Background Contemporary cognitive psychological theories suggest that distress plays a mediating role in delusion formation. Aims To study the amplifying role of distress from early perceptual intrusions to delusion formation. Method A general population sample of 7076 individuals was interviewed with the Composite International Diagnostic Interview (CIDI) in 1996 (baseline), 1997 (T1) and 1999 (T2). At T2, clinicians also scored the Brief Psychiatric Rating Scale (BPRS) itema€?unusual thought contenta€?. Analyses compared hallucinatory experiences with and without subjective distress at baseline for risk of delusion formation at follow-up. Results Individuals experiencing hallucinations with distress, compared with those without distress had a fourfold increased risk of subsequent delusion formation. Conclusions This finding corroborates the hypothesis that distress associated with early perceptual intrusions serves as a catalyst in the development of delusions.
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