Attributional biases, paranoia, and depression in early psychosis

Authors


Abstract

Objectives

Attributional biases to externalize blame for negative events (externalizing bias) and to target other people for blame (personalizing bias) may constitute a vulnerability to psychosis. However, most research to date has only examined attributional biases in chronic patients. We examined attributional style, paranoia, and depression in early psychosis patients to assess the primacy of attributional biases in psychosis.

Design

A quasi-experimental design was adopted to compare the attributional style of patients and controls. Correlates of attributional style were also examined.

Methods

Early psychosis patients and age- and gender-matched healthy controls completed the ‘Internal, Personal and Situational Attributions Questionnaire’. Paranoid tendencies, suspiciousness, and depression were also assessed in both groups, while severity of current symptoms was assessed in patients.

Results

A high proportion of patients had persecutory delusions. These patients, however, did not differ from controls in externalizing or personalizing bias. Whereas suspiciousness and persecutory delusions in patients associated with externalizing bias, no bias measures associated with paranoid tendencies in either patients or controls. Counter to the pattern seen for endogenous depression, depression in patients was associated with an increased tendency to attribute events to self and a decreased tendency to attribute events to circumstances.

Conclusions

These preliminary findings raise doubts about the primacy of attributional biases in psychosis. The novel findings with regard to depression warrant further investigation and suggest that young people, who develop depression after the onset of psychosis, may experience a need to re-establish a sense of personal control over life events that appear unpredictable.

Practitioner points

Findings

  • Attributional biases are not prominent in the early stages of psychosis. Early psychosis patients with suspicious ideation of delusional intensity and more severe persecutory delusions do, however, show a more extreme tendency to avoid self-blame for negative events.
  • Depression in the early stages of psychosis is not associated with an increased tendency to blame self for negative events, as it is in endogenous depression, but is instead associated with an increased tendency to attribute events to self and a reduced tendency to attribute events to circumstances.
  • These preliminary findings suggest that a reactive depression in early psychosis associates with a need to regain a sense of personal control over life events that may appear overwhelmingly unpredictable.

Limitations

  • The study was cross-sectional. As such, the findings are equivocal with regard to whether a pre-existing externalizing bias shapes suspicious delusional themes in young people who become psychotic or whether instead such a bias is a consequence of suspicious delusional preoccupations.
  • Future work is needed to replicate the findings with a larger early psychosis cohort and to longitudinally track attributional style in ‘ultra high risk’ young people who go on to develop psychosis.

Ancillary