Course and determinants of self-esteem in people diagnosed with schizophrenia during psychiatric treatment

Steffen Moritz*, Ruth Veckenstedt, Sarah Randjbar, Francesca Vitzthum, Anne Karow, Tania M. Lincoln

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: Opposing predictions have been formulated with regard to the causal relationship between paranoia and self-esteem, either assuming a protective role of paranoia for explicit self-esteem or a linear decrease of self-esteem upon symptom deterioration. The primary purpose of the present study was to provide estimates for the prevalence of low self-esteem in people diagnosed with schizophrenia during psychiatric treatment.

Method: Self-esteem was assessed in a cohort of 58 schizophrenia patients at the beginning of psychiatric treatment and 44 healthy controls. A subgroup of 45 patients and 24 controls was reassessed 4 weeks later.

Results: At baseline, 42% of the patients displayed low self-esteem (i.e. one standard deviation below the norm; re-assessment: 49%). Baseline depression and antipsychotic dosage were the strongest predictors for low self-esteem after 4 weeks. While paranoid ideas were not related to self-esteem, neither cross-sectionally nor longitudinally, grandiose delusions were modestly associated to higher self-esteem.

Conclusions: Symptom improvement over time did not translate into altered explicit self-esteem. The results are inconsistent with a strong formulation of the hypothesis that paranoid ideas act as a defence. However, before dismissing this hypothesis, future investigations should look at qualitative aspects of delusional beliefs along with potential functional benefits of paranoia other than self-esteem that may moderate the relationship.

Original languageEnglish
Pages (from-to)144-153
Number of pages10
Issue number2
Publication statusPublished - 2010
Externally publishedYes


  • Course
  • Neuroleptics
  • Paranoia
  • Self‐esteem
  • Well‐being

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