Social Problems Linked to Delusions in Adolescents

Social problems were related to subclinical delusions but not subclinical hallucinations in a representative adolescent population.

There is a bidirectional association between social problems and delusions in adolescents, according to research published in Acta Psychiatrica Scandinavica. This may indicate a downward negative spiral in which delusional thoughts and social problems reinforce one another.

In order to investigate the longitudinal relationship between subclinical psychotic symptoms and social functioning in adolescents, researchers collected data from a routine general health screening of 1909 adolescents in a circumscribed region of The Netherlands. Baseline measurements were acquired in the second grade of secondary school (age 13 to 14 years), and follow-up was conducted 2 years later (age 15 to 16 years). Both social functioning and subclinical psychotic symptoms were evaluated during each assessment using questions derived from the Diagnostic Interview Schedule for Children (DISC-C) 24 for DSM-III.

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Researchers found that baseline social problems preceded follow-up subclinical delusions and that delusions preceded social problems. However, they found no link between subclinical hallucinations and social problems. The lack of an association between hallucinations and social functioning indicate that the potential negative spiral of social problems and psychotic symptoms is unique to delusions.

The study included only a limited number of items to construct the symptom and social variables, which may have resulted in lowered sensitivity for detecting hallucinations.

This may be the first study to report a significant bidirectional relationship between social functioning and subclinical delusions in a general population of adolescents. Researchers stated, “This is highly relevant, as it highlights how social dysfunction might be a driving force behind the initial development and subsequent maintenance of delusions.”

“In order to foresee and potentially prevent the development of clinically relevant delusions, researchers and clinicians should be aware of this potential negative spiral [of delusions and social problems],” researchers concluded.


Heins M, Achterhof R, Collip D, et al. Social functioning and subclinical psychosis in adolescence: a longitudinal general adolescent population study [published online July 2, 2019]. doi:10.1111/acps.13069