The relevance of self-esteem and self-schemas to persecutory delusions: A systematic review

• Published in: Comprehensive psychiatry Vol. 54; no. 7; pp. 766 - 789
• Main Authors: Kesting, Marie-Luise, Lincoln, Tania Marie
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2013; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Delusions - psychology; Humans; Hypotheses; Medical sciences; Models, Psychological; Paranoid Disorders - psychology; Patients; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Self Concept; Self esteem; Standard deviation; Studies; Systematic review; Theory; Self esteem; Persecutia complex; Scheme; Review; Self
• ISSN: 0010-440X; 1532-8384; 1532-8384
• DOI: 10.1016/j.comppsych.2013.03.002

Self-esteem is frequently targeted in psychological approaches to persecutory delusions (PD). However, its precise role in the formation and maintenance of PD is unclear and has been subject to a number of theories: It has been hypothesized that PD function to enhance self-esteem, that they directly reflect negative conceptualizations of the self, that self-esteem follows from the perceived deservedness of the persecution (poor-me versus bad-me-paranoia) and that the temporal instability of self-esteem is relevant to PD. In order to increase our understanding of the relevance of self-esteem to PD, this article systematically reviews the existing research on self-esteem in PD in the light of the existing theories. We performed a literature search on studies that investigated self-esteem in PD. We included studies that either investigated self-esteem a) within patients with PD or compared to controls or b) along the continuum of subclinical paranoia in the general population. We used a broad concept of self-esteem and included paradigms that assessed implicit self-esteem, specific self-schemas and dynamic aspects of self-esteem. The literature search identified 317 studies of which 52 met the inclusion criteria. The reviewed studies consistently found low global explicit self-esteem and negative self-schemas in persons with PD. The studies therefore do not support the theory that PD serve to enhance self-esteem but underline the theory that they directly reflect specific negative self-schemas. There is evidence that low self-esteem is associated with higher perceived deservedness of the persecution and that PD are associated with instable self-esteem. Only few studies investigated implicit self-esteem and the results of these studies were inconsistent. We conclude by proposing an explanatory model of how self-esteem and PD interact from which we derive clinical implications.