title: The relevance of self-esteem and self-schemas to persecutory delusions: a systematic review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  We conclude by proposing an explanatory model of how self-esteem and PD interact from which we derive clinical implications.
authors.affiliation: Section for Clinical Psychology and Psychotherapy, Department of Psychology, Philipps Universität Marburg, Gutenbergstraße 18, 35032 Marburg, Germany. Electronic address: marieluise.kesting@gmx.de.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Kesting
authors.forename: Tania Marie
authors.initials: TM
authors.lastname: Lincoln
mesh_terms: D003702:Delusions / Q000523:psychology*; D006801:Humans; D008960:Models, Psychological; D010259:Paranoid Disorders / Q000523:psychology*; D012649:Self Concept