Course and determinants of self‐esteem in people diagnosed with schizophrenia during psychiatric treatment

Background: Opposing predictions have been formulated with regard to the causal relationship between paranoia and self?esteem, either assuming a protective role of paranoia for explicit self?esteem or a linear decrease of self?esteem upon symptom deterioration. The primary purpose of the present study was to provide estimates for the prevalence of low self?esteem in people diagnosed with schizophrenia during psychiatric treatment. Method: Self?esteem was assessed in a cohort of 58 schizophrenia patients at the beginning of psychiatric treatment and 44 healthy controls. A subgroup of 45 patients and 24 controls was reassessed 4 weeks later. Results: At baseline, 42% of the patients displayed low self?esteem (i.e. one standard deviation below the norm; re?assessment: 49%). Baseline depression and antipsychotic dosage were the strongest predictors for low self?esteem after 4 weeks. While paranoid ideas were not related to self?esteem, neither cross?sectionally nor longitudinally, grandiose delusions were modestly associated to higher self?esteem. Conclusions: Symptom improvement over time did not translate into altered explicit self?esteem. The results are inconsistent with a strong formulation of the hypothesis that paranoid ideas act as a defence. However, before dismissing this hypothesis, future investigations should look at qualitative aspects of delusional beliefs along with potential functional benefits of paranoia other than self?esteem that may moderate the relationship.