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There are anecdotal clinical reports of fear of madness occurring in individuals with psychosis, but the topic has not been a focus of empirical scrutiny. The first aim of the study was to investigate whether fear of madness is present in individuals with persecutory delusions. The second aim was to investigate whether fear of madness is linked to paranoia: it was hypothesised that fear of madness is an anxious worry associated with more distressing persecutory experience. Twenty-five individuals with persecutory delusions were compared with 25 non-clinical individuals. The participants completed the newly developed Worries About Mental Health questionnaire and assessments of paranoia, anxiety and worry. It was found that the individuals with delusions reported significantly higher levels of anxiety, worry and fear of madness than the non-clinical control group. Importantly, in the clinical group higher levels of fear of madness were associated with higher levels of anxiety, worry and persecutory delusion distress. In summary, fear of madness may be a common concern in people with persecutory delusions that is a contributory cause of paranoia distress. Sensitively addressing the content of ideas about madness during interventions may therefore help reduce patient distress about persecutory delusions. © 2009 Taylor & Francis Group, LLC.

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