The inferiority complex in paranoia readdressed: A study with the implicit association test

Introduction. It has been theorised that patients with persecutory delusions display a lack of covert self-esteem (formerly termed the 'inferiority complex'), while at the same time displaying normal or even heightened levels of explicit self-esteem. However, the empirical basis for this assumption is inconsistent. Methods. In view of apparent shortcomings of prior studies to assess implicit self-esteem, the Implicit Association Test was utilised to readdress this theory. The Rosenberg scale served as an index of overt self-esteem. A total of 23 schizophrenic patients, 13 of whom showed current symptoms of persecutory delusions, participated in the study; 41 healthy and 14 depressed participants served as controls. Results. Schizophrenic patients showed decreased levels of both implicit and explicit self-esteem relative to healthy controls. In line with recent studies, patients with current ideas of persecutory delusions displayed greater explicit self-esteem than nonparanoid patients. Conclusions. The present study lends partial support for the notion that persecutory delusions serve as a defence against low implicit self-esteem, although the explicit self-esteem of these patients is still lower than in normal participants. Apart from abnormalities of attributional style, which have been assumed to convert low into high self-esteem, the assumption that a 'feeling of personal significance' heightens self-esteem in paranoid schizophrenia deserves further consideration.