Inconsistencies among paranoid functioning, premorbid adjustment and chronicity : a question of diagnostic criteria?



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Despite the widely held belief that paranoid behavior is associated with good premorbid adjustment, low chronicity and high current functioning in psychiatric inpatients, inconsistencies in the literature suggest that supportive evidence may be an artifact of the measurement model commonly employed to index paranoid status. This hypothesis was tested with 497 nonorganic psychiatric inpatients selected from 19 treatment units by employing a dimensional/cumulative model versus two forms of the traditional predominance- defined class model for indexing paranoid and nonparanoid status. As hypothesized, results found that paranoid behavior per se - - ie. measured by a dimensional/cumulative model - - is not indicative of higher functioning and associated relationships, but rather simply reflects a narrower class of problem behavior. Only when status was determined on the basis of the predominance of the defining class of behavior did paranoid subjects demonstrate better premorbid adjustment, lower chronicity, and higher levels of functioning than nonparanoid subjects. Not only were the latter relationships due to an artifactual exclusion cf more disabled subjects from paranoid groups but conceptually relevant relationships were also obscured. Serious problems exist in the use of information obtained from traditional class models for either theoretical or practical purposes.