomatology were lower on other measures of current functioning, a finding inconsistent with other literature.…”

Theories of Delusional Disorders

“…So far, no indices for localizable cerebral dysfunctions in paranoid disorders have been found in neuropsychological studies, although the results are heterogeneous, probably at least in part due to different diagnostic criteria, the influence of medication, artifacts produced by spot sampling, as well as different neuropsychological tests. Regarding the problem of inclusion and exclusion criteria, Sorensen et al [65] pointed out that these factors may artificially increase or decrease the number of paranoid or non-paranoid test subjects, thereby also skewing the test data for group comparisons. Bornstein et al [57] also showed that between-group differences in cognitive performance could be due to confounding variables (see above).…”

Paranoia, self-consciousness, and social cognition in schizophrenics

“…However, as emphasized by Sorensen, Paul, and Mariotto (1988), the model behind, for example, the DSM-III diagnosis of paranoid schizophrenia is a predomi-nance model. In such a model a diagnosis is based principally on the predominance of paranoid symptoms over other symptoms rather than on the intensity of paranoid thought and behavior as such.…”

“…In such a model a diagnosis is based principally on the predominance of paranoid symptoms over other symptoms rather than on the intensity of paranoid thought and behavior as such. Of course, paranoid symptoms are frequent in other types of schizophrenia and, as argued by Sorensen et al (1988), predominance models largely neglect this wider significance of paranoid symptoms. Thus, it is not evident that a paranoia measure should necessarily be strongly related to the paranoid subtype to be valid.…”