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Longitudinal relationships among dissociation, paranoia, and anxiety in a clinical sample of individuals with schizophrenia-spectrum conditions.

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Τίτλος: Longitudinal relationships among dissociation, paranoia, and anxiety in a clinical sample of individuals with schizophrenia-spectrum conditions.
Συγγραφείς: Lebovitz JG; Psychology Department, Vanderbilt University, Nashville, TN, USA. Electronic address: julia.g.lebovitz@vanderbilt.edu., Kittleson AR; Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA., Sloan AF; Psychology Department, Vanderbilt University, Nashville, TN, USA., Torregrossa LJ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA., Park S; Psychology Department, Vanderbilt University, Nashville, TN, USA., Sheffield JM; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
Πηγή: Psychiatry research [Psychiatry Res] 2026 Aug; Vol. 362, pp. 117174. Date of Electronic Publication: 2026 Apr 15.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier/North-Holland Biomedical Press Country of Publication: Ireland NLM ID: 7911385 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7123 (Electronic) Linking ISSN: 01651781 NLM ISO Abbreviation: Psychiatry Res Subsets: MEDLINE
Imprint Name(s): Publication: Limerick : Elsevier/North-Holland Biomedical Press
Original Publication: Amsterdam, Elsevier/North-Holland Biomedical Press.
Ιατρικοί όροι (MeSH): Paranoid Disorders*/complications , Paranoid Disorders*/diagnosis , Anxiety*/complications , Anxiety*/diagnosis , Dissociative Disorders*/complications , Dissociative Disorders*/diagnosis , Schizophrenia*/complications , Schizophrenia*/diagnosis , Psychotic Disorders*/complications , Psychotic Disorders*/psychology , Schizophrenic Psychology*, Schizophrenia Spectrum and Other Psychotic Disorders/complications ; Schizophrenia Spectrum and Other Psychotic Disorders/diagnosis ; Schizophrenia Spectrum and Other Psychotic Disorders/psychology ; Self Report/statistics & numerical data ; Longitudinal Studies ; Psychiatric Status Rating Scales ; Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged
Περίληψη: Individuals with schizophrenia endorse high levels of dissociative experiences; however, little is known about the mechanisms driving the link between psychosis and dissociative experiences. Cross-sectional research has indicated that anxiety mediates the dissociation-paranoia relationship, but longitudinal investigations of these associations remain lacking. We therefore examined how dissociation, paranoia, and anxiety-related processes relate over time in a clinical sample. Seventy-seven individuals with schizophrenia-spectrum conditions (SZ) and 72 non-clinical comparison (NCC) participants completed a 24-week longitudinal study with self-report and clinician-administered measurements of dissociation, paranoia, and anxiety. Assessments were collected at six timepoints. Dissociation was significantly elevated in SZ and was significantly associated with paranoia at every study visit. Baseline dissociation related to paranoia at four and 24 weeks. Dissociation and paranoia were significantly associated longitudinally, with both decreasing over time. While there was an overall decrease in dissociative symptomology across the study duration in SZ, certain dissociative factors (body and reality) remained stably elevated. Anxiety-related processes at four-weeks, including general anxiety, perseverative thinking, and worry, showed indirect associations with the relationship between baseline dissociation levels and paranoia at 24-weeks, consistent with a mediation model. These results highlight the importance of anomalous experiences and worry in maintaining persecutory delusions. In addition, these findings underscore altered self-experience in schizophrenia and the importance of perceptual disturbance and anxiety-related processes in sustaining paranoia over time.
(Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Grant Information: K23 MH126313 United States MH NIMH NIH HHS
Contributed Indexing: Keywords: Anxiety; Dissociation; Paranoia; Perseverative thinking; Schizophrenia; Worry
Entry Date(s): Date Created: 20260429 Date Completed: 20260528 Latest Revision: 20260726
Update Code: 20260726
DOI: 10.1016/j.psychres.2026.117174
PMID: 42054844
Βάση Δεδομένων: MEDLINE
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  Data: Longitudinal relationships among dissociation, paranoia, and anxiety in a clinical sample of individuals with schizophrenia-spectrum conditions.
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  Data: <searchLink fieldCode="AU" term="%22Lebovitz+JG%22">Lebovitz JG</searchLink>; Psychology Department, Vanderbilt University, Nashville, TN, USA. Electronic address: julia.g.lebovitz@vanderbilt.edu.<br /><searchLink fieldCode="AU" term="%22Kittleson+AR%22">Kittleson AR</searchLink>; Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.<br /><searchLink fieldCode="AU" term="%22Sloan+AF%22">Sloan AF</searchLink>; Psychology Department, Vanderbilt University, Nashville, TN, USA.<br /><searchLink fieldCode="AU" term="%22Torregrossa+LJ%22">Torregrossa LJ</searchLink>; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.<br /><searchLink fieldCode="AU" term="%22Park+S%22">Park S</searchLink>; Psychology Department, Vanderbilt University, Nashville, TN, USA.<br /><searchLink fieldCode="AU" term="%22Sheffield+JM%22">Sheffield JM</searchLink>; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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  Data: <searchLink fieldCode="MM" term="%22Paranoid+Disorders%22">Paranoid Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Paranoid+Disorders+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Paranoid+Disorders%22">Paranoid Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Paranoid+Disorders+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Anxiety%22">Anxiety*</searchLink>/<searchLink fieldCode="MM" term="%22Anxiety+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Anxiety%22">Anxiety*</searchLink>/<searchLink fieldCode="MM" term="%22Anxiety+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Dissociative+Disorders%22">Dissociative Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Dissociative+Disorders+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Dissociative+Disorders%22">Dissociative Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Dissociative+Disorders+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Schizophrenia%22">Schizophrenia*</searchLink>/<searchLink fieldCode="MM" term="%22Schizophrenia+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Schizophrenia%22">Schizophrenia*</searchLink>/<searchLink fieldCode="MM" term="%22Schizophrenia+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Psychotic+Disorders%22">Psychotic Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Psychotic+Disorders+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Psychotic+Disorders%22">Psychotic Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Psychotic+Disorders+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Schizophrenic+Psychology%22">Schizophrenic Psychology*</searchLink><br /><searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders%22">Schizophrenia Spectrum and Other Psychotic Disorders</searchLink>/<searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders+complications%22">complications</searchLink> ; <searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders%22">Schizophrenia Spectrum and Other Psychotic Disorders</searchLink>/<searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders+diagnosis%22">diagnosis</searchLink> ; <searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders%22">Schizophrenia Spectrum and Other Psychotic Disorders</searchLink>/<searchLink fieldCode="MH" term="%22Schizophrenia+Spectrum+and+Other+Psychotic+Disorders+psychology%22">psychology</searchLink> ; <searchLink fieldCode="MH" term="%22Self+Report%22">Self Report</searchLink>/<searchLink fieldCode="MH" term="%22Self+Report+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> ; <searchLink fieldCode="MH" term="%22Longitudinal+Studies%22">Longitudinal Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Psychiatric+Status+Rating+Scales%22">Psychiatric Status Rating Scales</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Young+Adult%22">Young Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink>
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  Data: Individuals with schizophrenia endorse high levels of dissociative experiences; however, little is known about the mechanisms driving the link between psychosis and dissociative experiences. Cross-sectional research has indicated that anxiety mediates the dissociation-paranoia relationship, but longitudinal investigations of these associations remain lacking. We therefore examined how dissociation, paranoia, and anxiety-related processes relate over time in a clinical sample. Seventy-seven individuals with schizophrenia-spectrum conditions (SZ) and 72 non-clinical comparison (NCC) participants completed a 24-week longitudinal study with self-report and clinician-administered measurements of dissociation, paranoia, and anxiety. Assessments were collected at six timepoints. Dissociation was significantly elevated in SZ and was significantly associated with paranoia at every study visit. Baseline dissociation related to paranoia at four and 24 weeks. Dissociation and paranoia were significantly associated longitudinally, with both decreasing over time. While there was an overall decrease in dissociative symptomology across the study duration in SZ, certain dissociative factors (body and reality) remained stably elevated. Anxiety-related processes at four-weeks, including general anxiety, perseverative thinking, and worry, showed indirect associations with the relationship between baseline dissociation levels and paranoia at 24-weeks, consistent with a mediation model. These results highlight the importance of anomalous experiences and worry in maintaining persecutory delusions. In addition, these findings underscore altered self-experience in schizophrenia and the importance of perceptual disturbance and anxiety-related processes in sustaining paranoia over time.<br /> (Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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