Social anxiety and paranoid beliefs in adolescents

Background: Paranoid beliefs are common in the general adolescent population. The paranoia hierarchy suggests common social evaluative concerns may develop into persecutory thoughts via ideas of reference, a milder intermediary facet of paranoia. Socially anxious concerns and paranoid beliefs co-occur in adolescent and adult groups, but the specifics of their association is not well understood. In a general population adolescent sample, we examined (a) whether social anxiety and paranoia can be differentiated, (b) patterns of co-occurrence and (c) psychosocial factors that differentiate social anxiety alone versus in combination with paranoia. Methods: An online cross-sectional survey design, recruiting UK adolescents (n = 604, 14-17 years), via Qualtrics. Participants were quota sampled for equal distribution on age and gender. Results: Measurement models supported a hierarchical structure, with separate but correlated general factors of paranoia and social anxiety. This model was invariant across age groups 14-15 and 16-17 years. The largest subgroup of participants with clinically significant symptoms showed elevated social anxiety plus paranoia (21%, n = 124), followed by high social anxiety without paranoia (14%, n = 84). Paranoia without social anxiety occurred the least (7% n = 39). Subgroup comparisons suggested social anxiety plus paranoia was characterised by exposure to threating experiences (discrimination, bullying, adverse life events in the last 12-month), anxious attachment and high levels of distress, whereas social anxiety was more associated with feeling inferior to others, enhanced loneliness, avoidant attachment and a low sense of belonging. Conclusions: Social anxiety and paranoia are differentiable in adolescents. Paranoia commonly co-occurs with social anxiety, especially in those with exposure to threat environments in the last 12-month. Adolescents with social anxiety plus paranoia reported the highest levels of distress, underscoring the importance of improved understanding of this group.