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Role of distress in delusion formation^*

Department of Psychiatry and Neuropsychology, Maastricht University

RON de GRAAF, MA, PhD and WILMA VOLLEBERGH, MA, PhD

The Netherlands Institute of Mental Health and Addiction, Utrecht

JIM van OS, MD, PhD, MRCPsych

Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands and Division of Psychological Medicine, Institute of Psychiatry, London, UK

Correspondence: Professor Jim van Os, Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (DRT 10), 6200MD Maastricht, The Netherlands. Tel: +31 43 387 5443; fax: +31 43 387 5444; e-mail: j.vanos{at}sp.unimaas.nl

Declaration of interest None. Funding detailed in Acknowledgements.

^* Paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Background Contemporary cognitive psychological theories suggest that distress plays a mediating role in delusion formation.

Aims To study the amplifying role of distress from early perceptual intrusions to delusion formation.

Method A general population sample of 7076 individuals was interviewed with the Composite International Diagnostic Interview (CIDI) in 1996 (baseline), 1997 (T1) and 1999 (T2). At T2, clinicians also scored the Brief Psychiatric Rating Scale (BPRS) item‘unusual thought content’. Analyses compared hallucinatory experiences with and without subjective distress at baseline for risk of delusion formation at follow-up.

Results Individuals experiencing hallucinations with distress, compared with those without distress had a fourfold increased risk of subsequent delusion formation.

Conclusions This finding corroborates the hypothesis that distress associated with early perceptual intrusions serves as a catalyst in the development of delusions.

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