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The Nature of Delusion and Delusion-Like Belief THE NATURE OF DELUSION AND DELUSION-LIKE BELIEF Rachel Pechey Thesis submitted to Cardiff University in fulfilment of the requirements for the degree of Doctor of Philosophy March 2010 UMI Number: U584420 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U584420 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ACKNOWLEDGEMENTS Firstly, 1 would like to particularly thank Professor Peter Halligan for all his help, enthusiasm and encouragement throughout this project. I would also like to take this opportunity to thank Dr. Gordon Harold for his helpful advice on a number of issues, and Dr. Sirwan Abdul and Dr. Kate Pietura, who offered advice and support for my work with patients. I am also very grateful to Tom Hamilton-James and the rest of the team at mruk, who carried out the research interviews. In addition, I am indebted to Sue Dentten for all her help with administrative issues. Special thanks are also due to Rhys Morgan, Harriet Over, Alan Pechey, and Hannah Togneri, who read and made constructive criticisms on earlier drafts. Moreover, I would like to thank all my family and friends for putting up with me throughout the highs and lows of this project. Finally, I am especially grateful for the contribution of Professor Hadyn Ellis, who helped to develop the Cardiff Beliefs Questionnaire and characteristics of belief study, but sadly passed away before their completion. This research was made possible by an Economic and Social Research Council studentship [PTA-031-2005-00352]. DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature for any degree Signed: ................................... Date: ....^.U Y.S .^.^Q .L C '............................... This dissertation is being submitted in partial fulfilment of the requirements of the degree of Doctor of Philosophy. Signed: ....! ft A ............................................ Date: ... / .1 / . %Q. l .0 .................................... This dissertation is the result of my own independent work, except where otherwise stated. Other sources are acknowledged by explicit references. Signed: ... .v* .QSrVr Date: — W. /. .^. /.. ^?r&. J. C. I hereby give my consent for my dissertation, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed:....................................................................................... Date: .? ..U ./..^ ./.^ .Q .» .0.............................. ii SUMMARY Delusions have been defined as false beliefs different from those that almost everyone believes. However, studies suggest that beliefs (including delusions) comprise a continuum where content does not distinguish psychosis. Despite the explicit characterisation of delusions as (false) beliefs, most research has focused on delusions while neglecting non-clinical beliefs. To address this, the first formal study of key features of belief was conducted. A large public survey (n=1000) confirmed that most regarded beliefs as relatively stable personal convictions, capable of influencing thoughts and/or behaviour. These participants then completed the Cardiff Beliefs Questionnaire (CBQ), a newly developed measure designed to investigate the prevalence of different types of belief (delusion­ like [bizarre and non-bizarre], paranormal, religious, and societal/cultural). Results showed that 38% of participants strongly endorsed one or more delusion-like beliefs) (DLB), with 91% reporting at least one ‘weak’, ‘moderate’ or ‘strong’ DLB. Moreover, 26% strongly endorsed at least one bizarre DLB. Levels of DLB endorsement were not distinguishable from those of paranormal and religious beliefs (P&RB). These findings support a continuum account but present difficulties for existing clinical definitions of delusion. The CBQ also investigates anomalous experiences (AE), given their proposed causal role in delusion formation. AE and anomalous beliefs (DLB and P&RB) were associated in this sample, but the relationship was not found for all individuals, suggesting that having AE is neither necessary nor sufficient for holding anomalous beliefs. Finally, belief consistency and coherence were explored across and within different belief types. DLBs appeared less stable than other belief types, emphasising the importance of functional characteristics in distinguishing clinically relevant beliefs. In addition, while seemingly contradictory beliefs were reported by some, results generally supported coherence between DLB and P&RB. Collectively, these findings complement those of traditional clinical studies, while demonstrating the value of non-clinical investigations in elucidating the nature of delusions. TABLE OF CONTENTS CHAPTER 1 BELIEF AND DELUSION................................................................................................ 1 1.1 Introduction...............................................................................................................1 1.2 What is meant by a belief? ......................................................................................4 1.2.1 Philosophical concepts of belief...................................................................... 4 1.3 Validity of the concept...........................................................................................10 1.4 Content-specific beliefs..........................................................................................14 1.4.1 Assessment of specific beliefs........................................................................ 14 1.4.2 Working definition o f‘belief ........................................................................ 16 1.5 Delusional beliefs ....................................................................................................17 1.5.1 Importance of delusion....................................................................................17 1.5.2 Are delusions a form of belief? ...................................................................... 18 1.6 The continuum hypothesis..................................................................................... 24 1.6.1 Continuum of psychosis................................................................................. 24 1.6.2 Areas for further research ............................................................................... 29 1.6.3 Implications of the continuum approach....................................................... 31 1.7 Aims of the thesis................................................................................................... 33 CHAPTER 2 DELUSIONS: HISTORY, CONCEPT AND THEORY...............................................38 2.1 Background .............................................................................................................38 2.2 History of the concept of delusion........................................................................38 2.2.1 Background ................................................................................................... 38 2.2.2 Diagnostic reliability...................................................................................... 40 2.2.3 The cognitive neuropsychiatric approach......................................................43 2.3 Types of delusion...................................................................................................45 2.3.1 Different diagnoses......................................................................................... 46 2.3.2 Bizarre vs. non-bizarre ...................................................................................48 2.4 Defining delusion................................................................................................... 50 2.5 Theoretical accounts of delusion ...........................................................................56 2.5.1 The role of anomalous perceptual experiences.............................................59 2.5.2 The role of cognitive biases ............................................................................61 2.5.3 Physiological models.......................................................................................68 2.6 Summary................................................................................................................. 70 CHAPTER 3 CHARACTERISTIC FEATURES OF BELIEF............................................................ 71 3.1 Background .............................................................................................................71 3.1.1 How should we assess reports of ‘belief?....................................................71 3.2 Study 1: People’s understanding of ‘belief......................................................... 73 3.2.1 Background ..................................................................................................... 73 3.2.2 Developing a nature of belief measure.........................................................
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