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Dimensional approach to delusions: comparison across types and diagnoses
P S Appelbaum1, P C Robbins, L H Roth
1Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA. appelbap@ummhc.org
The American Journal of Psychiatry
|December 10, 1999
Summary
A dimensional approach reveals common structures in delusions across psychiatric diagnoses. This suggests shared underlying causes and highlights the utility of dimensional characterization for understanding and treating delusions.
Area of Science:
- Psychiatry
- Clinical Psychology
- Psychopathology
Background:
- Delusions are a core symptom in various psychiatric disorders.
- Characterizing delusions solely by content may obscure underlying similarities.
- A dimensional approach offers a framework to explore non-content-related features of delusions.
Purpose of the Study:
- To investigate the utility of a dimensional approach in characterizing delusions.
- To examine differences in delusion dimensions across diagnostic categories and delusion types.
- To identify common structural properties of delusions.
Main Methods:
- Interviews with 1,136 acutely hospitalized psychiatric patients.
- Use of the MacArthur-Maudsley Delusions Assessment Schedule to score six delusion dimensions.
- Classification of delusions by type and assignment of diagnoses using DSM-III-R criteria.
Main Results:
- 328 subjects (29%) were identified as delusional.
- Delusion dimensions were significantly, though modestly, intercorrelated.
- Schizophrenia patients exhibited more intense delusions; grandiose/religious delusions had high conviction, persecutory delusions involved negative affect and action.
- Factor analysis revealed a consistent two-factor structure: 'intensity and scope' and 'affect and action'.
Conclusions:
- The stable dimensional structure of delusions across diagnoses and types suggests shared etiologic mechanisms.
- A dimensional approach effectively characterizes diverse delusions, highlighting therapeutic implications.
- This framework supports viewing delusions as more similar than different, irrespective of specific content or diagnosis.