Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation

Abstract

Background and hypothesis: Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

Study design: In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter's Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

Study results: Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

Conclusions: These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.

Keywords: community sample; paranoia; psychosis; sleep quality; traumatic experiences.

Fig. 1

Design for path models. Note. Covariates: age, sex, intelligence, depression, and anxiety; included only in follow-up models.