Deserved or Undeserved? Paranoia Subtypes as Predictors of Internalized Stigma in Schizophrenia

According to the cognitive model known as poor-me/bad-me paranoia, the feeling of deservedness in the formation of persecutory delusions predicts the individual's self-esteem and depressive symptoms. Internalized stigma is associated with poor outcomes in many areas of functioning throughout the course of psychotic disorders and may also be related to the bad-me/poor-me distinction, as both cognitive phenomena are thought to stem from social-cognitive biases regarding how the individual is represented in the minds of others. This study aims to investigate whether the bad-me/poor-me distinction is related to internalized stigma in individuals with persecutory delusions.

The type of paranoia was determined based on the content of delusions. Sociodemographic data form, Rosenberg Self-Esteem Scale, Internalized Stigma of Mental Illness Scale, Beck Depression Inventory, and Perceived Social Support Scale were administered to the participants. Group differences and variables affecting stigma perception were examined.

In the bad-me group, depression scores, total stigma perception, and alienation scores were higher, while stigma resistance scores were lower. A positive and significant relationship was found between self-esteem and family support. Paranoia type and depressive symptoms were identified as stronger predictors of alienation than self-esteem and perceived social support.

The relationship between paranoia subtype and stigma perception may be important in risk assessment and in identifying therapeutic intervention targets. However, further studies are needed to better understand the relationships among persecutory delusions, self-esteem, depression, and stigma perception.