Racial Disparities in the Expression of Paranoia

Paranoia, a core symptom of psychosis, is characterized by beliefs of being threatened, persecuted, or conspiratorially targeted. In contemporary psychological approaches, paranoia is defined as a dimensional and transdiagnostic construct existing on a continuum of severity throughout the population and conferring risk for negative outcomes including impairments in social functioning, well-being, and quality of life.

Despite its centrality in understanding the psychosis spectrum, including clinical conditions such as schizophrenia, paranoia is a construct vulnerable to various individual- and group-level influences. Social threats experienced by some groups may rightfully compel increased mistrust and suspiciousness of others. In fact, numerous cross-sectional investigations demonstrate that Black Americans consistently endorse higher levels of paranoia compared to their White counterparts, independent of clinical status. Furthermore, emerging evidence indicates a positive association between adverse experiences related to race and increased paranoia endorsements among Black Americans.

This project addresses the insufficient understanding of factors contributing to group differences in paranoia between Black and White Americans. Moreover, existing evidence linking adverse experiences related to race and heightened paranoia among Black Americans is correlational; possible causal pathways have not been examined through experimental means. This knowledge gap is significant because Black Americans endorse heightened traits and experiences associated with psychosis across the severity spectrum, ultimately leading to a three- to fourfold higher diagnostic rate of psychotic disorders compared to their White counterparts. Importantly, current assessment tools may systematically mischaracterize psychosis risk among Black Americans across this severity spectrum in both research and clinical practice, as they were not designed to account for the potential confounding impact of adverse experiences related to race on item endorsements among diverse respondents. Errors in measurement-which may stem from poor cultural sensitivity and be sustained by a paucity of knowledge of how social threats may impact the phenotypic expression of psychosis-have been implicated as one potential cause of the overrepresentation of Black Americans within psychotic disorder diagnoses. This theory is compatible with other potential mechanisms, including inequities in social determinants of health driving true increases in psychotic disorders among Black Americans. Consequently, there is a high likelihood that assessment tools systematically conflate culturally justified mistrust with psychopathological symptomology across this severity spectrum, making accurate assessment of paranoia among diverse respondents a pressing clinical concern. Accordingly, this project focuses on self-reported paranoia among Black and White adults in the general population.

The primary objective of this study is to experimentally test whether exposure to race-related adverse experiences results in acute increases in self-reported paranoia. Our first goal is to experimentally test the causal impact of adverse experiences related to race on paranoia among Black Americans by examining the extent to which paranoia can be increased following priming exposure to blatant and subtle adverse experiences related to race using a guided visual imagery paradigm. Study participants, comprising 480 Black American adults recruited from the community, will engage in a guided visual imagery task that involves actively envisioning scenarios presented via audiotape-an established method for priming race-related stressors in controlled experimental settings. Participants will be randomly assigned to one of three conditions: blatant adverse experience, subtle adverse experience, social exclusion, or neutral control. Primary outcomes include changes in self-reported paranoia following experimental exposure. It is hypothesized that priming adverse experiences related to race will drive significant increases in self-reported paranoia compared to the neutral control condition.

A secondary objective of this study is to identify individual-level risk and resilience factors that influence variability in experimentally induced changes in paranoia. A subsequent goal will identify risk and resilience factors that may influence the magnitude of the experimental effects observed in Goal 1. Using data collected within the same experimental framework, it is hypothesized that self-reported adverse experiences related to race, in addition to race and ethnicity, will moderate paranoia endorsements observed among Black Americans following experimental exposure to race-related adverse experiences.