Paranoiacs are angry and erroneously sense anger in others

Two reports on negative attributional bias and paranoia:

First,  people who have negative attributional bias and a “poor me” (vs. “bad me”) paranoia have a high dose of anger.  The researchers note that “poor me” persecutory delusions may be a prelude to psychosis.

Second, people with paranoia perceive hostility and aggression in others in ambiguous situations. Other people who have various forms of psychoses do not.

Update: See the NYT article about the NY shooter, Jiverly Wong, and the hand written letter. Both demonstrate anger and negative attributional bias. This looks like the tragic outcome when paranoia (or whatever shrinks call it) is not recognized.

Are there any paranoiacs out there? Can you let us know what it’s like? Probably no one will respond. . . but still, there were some OCD folks who responded to my query about OCD and stalking, so perhaps we’ll get a response.  (“National Stalking Awareness Month. Q: Why do stalkers stalk? A: Unknown. But looks a lot like OCD with an inability to have self-insight due to right inferior parietal region problems.. .” Neurological Correlates 01.18.09).

The paranoiacs in my life (yes, I’m armchair diagnosing them) clearly are  cognitively impaired in selective areas. Like, compassion. Can there be a compassionate paranoiac? They had empathy, as that term is defined to mean they could sense other people’s feelings, if erroneously: they sensed anger when there was none, and erroneously believed people were out to exploit them.

For instance, a relative invited me to dinner at a multi- starred -restaurant, and it was sort of a biggish deal,  get all cleaned up and all.  It didn’t go off well — we were extremely early, like early-bird special early. The waiter was attentive because there was no one else in the place. The relative began to get agitated and ordered two stiff cocktails. Then this person’s eyes began darting around, and startled at even small noises. When the waiter came back, this relative barraged the waiter with red-face rageful accusations of  avoiding us and giving us bad service. My relative was enraged at being so insulted.  The waiter and I exchanged glances like, “what is going on?”.  We were served, ate, and left really fast. At the time, I didn’t realize this was a symptom of a mental illness, I chalked it up to mean and nastiness of this particular person.

There was plainly narcissism, paranoia and who knows what going on, but the paranoia stands out for me. Later this rageful paranoia was disgorged in my direction for similarly  innocuous behavior.  Maybe you had to be there, but this kind of negative attributional bias looks like standing on the edge of the psychosis pool ready to dive in.

I wonder if persistent “anger” and persistent negative attributional bias is really the neurological canary in the frontal lobe coal mine. Irritability and agitation is a symptom of  dementia. Is anger or agitation used as a diagnostic criteria?

Fornells-Ambrojo M, Garety PA., “Understanding attributional biases, emotions and self-esteem in ‘poor me’ paranoia: Findings from an early psychosis sample,” Br J Clin Psychol. 2008 Dec 2. [Epub ahead of print]PMID: 19054432 DOI: 10.1348/014466508X377135

Combs DR, Penn DL, Michael CO, Basso MR, Wiedeman R, Siebenmorgan M, Tiegreen J, Chapman D.,”Perceptions of hostility by persons with and without persecutory delusions,” Cogn Neuropsychiatry 14: 30-52 (January 2009). PMID: 19214841 DOI: 10.1080/13546800902732970

Abstracts reproduced below the jump.

Fornells-Ambrojo M, Garety PA., “Understanding attributional biases, emotions and self-esteem in ‘poor me’ paranoia: Findings from an early psychosis sample,” Br J Clin Psychol. 2008 Dec 2. [Epub ahead of print]PMID: 19054432 DOI: 10.1348/014466508X377135

Objectives: Trower and Chadwick’s (1995) theory of two types of paranoia (‘poor me’ and ‘bad me’) provides a framework for understanding the seemingly contradictory evidence on persecutory delusions. Paranoia has been argued to defend against low self-esteem, but people with persecutory delusions report high levels of emotional distress and, in some instances, low self-worth.The current study investigates attributions and emotions in a sample of people with early psychosis who have persecutory delusions. ‘Poor me’ paranoia has been found to be more frequent than ‘bad me’ paranoia in the early stages of psychosis. Anger and a tendency to blame other people are hypothesized to characterize ‘poor me’ paranoia.

Design and methods: The study had a cross-sectional design. Twenty individuals with early psychosis, 21 clinical controls with depression and 32 healthy volunteers completed a thorough assessment of emotions and attributions.

Results: The ‘poor me’ paranoia group showed higher levels of anger, anxiety and depression than the non-clinical control group. Self-esteem and guilt were however preserved. A tendency to blame others but not themselves was characteristic of the ‘poor me’ paranoia group whereas people in the clinical control group tended to self-blame for failures. Anger, but not self-esteem, was associated with an attributional bias characterized by blaming other people instead of oneself. Conclusions In conclusion, anger, a previously overlooked emotion in the study of persecutory delusions, warrants further attention. The other-directed nature of this emotion highlights the potential role of interpersonal schemas in understanding paranoia.

Tags: attributional bias, mental health, neuropsychology, paranoia, psychology, research, victimhood