Why Do Bad Things Happen to Me? Attributional Style, Depressed Mood, and Persecutory Delusions in Patients With Schizophrenia

Abstract

Theoretical models postulate an important role of attributional style (AS) in the formation and maintenance of persecutory delusions and other positive symptoms of schizophrenia. However, current research has gathered conflicting findings. In a cross-sectional design, patients with persistent positive symptoms of schizophrenia (n = 258) and healthy controls (n = 51) completed a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) and assessments of psychopathology. In comparison to controls, neither patients with schizophrenia in general nor patients with persecutory delusions (n = 142) in particular presented an externalizing and personalizing AS. Rather, both groups showed a "self-blaming" AS and attributed negative events more toward themselves. Persecutory delusions were independently predicted by a personalizing bias for negative events (beta = 0.197, P = .001) and by depression (beta = 0.152, P = .013), but only 5% of the variance in persecutory delusions could be explained. Cluster analysis of IPSAQ-R scores identified a "personalizing" (n = 70) and a "self-blaming" subgroup (n = 188), with the former showing slightly more pronounced persecutory delusions (P = .021). Results indicate that patients with schizophrenia and patients with persecutory delusions both mostly blamed themselves for negative events. Nevertheless, still a subgroup of patients could be identified who presented a more pronounced personalizing bias and more severe persecutory delusions. Thus, AS in patients with schizophrenia might be less stable but more determined by individual and situational characteristics that need further elucidation.Key words: schizophrenia/persecutory delusions/ positive symptoms/attributional style/depression/ negative emotions Attributional style (AS) is defined as the way of inferring a causal explanation for important life events, 1,2 either toward oneself (internal), toward other persons (personal), or toward circumstances or fate (situational). For example, if "a friend starts a fight with me," it is possible to attribute this event to internal factors ("I am a bad person"), to personal factors ("He is annoyed quite quickly"), or to situational factors ("We lived in different parts of the country").Analysis of AS in schizophrenia derived from the clinical insight that persecutory delusions can be viewed as an excessive tendency to attribute negative events toward other persons. Initial studies used the Attributional Style Questionnaire (ASQ), 3 an instrument originally developed for the assessment of AS in depression. These studies found that patients with persecutory delusions showed more internal attributions for positive events and less internal attributions for negative events, compared with controls. This AS has been termed self-serving bias or externalizing bias (EB). [4][5][6] Because the ASQ showed quite

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Effects of antipsychotics on insight in schizophrenia

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