Persecutory delusions and the self: An investigation of implicit and explicit self-esteem

Persecutory delusions are proposed to be a defence against low self-esteem reaching conscious awareness (Bentall, Corcoran, Howard, Blackwood, & Kinderman, 2001). Key predictions of this proposal are that individuals with persecutory delusions will have lower implicit self-esteem and equivalent levels of explicit self-esteem compared to healthy controls. This study aims to test the predictions regarding implicit and explicit self-esteem in people with persecutory delusions. Of 22 people screened for persecutory delusions, 16 were recruited to the study. 20 healthy control participants were recruited. The Implicit Association Test was used to measure implicit self-esteem and the Rosenberg self-esteem scale was used to assess explicit self-esteem. Positive and negative self and other schemas were also assessed using the Brief Core Schema Scales. People with persecutory delusions had positive implicit self-esteem, comparable to that of the control group. Explicit self-esteem was lower for the persecutory delusion group, but was associated with increased depression and anxiety. Negative self and other schemas were higher in the clinical group. The results do not support the contention that persecutory delusions defend against negative self-representations and low self-esteem reaching conscious awareness. Non-defensive cognitive models are discussed as an alternative way of understanding persecutory delusions.