Background: Evidence suggests psychotic-like-experiences exist on a spectrum of severity, ranging from normative to clinical psychosis. Individuals experiencing subclinical levels of symptoms are at clinical high risk (CHR) for developing full psychosis. Declines in social functioning are a risk factor for conversion to psychosis in CHR populations, and changes in social anxiety are associated with changes with social functioning in patients with schizophrenia. Clinically, extreme levels of social anxiety in CHR can appear similar to paranoid/suspicious thinking and both constructs engage biologically-similar neural circuitry. This study evaluates if social anxiety and lower social functioning can predict greater paranoid ideation.
Method: Adolescents and young adults participated in a clinical evaluation at the Center for Evaluation, Detection, and Response to Risk (CEDAR), a research and clinical center for young people at risk for developing psychosis. The Structured Interview for Psychosis Risk Syndromes (SIPS), the Social Functioning Scale, and the Social Interaction Anxiety Scale were used to measure paranoia/suspiciousness, social functioning, and social anxiety. Data from 200 individuals (mean age =18.75) were analyzed. Item Response Theory assessed the psychometric functioning of the SIAS, and multiple linear regression examined whether levels of social anxiety and social functioning predicted higher levels of paranoid symptoms.
Results: IRT results of the SIAS demonstrated a hierarchical continuum of social anxiety, ranging from normative social anxiety to theoretical sub-clinical levels of paranoia. Regression analyses demonstrated higher ratings of social anxiety and lower ratings of social functioning predicted greater levels of paranoia.
Conclusion: Our results show that elevated social anxiety and lower social functioning are associated with higher levels of paranoid ideation within a CHR population. Further research in this topic (i.e., on interventions targeting social anxiety and social functioning) could advance understanding of the development of psychosis spectrum disorders and inform treatment targets for CHR populations.
Live Zoom Session – April 21st
James B. Green B.A., Stephanie N. DeCross M.A., Michelle Friedman-Yakoobian Ph.D
Michelle Friedman-Yakoobian Ph.D