Section for Clinical Psychology and Psychotherapy, Department of Psychology, Philipps Universität Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
Compr Psychiatry. 2013 Oct;54(7):766-89. doi: 10.1016/j.comppsych.2013.03.002. Epub 2013 May 17.
Self-esteem is frequently targeted in psychological approaches to persecutory delusions (PD). However, its precise role in the formation and maintenance of PD is unclear and has been subject to a number of theories: It has been hypothesized that PD function to enhance self-esteem, that they directly reflect negative conceptualizations of the self, that self-esteem follows from the perceived deservedness of the persecution (poor-me versus bad-me-paranoia) and that the temporal instability of self-esteem is relevant to PD. In order to increase our understanding of the relevance of self-esteem to PD, this article systematically reviews the existing research on self-esteem in PD in the light of the existing theories.
We performed a literature search on studies that investigated self-esteem in PD. We included studies that either investigated self-esteem a) within patients with PD or compared to controls or b) along the continuum of subclinical paranoia in the general population. We used a broad concept of self-esteem and included paradigms that assessed implicit self-esteem, specific self-schemas and dynamic aspects of self-esteem.
The literature search identified 317 studies of which 52 met the inclusion criteria. The reviewed studies consistently found low global explicit self-esteem and negative self-schemas in persons with PD. The studies therefore do not support the theory that PD serve to enhance self-esteem but underline the theory that they directly reflect specific negative self-schemas. There is evidence that low self-esteem is associated with higher perceived deservedness of the persecution and that PD are associated with instable self-esteem. Only few studies investigated implicit self-esteem and the results of these studies were inconsistent.
We conclude by proposing an explanatory model of how self-esteem and PD interact from which we derive clinical implications.
自尊经常成为针对被害妄想症（PD）的心理干预的目标。然而，它在 PD 的形成和维持中的确切作用尚不清楚，并且存在多种理论：有人假设 PD 有助于增强自尊，PD 直接反映了对自我的负面概念化，自尊源于对迫害的感知应得性（可怜的我与邪恶的我——妄想），自尊的时间不稳定性与 PD 有关。为了增加我们对自尊与 PD 的相关性的理解，本文根据现有理论系统地回顾了 PD 中自尊的现有研究。
我们对研究 PD 中自尊的研究进行了文献检索。我们纳入了研究 PD 患者或对照者自尊的研究，或纳入了在普通人群中沿亚临床妄想连续体研究自尊的研究。我们使用了广泛的自尊概念，并纳入了评估内隐自尊、特定自我图式和自尊动态方面的范式。
文献检索确定了 317 项研究，其中 52 项符合纳入标准。综述研究一致发现 PD 患者的总体外显自尊低，自我图式消极。因此，这些研究不支持 PD 有助于增强自尊的理论，而是强调了 PD 直接反映特定的消极自我图式的理论。有证据表明，低自尊与更高的感知迫害应得性有关，而 PD 与不稳定的自尊有关。只有少数研究调查了内隐自尊，这些研究的结果不一致。
我们通过提出一个关于自尊和 PD 如何相互作用的解释模型来得出结论，并从中得出临床意义。
