Instability in self-esteem and paranoia in a general population sample

Background Research on the association between paranoia and self-esteem has yielded inconsistent findings. Some studies have indicated an association between paranoia and low self-esteem, while other studies have shown an association with high self-esteem. A plausible explanation for these inconsistencies is that self-esteem is unstable in paranoid individuals. Method The association between instability in self-esteem and paranoia was assessed in a general population risk set of 4636 individuals using logistic regression analysis. Results Self-esteem instability was significantly associated with the presence of paranoid symptoms (OR 1.27 95% CI 1.12–1.45) and not with other positive psychotic symptoms (OR 1.09 95% CI 0.96–1.23), adjusted for a range of a priori selected confounders. Conclusion The finding of a specific association between unstable self-esteem and paranoia is in line with a recent psychological model suggesting that paranoid beliefs arise partly as a consequence of dysfunctional efforts to regulate self-esteem.