Confluent paranoia in African American psychiatric patients: an empirical study of Ridley's typology

This study examined Ridley's (1984) typology of paranoia in African Americans, which assumes orthogonal dimensions of culture and pathology in symptom expression. Median split of scores on the Cultural Mistrust Inventory and the scale of False Beliefs and Perceptions represented high and low levels of cultural paranoia and pathological paranoia, respectively. The 4 groups of Black patients were nonparanoia, cultural paranoia, pathological paranoia, and confluent paranoia. A Fenigstein Paranoia Scale manipulation check indicated that differences in paranoid symptom expression among the groups were partially supportive of Ridley's model, as were measures of perceptions of hostility and self-esteem. Omnibus tests of between-groups differences were significant for global assessment of functioning and number of symptoms recorded in patients' charts. Predicted pattern testing revealed a significant severity dimension in mean scores across paranoia groups for some measures of clinician-rated functioning but not others. SCID interviewers' ratings of cultural mistrust and number of times restrained (or secluded) were more consistent with a pattern representing a cultural dimension than a severity dimension across paranoia groups. Findings provide limited empirical validation of Ridley's typology of paranoia in African Americans.