Delusional distress is associated with global emotion dysregulation in schizophrenia-spectrum disorders

Background: The distressing nature of delusional beliefs is considered key to their persistence. One potential mechanism underlying delusional distress is global emotion dysregulation, which refers to a broad deficit in overall emotion regulation and emotional functioning. Global emotion dysregulation is associated with general psychotic symptom severity, but its specific relationship to delusional distress has yet to be closely examined. Methods: People with (n = 100) and without (n = 52) schizophrenia-spectrum disorders completed measures of delusional ideation (Peters Delusion Inventory; PDI-21) and global emotion dysregulation (Difficulties in Emotion Regulation Scale; DERS-16). Participants with schizophrenia also completed a measure of delusion severity (Psychotic Symptom Rating Scales; PSYRATS). Relationships between delusion severity and global emotion dysregulation were assessed with linear regression, controlling for age, sex, and group. Associations between delusional distress and specific aspects of emotion dysregulation were determined using stepwise linear regression. Results: Global emotion dysregulation was significantly elevated in those with schizophrenia compared to healthy comparison participants, across all subscales (p<.001). Global emotion dysregulation was significantly associated with delusional distress on both the PDI-21 (p<.001) and PSYRATS (p<.001). Stepwise regression revealed a specific association between limited access to emotion regulation strategies and delusional distress on both scales (p’s<.001). Delusional distress remained associated with emotion dysregulation when controlling for delusional preoccupation, and emotion dysregulation was not significantly associated with delusional conviction on either scale. Conclusions: Emotion dysregulation, particularly the sense that there is little one can do to regulate themselves when upset, relates to delusional distress. Interventions that increase access to more emotion regulation strategies may help decrease distress associated with delusional thinking.