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.