VOL 6, NO. 4, 1980 Physical Anhedonia,Perceptual Aberration, andPsychosis Proneness

by Loren J. Chapman,William S. Edell, andJean P. Chapman

Abstract

Two groups of hypothetically psy-chosis-prone subjects were chosenfrom among college students whoscored deviantly high on scales ofPhysical Anhedonia (n = 50) orPerceptual Aberration (n = 65).Scores on these two scales had asmall negative correlation, indicatingthat the scales identify different setsof deviant subjects. These experi-mental subjects and a control group(n — 66) were interviewed using amodification of the Schedule for Af-fective Disorders and Schizo-phrenia—Lifetime Version. A secondinterview covered social andacademic adjustment. Psychotic andpsychotic-like symptoms (attenuatedforms of psychotic experiences) werescored on a recently devised scale ofdeviancy. The perceptual aberrationsubjects exceeded the control subjectson each of several psychotic-like ex-periences (auditory and visual ex-periences, thought transmission,passivity experiences, aberrantbeliefs), as well as on depression,hypomania, social withdrawal, prob-lems of concentration, deviancies incommunication and speech, and acomposite score for schizotypalfeatures. Anhedonics did not differfrom controls on psychotic-like ex-periences but were more sociallywithdrawn, had less heterosexual in-terest and activity, and scored higheron the composite score of schizotypalfeatures. The findings support thehypothesis that the scales identifypersons who are at risk for psychosisbut probably for different psychoses.

Numerous writers have describedtraits and symptoms that are believedto characterize persons who are atelevated risk for psychosis. In par-ticular, these descriptions have usu-ally been offered for persons at risk

for schizophrenia, and have beenbased on several different sources ofdata. These include case histories ofschizophrenics, retrospective studiesof premorbid school or clinic recordsof persons who later became schizo-phrenic, studies of persons who ap-pear clinically to be schizophrenic-like, clinical reports of the symptomsof very early schizophrenia, andstudies of relatives of schizophrenicpatients. It should be possible tomeasure the traits described in thisliterature and to use these measuresto predict possible future psychosis.

Traits and symptoms that havebeen prominently implicated includeperceptual distortion, especially inrelation to one's own body (Fenichel1945; Meehl 1964; Frosch 1970),anhedonia (Rado 1956, 1962;Schmideberg 1959; Meehl 1964,1973), emotional ambivalence (By-chowski 1957; Hoch and Cattell 1959;Schmideberg 1959; Meehl 1964,1973), social isolation and avoidanceof other people (Wittman and Stein-berg 1944; Friedlander 1945; Meehl1964, 1973; Nameche, Waring, andRicks 1964), mild thought disorder(Hoch and Cattell 1959; Singer andWynne 1966; Meehl 1964, 1973),transient or isolated psychotic symp-toms (Frosch 1964; Kety et al. 1968;Chessick 1971; Adler 1973), and anti-social behavior (Kraepelin 1919;Kallmann 1938; Dunaif and Hoch1955; O'Neal and Robins 1958;Heston 1966; Planansky 1972; Watt1972, 1974; Roff, Knight, and Wert-heim 1976).

The present study is an examina-tion of college students who scorehigh on measures of two of thesetraits, physical anhedonia and per-

Reprint requests should be sent to Dr.Chapman at Department of Psychology,University of Wisconsin, 1202 W. JohnsonSt., Madison, WI 53706.

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ceptual aberration. Its purpose is todetermine if such persons have othercharacteristics that one might expectin the psychosis-prone.

Earlier Attempts to MeasurePersonality Traits of thePsychosis-Prone

There have been several previous at-tempts to measure personality traitswhich indicate a predisposition to-ward psychosis.

The MMPI as a Measure of Schizo-phrenia Proneness. Gilberstadt andDuker (1965) reported, on the basisof study of psychiatric hospital rec-ords, that patients who have a 2-7-8profile on the Minnesota MultiphasicPersonality Inventory (MMPI), thatis, have elevated scores on Scale 2(Depression), Scale 7 (Psychasthenia),and Scale 8 (Schizophrenia), are mostoften either pseudoneurotic schizo-phrenic or chronic schizophrenic.Peterson (1954) found that 2-7-8 pro-files were correlated with the laterdevelopment of schizophrenia in non-psychotic patients. Fine (1973) inter-viewed college students with a 2-7-8profile and formed a clinical impres-sion that half of them were nonpsy-chotic schizophrenics, although hedid not have that impression of col-lege students who scored in the nor-mal range on the MMPI. Koh andPeterson (1974), Schulman (1976),and Sterenko and Woods (1978)found various cognitive abnormalitiesin college students with 2-7-8 profiles.

The Eysenck Psychotidsm Scale. Thelargest prior attempt to measure thepredisposition toward psychosis hasbeen the research on psychotidsm byEysenck's group (Eysenck and Ey-serick 1975, 1976). The Eysenck Psy-choticism Scale consists largely ofitems that appear to tap noncon-

formity and antisodal attitudes,paranoid traits, and mildly sadisticimpulses. High-psychoticism subjectswere found to be less accurate indiscriminating light flashes, to scorelower on scholastic achievement, andto be overinclusive in listing ad-jectives that apply to a noun. Thesedeviandes are not compelling as char-acteristics of the psychosis-prone.Bishop (1977) has argued that thescale does not measure psychosisproneness, pointing out that manyother groups score higher on the scalethan do schizophrenics. Such groupsinclude art students, alcoholics,prison inmates, drug addicts, and pa-tients with personality disorders.Bishop also pointed out that peoplewho are high on the scale lack char-acteristics that one would expect ofsubjects truly prone to psychosis. Forexample, high-psychoticism subjectsare faster than control subjects on areaction time task, rather thanslower, like schizophrenics.

The Schizophrenism Scale. Nielsenand Peterson (1976) developed a14-item scale based on the earlysymptoms of schizophrenia, espe-rially symptoms of attentional dys-function and social withdrawal. Theyfound that undergraduates who werehigh on their scale showed abnormalpatterns of electrodermal reactivityresembling those that Mednick andSchulsinger (1968) found in thosechildren of schizophrenic motherswho, like their mothers, became psy-chiatrically disturbed.

The Present Approach

The present approach differs fromearlier ones because it is based on theassumption that schizophrenia isprobably more than one disorder.This research began as an attemptboth to measure proneness toward

schizophrenia and to distinguishproneness toward different varietiesof disorder within schizophrenia. Ini-tially, a broad definition of schizo-phrenia was used. Because DSM-III(American Psychiatric Assodation1980) narrows the definition ofschizophrenia and places some pa-tients formerly called schizophrenicinto other categories of psychosis, wehave now restated the goal of ourproject as measuring pronenesstoward psychosis, and as differ-entiating among psychotic disorders.The identification of the psychosis-prone and the study of theircharacteristics should facilitate thesearch for distinct psychoses, becausedifferent disorders should have dif-ferent precursors.

This goal of identifying pronenesstoward different psychoses should notbe interpreted as that of differentiat-ing proneness toward the variouspsychoses of DSM-III, that is, schizo-phrenia, affective disorder, schizo-affective disorder, schizophrenifonmdisorder, paranoid disorder, briefreactive psychosis, and atypicalpsychosis. The new DSM-IIIdiagnostic categories for psychosisadvance nosology by attempting todescribe more homogeneous groupsof patients. However, further modi-fications will surely occur aspsychosis becomes better understood.Thus, attainment of the goal of dif-ferentiating proneness toward dif-ferent psychoses would probablymean finding other diagnostic cate-gories. Finding such disorders mightbe easier among psychosis-prone sub-jects than among clinical psychoticsbecause the symptoms are lessclouded by drug effects, hospitaliza-tion effects, and the massive disrup-tions of psychosis. We seek syn-dromes of psychosis-proneness bymeasuring various symptoms andtraits that have been reported tocharacterize the psychosis-prone.

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The Scales for PhysicalAnhedonla and PerceptualAberration

Chapman, Chapman, and Raulin(1976, 1978) have previously reportedthe development of scales for physicalanhedonia and for perceptual aberra-tion. Both scales were developed withan emphasis on internal consistencyand on as low as possible a correla-tion with independent measures ofsocial desirability and acquiescence.Illustrative items for physical an-hedonia are "On seeing a soft, thickcarpet, 1 have sometimes had the im-pulse to take off my shoes and walkbarefoot on it" (keyed false) and "Sexis OK but not as much fun as mostpeople claim it is" (keyed true). ThePerceptual Aberration Scale consistslargely of items designed to tap majordistortions in the perception of one'sown body. Illustrative items for per-ceptual aberration are "I have neverfelt that my arms or legs havemomentarily grown in size" (keyedfalse), and "Occasionally it hasseemed as if my body had taken onthe appearance of another person'sbody" (keyed true).

The original Physical AnhedoniaScale consisted of 40 items. To in-crease reliability, Chapman andChapman (1978) lengthened the scaleto 61 items. Heterosexual items weredropped so that the scale would beequally applicable to homosexual andheterosexual subjects.

Test-retest reliability with 12 weeksbetween the first and second testingwas computed for 178 male and 333female students. The reliability of thePhysical Anhedonia Scale was .78 forthe male group and .79 for the femalegroup. The reliability of the Per-ceptual Aberration Scale was .75 formales and .76 for females.

Although schizophrenics, as agroup, score higher than normal sub-jects on both scales, not all schizo-

phrenics are deviant on either one.Poor premorbid schizophrenics aremore often anhedonic than good pre-morbid, and tend to be more oftenperceptually aberrant than goodpremorbid schizophrenics. Whenthese two scales are both scored inthe pathology direction, they cor-relate slightly in the negative direc-tion in large samples of collegestudents. This is surprising, given thefact that any acquiescence or socialdesirability bias in the scales wouldtend to produce a positive correla-tion, as would generalizedpsychopathology. Thus, if these twoscales identify psychosis-prone sub-jects, they may identify differentkinds of psychosis proneness, pos-sibly corresponding to differentpotential psychoses.

Earlier research in our laboratoryhas indicated that subjects high onphysical anhedonia and on perceptualaberration have some characteristicsthat are expected in the psychosis-prone. Edell and Chapman (1979)found that both of these groupssharply exceed control subjects inschizophrenic-like thought disorderon the Rorschach Test. Haberman etal. (1979) found that anhedonic sub-jects are poorer than control subjectson social skill as measured by a role-playing task. The present researchused interviews to extend and clarifythe description of the deviancies ofthese subjects.

Method

The Perceptual Aberration Scale andPhysical Anhedonia Scale were ad-ministered to 1,209 male and 1,367female college students as part of alarger battery of true-false paper-and-pencil measures. The mean perceptualaberration score was 5.96(SD = 5.8) for males, and 7.35(SD = 6.6) for females. Coefficientalpha (Kuder-Richardson Formula 20)

estimate of reliability was .89 formales and .91 for females.

The mean physical anhedonia scorewas 12.93 (SD = 6.2) for males, and8.96 (SD = 5.2) for females, with acoefficient alpha value of .79 formales and .78 for females. The twoscales correlated — .19 for males and— .09 for females.

Subjects were selected for furtherstudy on the basis of their scores.Subjects were labeled as high onphysical anhedonia or high onperceptual aberration if they scoredat least two standard deviationsabove the mean on one of the scales.Because of skewed distributions, 5.2percent of the subjects scored thishigh on perceptual aberration and 4.4percent on physical anhedonia. Only2 of the 2,576 subjects scored de-viantly on both scales, and these sub-jects were not included in the inter-view sample. Subjects were desig-nated as control subjects if theyscored no higher than one-half a stan-dard deviation above the mean oneither of the two scales.

Altogether, 181 subjects were seen.These included 50 anhedonics (29male, 21 female), 65 perceptual aber-ration subjects (35 male, 30 female),and 66 control subjects (35 male, 31female). The three groups werematched on distribution of academicyear: 50 percent freshman, 35 percentsophomore, and the remainder junioror senior. The sample was limitedto white subjects because our scaleshad been standardized using a pri-marily white group.

Interview Procedures. Subjects weretelephoned and invited to participatein an interview concerning variablesrelated to college adjustment. Extracredit in their course and/or moneywere used as inducements. Almost allthose invited did participate, al-though we observed, anecdotally,that perceptual aberration subjects

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often missed their first appointments.The interviewers were two advancedgraduate students, both of whom hadconsiderable clinical experience. Theywere trained in use of the Schedulefor Affective Disorders and Schizo-phrenia—Lifetime Version (SADS-L)interview. The callers, interviewers,and scorers of the interviews wereblind as to group membership.

Structured interview procedureswere used. For inquiry into symp-toms, parts of Spitzer and Endicott's(1977) SADS-L were used. TheSADS-L sections that were used in-vestigate schizophrenia, major andminor depressive symptoms, manicand hypomanic symptoms, andschizotypal features. Drug experienceswere inquired after, as well as thepossible relationship of each symp-tom of psychopathology to drugusage, in order to avoid scoring drugexperiences and flashback ex-periences. The groups were almostidentical on reported history of use ofmarijuana. The perceptual aberrationsubjects showed a tendency towardgreater use of other drugs, but noneof the statistical comparisons yieldeda significant difference.

A second interview consisted ofquestions that dealt with social ad-justment, heterosexual interests,academic problems, distractibility,and difficulty in concentrating. Bothinterviews were tape recorded tofacilitate reliable rating of symptoms.

The Evaluation of Psychotic and Psy-chotic-like Experiences as Continua.Systems for diagnosing individuals aspsychotic rely on either/or judgmentsconcerning the presence or absence ofa given symptom, and only very de-viant symptoms are judged to be psy-chotic. The subjects in the presentstudy were not full-blown psychotics,although many of them reportedeither isolated psychotic experiences

or experiences that might be called"psychotic-like." A dichotomousjudgment of presence or absence ofpsychotic symptoms would overlookmost of the rich pathology of thesesubjects. In order to score these psy-chotic-like experiences, Chapman andChapman (1980) constructed a ratingmanual. It provides rating values fordegree of deviancy of 80 such psy-chotic-like types of experience. These80 types of deviant experiences fallinto six classes or continua, each ofwhich is represented by a scale.

Ratings of deviancy can range from1 to 11 for each scale. The ratingvalues provided by the manual arethe median of the ratings suggestedby six schizophrenia researchers. Themanual provides descriptions, -oftenwith examples, of experiences that fitthe various rating scores. The 11- and10-point ratings are for symptoms ofa psychotic degree of deviancy, thatis, symptoms that are similar to thoseexperiences reported by clinicalpsychotics. Scores from 9 to 6 are forsymptoms that are judged to be ofpsychotic degree but are less severethan those earning a score of 10. Thenonpsychotic symptoms range from 5(not psychotic but very psychotic-like) to 2 (slightly deviant in a psy-chotic-like direction).

The description of the six ratingscales must be very brief here. Amore detailed presentation is found inChapman and Chapman (1980).

1. Experiences of transmission ofone's own thoughts (14 items) rangefrom the subject's active experience ofthoughts leaving his head so thateveryone in the area can hear histhoughts through their ears (score of10) to the suspicion that one or twopeople who know him well can readhis mind when he is physically withthem (score of 2). A midrange ex-ample is a subject's experience of sus-pecting (but not firmly believing) that

strangers whom she passes on thestreet can read her mind and knowher bad thoughts (scored "5").

2. Passivity experiences (16 items)range from the subject's belief thatanother person or force other thanGod, or the devil, or an angel orspirits, seized control of his body ormind to think ideas, or to feel feel-ings, or to act (score of 10), to thesuspicion that God gave him thoughtsor feelings or forced him to act, feel,or think, but in a socially acceptableway (scores of 2 to 4). A midrangeexample is a subject's experience ofsuspecting (but not firmly believing)that other people put thoughts intohis head at a distance (scored "5").

3. Voice experiences and otherauditory hallucinations (24 items)range from a hallucinatory outervoice that recites a running commen-tary on the subject's behavior (scoreof 10) to the subject's hearing thevoice of his conscience as an innervoice (score of 3). A midrange ex-ample is a subject's experience ofhearing her deceased grandfatherspeak as an inner voice, and believingthat her grandfather is truly com-municating with her (score "6").

4. Thought withdrawal (6 items)ranges from the subject's active ex-perience of another person or being,other than God, snatching histhoughts away (score of 10) to hissuspicion that God took his thoughtsaway (score of 2 to 4). A midrangeexample is a subject's frequent ex-perience of his mind going blank andhis thinking that someone else maybe stealing his thoughts away (scored"6").

5. Other personally relevant aber-rant beliefs (8 items) range frombizarre delusional beliefs (score of 10)to nonbizarre ideas of reference, ormistaken ideas of mistreatment or ofbeing observed (score of 4). A mid-range example is the report of a

VOL 6, NO. 4, 1980 643

young man who, for 3 months afterarriving in a new town, believedthat strangers on the street were star-ing at him (scored "5").

6. Visual experiences (12 items)range from seeing external hallucina-tory objects for longer than a mo-ment when not resting or meditatingand believing the experience was veri-dical (score of 8) to hypnogogichallucinations or illusions which thesubject did not later suspect as beingveridical (score of 2). A midrange ex-ample is a person's claim that heusually sees "auras" around otherpeople (scored "4").

The rating values provided by themanual for each of the 80 types ofexperience are modal values. Therater is permitted to rate 1 pointhigher or 1 point lower than thismodal value to recognize either ex-ceptionally severe or exceptionallymild deviancy of the type describedin the item. Such variations in de-viancy are judged by bizarreness ofcontent, amount of time preoccupiedwith the experience, frequency andduration of the experience, as well asdegree of cultural support for the ex-perience. Many items require evalua-tion of whether the subject believes inor merely suspects the validity of anexperience. Belief is evaluated for thetime of the experience, rather thanthe time of the interview. In addition,some experiences, especially thosewith religious content, can receiveone of a range of scores, with thevalue assigned depending on the ex-tent of subcultural support for the ex-perience.

Only experiences that are reportedas occurring after the 13th birthdayare scored, to avoid the problems ofscoring children's fantasies on de-viancy. Differences in frequency ofexperience are scored by the 1-pointraising or lowering of score for ex-ceptionally severe or exceptionally

mild deviancy. A subject who hasmultiple experiences of one type isscored only once, and receives thescore of the most deviant of those ex-periences. An experience that couldqualify for a score on either of twoor more scales is scored only on theone on which it qualifies for thehigher score. Experiences which oc-curred only while the subject was ondrugs, or which appear to be flash-back experiences, are not scored.

It is important to note that ratingan experience as psychotic in this sys-tem does not mean that the personreporting the symptom can be con-sidered to be clinically psychotic. In-stead, he is merely judged to havehad an experience of the kind thatcharacterizes clinical psychotics.A person may function fairly ade-quately in most aspects of living des-pite occasional or isolated psychoticsymptoms.

As previously reported (Chapmanand Chapman 1980), two studieswere done on the reliability of ratingsof interviews using the scales. Thesenior author and a second experi-enced clinician each rated 14 inter-view excerpts and obtained a correla-tion value of .81. In a secondcomparison the senior author and agraduate student rated 69 interviewexcerpts and obtained a correlationvalue of .78.

Results

The results for the two sexes were es-sentially the same, and so the maleand female subjects were combinedfor purposes of the analyses. To testdifferences between experimental andcontrol groups on number of subjectsshowing a symptom, chi-square wasused except when the expectednumber of subjects in a cell was lessthan five. In that case, the Fisher-Yates Exact Test was used. To com-

pare the experimental group with thecontrol group on continuous vari-ables, t tests were used except whenthe data were extremely skewed. Inthat case, a Mann-Whitney U-Testwas used. Two-tailed tests were usedthroughout. For each symptom, twoplanned comparisons were made, thatis, each experimental group was com-pared with the control group.

Psychotic and Psychotic-like Ex-periences. The perceptual aberrationsubjects reported many more psy-chotic (ratings of 6 to 10) andpsychotic-like (ratings of 2 to 5) ex-periences than the control subjects,while the anhedonic subjects did notdiffer significantly from the controlsubjects. Table 1 lists the percentageof each group who earned a score ofeither psychotic or psychotic-like de-viancy on each of the six scales.When the six scales were combined,32 percent of the anhedonic, 69 per-cent of the perceptual aberration, and23 percent of the control subjects re-ported an experience judged eitherpsychotic or psychotic-like. An ex-perience in the psychotic range wasreported by 2 percent of the an-hedonics, 17 percent of the perceptualaberration, and 2 percent of the con-trol subjects. In a group comparison,the perceptual aberration subjectswere found to exceed the control sub-jects, both on number of subjectswho reported psychotic experiences,X2 °* 7.58, p < .01, and on numberof subjects who reported eitherpsychotic or psychotic-like ex-periences, x2 =• 26.69, p < .001.

The perceptual aberration subjectswere found to exceed the control sub-jects on five of the six scales con-sidered separately. In reporting thesedata, we will list the percentage ofsubjects in each group who reportedeach type experience. (The chi-squareanalyses and Fisher-Yates exact tests

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Table 1. Percentage of subjects reporting psychotic and psychotic-like experiencesfor each class of symptoms1

Group

AnhedonicPerceptual

aberrationControl

Transmissionof one's

own thoughts

16%

25% (2%)6% (2%)

Passivityexperiences

6% (2%)

28% (9%)3%

Voiceexperiences

and otherauditory

hallucinations

16%

5 1 % (6%)15%

Thoughtwithdrawal

0%

3%0%

Otherpersonally

relevantaberrant beliefs

12%

32% (5%)5%

Visualexperiences

4%

11%0%

1The first percentage In each entry la the total percentage of subjects reporting such symptoms. The second number Is the percentage of subjectsreporting the symptom of psychotic degree (rating of 6 or higher).

were, however, computed on the rawfrequency data.) We will also brieflysummarize the nature of each deviantexperience.

Transmission of thoughts (16 per-cent of the anhedonic, 25 percent ofthe perceptual aberration, and 6 per-cent of the control subjects). The per-ceptual aberration group exceeded thecontrol group on mean deviancyscore, t = 2.89, p < .01. (In thiscomputation, and other such t testsreported here, subjects who did notreport a deviant experience of thetype were given a score of zero.) Oneperceptual aberration subject reportedthat it once seemed to him that histhoughts were echoing around theroom at his place of work, althoughhe realized at the time that it couldnot be so (score of 6). Four othersreported having directly experienced,with varying degrees of conviction,that other people could either hear,or see, or receive their thoughts, andat the time of the experience felt anx-ious lest other people learn theirthoughts (score of 5). Eight other per-ceptual aberration subjects reportedthe belief that they transmit thoughtswhich various other people receive,but concluded this from the fact thatother people knew what they were

thinking rather than by any direct ex-perience of their thoughts leavingtheir heads (scores of 4 or 5). Threeother subjects reported that closefriends received their thoughts on oc-casion (scores of 2, 3, or 4).

Among the anhedonic subjects,two subjects reported having had thesuspicion, based on experience withtheir thoughts, that other peoplemight read their thoughts or receivetheir thoughts by thought transmis-sion (score of 5). One subject con-cluded with certainty, from otherpeople's reports, that others couldreceive her thoughts at a distance(score of 5). Five subjects reportedhaving drawn the conclusion thatsomeone physically near receivedtheir thoughts (scores of 2, 3, or 4).

One control subject reported theactive experience of other peoplereceiving her thoughts by directtransfer to their brains (score of 8).One reported a fear that this mighthappen when she was thinking badthoughts (score of 4), and two sub-jects reported that a close friendsometimes received their thoughtswhen the friend was physically pres-ent (scores of 3 and 4).

Passivity experiences (6 percent ofthe anhedonic, 28 percent of the

perceptual aberration, and 3 percentof the control subjects). The percep-tual aberration group exceeded thecontrol group on mean deviancyscore, f = 4.56, p < .001. The ex-periences of the perceptual aberrationgroup were fairly varied. Fourreported the belief or suspicion thatthoughts or songs or feelings werefrequently put into their heads (scoresof 6 to 9). The experience wasvariously attributed to a mechanicaldevice, spirit possession, unknownpeople, and alien creatures fromanother planet. Six of the subjectsrelated experiences of passiveautomatic behavior or robot-likebehavior, and explained the ex-perience, with varying degrees ofconviction, by an external agent thatwas taking control of them (scores of3 to 8). Three of those six believedthat the external agent was God. Onethought it was either God or thedevil, and two had not identified theagent. Four other perceptual aberra-tion subjects drew a conclusion of ex-ternal influence from the experienceof having thoughts or feelings thatseemed not to be their own (scores of3 to 5). These three subjects variouslyidentified the agents as a secret friendat a distance, psychic energies, and

VOL 6, NO. 4, 1980 645

Satan. Two others attributed theirbad, hostile, or alien thoughts tosocial influences which they believedthey must have undergone withoutfull awareness (score of 2).

Three anhedonic subjects reportedhaving had beliefs or feelings thatthey were controlled by someone elsewho was not physically present(scores of 2, 4, and 6). One im-plicated both God and Satan, anothernamed her own mother, while an-other could not suggest the source.

One control subject suspected thatGod and Satan put thoughts into hishead (score of 3). Another subjectbelieved that his violent thoughtswere not his own, but he did not ac-count for their origin (score of 3).

Voice experiences and other audi-tory hallucinations (16 percent ofthe anhedonic, 51 percent of the per-ceptual aberration, and 15 percent ofthe control subjects). The perceptualaberration group exceeded the controlgroup on mean deviancy score, t =5.32, p < .001. Most of the voice ex-periences and all those describedbelow were inner voices, unlessotherwise specified. Inner voice ex-periences appear to be on a con-tinuum with thinking, and thedistinction between them may besomewhat arbitrary. In the presentstudy, an experience was not scoredas an inner voice unless the subjectstated that it was more like a voicethan like thoughts and unless hecould distinguish this kind of ex-perience from his usual thoughts.

Six perceptual aberration subjectsreported frequently hearing an innervoice give a running commentary ontheir behavior as it occurred (score of5 to 7). The voice was never the sub-ject's own. One subject attributed thevoice to a second person living insidehim, another attributed it to God,and four subjects could not identifyit. For one subject, the voice was

sometimes an outer voice and the restwere inner voices. Surprisingly, threeof the six subjects spontaneouslylikened the experience to hearing thedescription by a sports announcer ata football game. Four of the six sub-jects also reported hearing other innervoices from time to time, includingone subject who heard his good andbad angel, and another who heardthe voice of an alien creature fromanother planet.

Among other perceptual aberrationsubjects, one reported hearing, as aninner voice, people talking at adistance (score of 8), another re-ported the voice of an acquaintancespeaking critical comments (score of8), another reported hearing the voiceof God instructing her (score of 4).Five subjects reported hearing two ormore voices as inner voices (scores of5 or 6), in each case discussing thepros and cons of aspects of the sub-ject's behavior. These pairs of voicesinclude those of two deceased rel-atives, unknown persons (reported bytwo subjects), one unknown persontalking with the subject's own voice,and the subject's father talking withthe subject's friend.

Fourteen other perceptual aber-ration subjects reported hearing theirown voices as an inner voice (scoresof 3 to 5). In 11 cases the voice wascritical or a voice of conscience, andin the other three cases it gave adviceor recited useful material. Two ormore subjects heard an unidentifiedperson's voice as the voice of con-science (scores of 3 and 5). In twocases the subject reported hearing hisname called as an outer voice two orthree times over a few minutes (scoreof 5). Another heard outer musicwhich he discovered was not there(score of 5).

One anhedonic subject reportedthat he heard his own voice recit-ing a running commentary on his

behavior (score of 5), and sometimesheard two voices, both his own,argue about his behavior (score of 5).A second anhedonic subject heardtwo voices, again both his own,discussing his behavior (score of 5).Six others occasionally have other ex-periences of hearing their own voices(scores of 3 or 4). For three of thesesubjects the voice gives advice or en-couragement, and for the other threethe voice is more one of conscience.

Among the control subjects, oneheard his own voice give a runningcommentary from time to time (scoreof 5). Another heard two voices,both his own, talk to one another onthe two sides of an issue of con-science (score of 5). Two control sub-jects sometimes heard the voice ofGod as an inner voice (score of 4 and5), and one of these suspected that hesometimes heard the voice of Satanas well. Six other control subjectsreported hearing their own voices aseither a voice of conscience or givingadvice (score of 3).

Because this voice of conscience ex-perience was so common among ourcontrol subjects, we reduced its de-viancy rating to "2" in the ratingmanual for general use (Chapmanand Chapman 1980). In the presentanalysis we retained the "3" rating,the modal suggestion of our originalsix judges, to avoid any circularity offinding.

Thought withdrawal (no anhe-donic, 3 percent of the perceptualaberration, and no control subjects).One perceptual aberration subjectreported that his thoughts often dis-appeared mysteriously, and he wasuncertain whether some person orother external force was taking themaway (score of 5). A second subjectreported that God takes his badthoughts away (score of 3).

Aberrant beliefs (12 percent of theanhedonic, 32 percent of the percep-

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tual aberration, and 5 percent of thecontrol subjects). The perceptualaberration group exceeded the controlgroup on mean deviancy score, t =4.53, p < .001. A number of deviantbeliefs were not scored here becausethey were a feature of experienceswhich could be scored on other scaleson which the experiences receivedhigher scores, such as the scales forpassivity experiences and transmissionof thoughts.

Among the perceptual aberrationsubjects, the deviant beliefs whichwere scored include a belief in hyp-notic influence by people whom thesubject meets (score of 7), anelaborate personal theory by whichthe subject explains his out-of-bodyexperiences (score of 5), a belief thatother people control his verbal be-havior by dropping odd words inconversation (score of 8), and a beliefthat the entire world is an artificialarrangement that is constructed inorder to test the subject for his reac-tions (score of 10). Two subjectsoften believe that strangers are talk-ing about them (score of 5), and oneof these feels that the lecturer in hisclasses is speaking only to him andthat everyone in the class knows it(score of 5). Another subject hasunusually strong beliefs in his ownpsychic powers, which include bothextrasensory perception and precogni-tion (score of 4). Fourteen subjectsreported that they frequently havethe experience of believing incorrectlyfor hours or days at a time that otherpeople are either talking about themor watching them or laughing at themor are out to get them (scores of 3or 4).

Six anhedonic subjects reportedthat they sometimes have themistaken belief that other people aretalking about them or persecutingthem (score of 4).

One control subject reported thatshe worries about whether other peo-

ple may be figments of her imagina-tion (score of 5). Two other subjectsreported having the mistaken beliefthat other people are talking aboutthem (scores of 3 and 4).

Visual experiences (4 percent ofthe anhedonic, 11 percent of the per-ceptual aberration, and no controlsubjects). The perceptual aberrationgroup exceeded the control group onmean deviancy score, f = 2.56,p < .02.

One perceptual aberration subjectreported very brief hallucinations ofpeople (score of 5). Another oftensees animals from the comer of hereye and then realizes they are notthere (score of 2). Two subjectsreported hypnopompic hallucinationsof people; one subject tends tobelieve that these are spirits (score of5), while the other never believes inthe validity of the experience (scoreof 2). Another subject hallucinatescolors including auras around people(score of 4). Two subjects reportedthe experience of looking in a mirrorand finding that the image does notappear to be oneself (scores of 2 and3). One of these two subjects also hashypnopompic hallucinations (score of2) as well as illusions while awake inwhich she misperceives shadows asthreatening people (score of 3).

One anhedonic subject sometimesbriefly hallucinates animals and peo-ple and then realizes they are notthere (score of 3). Another subjectreported hypnopompic visions whichhe believed were valid (score of 5).

Other Schizotypal Symptoms. The in-terviews yielded information on otherschizotypal symptoms that were notincluded in the ratings of psychotic-like symptoms. (This Hst of schizo-typal symptoms is taken in part fromthe SADS-L, and in part from thelists of Meehl, 1964, and of Hoch andCattell, 1959.)

Depersonalization (4 percent of the

anhedonic, 36 percent of the per-ceptual aberration, and 8 percent ofthe control subjects). The perceptualaberration subjects exceeded the con-trols, x2 = 13.46, p < .001. The ex-perience was usually that some partof the body sometimes seems not tobe one's own, or acts on its own, orseems detached from the rest of thebody, or seems not to be there, ortakes on an unusual appearance. Twoperceptual aberration subjects re-ported experiences of feeling that theyare someone else. The high numberof perceptual aberration subjects whoreport body misperceptions is notsurprising, since most of the items inthe Perceptual Aberration Scale weredesigned to tap this kind of experi-ence.

Derealization (4 percent of the an-hedonic, 11 percent of the perceptualaberration, and 2 percent of the con-trol subjects). The perceptual aber-ration subjects exceeded the controlsubjects, exact test, p = .03. This isusually the report that one's sur-roundings on occasion seem unreal ordream-like or very different fromusual, or like a specific other en-vironment, or that people seem some-times strange or robot-like.

Ideas of reference, extreme sus-piciousness, and paranoid ideation(12 percent of the anhedonic, 28 per-cent of the perceptual aberration, and3 percent of the control subjects).The perceptual aberration subjects ex-ceeded the controls, x2 = 13.55, p <.001. These deviant ideas were in-cluded under deviant beliefs, butwere scored separately here becausethe SADS-L treats them as schizo-typal.

Out-of-body experiences (6 percentof the anhedonic, 37 percent of theperceptual aberration, and 3 percentof the control subjects). The percep-tual aberration subjects exceeded thecontrol subjects, x2 = 21.56, p <.001. Subjects who had this symptom

VOL 6, NO. 4, 1980 647

reported two different kinds ofexperiences and both kinds were in-cluded in this analysis. Eight percep-tual aberration subjects (but none ofthe other subjects) reported that theysometimes leave their bodies andobserve their bodies from anotherpoint in space, usually from above.For five of them this occurs whenfalling asleep or awakening or whileresting. For three others it occurswhile engaged in other activites.

The remaining subjects who feelthat they leave their bodies do notobserve their bodies from anotherpoint in physical space, but either ex-perience their minds and bodies in theact of separating from one another orfeel that their bodies act without par-ticipation of the mind.

Feeling physically cut off fromother people (6 percent of the an-hedonic, 12 percent of the perceptualaberration, and 5 percent of the con-trol subjects). The difference betweenperceptual aberration and controlsubjects fell short of significance,X2 "• 1.66, NS. This experience is oneof feeling a sharp separation and iso-lation from other people who are ac-tually present. The experience wasreported as usually occurring at socialgatherings and is sometimes accom-panied by the feeling that other peo-ple are not real.

Dissociative episodes (4 percent ofthe anhedonic, 5 percent of theperceptual aberration, and no controlsubjects). None of the differenceswere significant. One perceptual aber-ration subject reported episodes of"blanking out." Another often findshimself in places where he does notremember going, and a third said thathe often believes for a few minutesthat he is in a different place than hereally is. One anhedonic subjectreports that she often loses touchwith where she is, and a second saidhe often finds himself in class withoutremembering how he got there.

Complaints of difficulty concentrat-ing. This report was rated on a3-point scale, with a score of 1 in-dicating that the subject finds it hardto concentrate and a score of 3 in-dicating that the subject finds it easyto concentrate. The mean ratingswere anhedonic, 2.16, perceptualaberration 1.83, and control 2.23.The perceptual aberration group re-ported greater difficulty in concen-trating than the control group,t - 2.98, p < .01.

Complaints of speech being mixedup. These reports of symptoms wererated on a 4-point scale of none,mild, moderate, and severe. Subjectsreporting moderate or severe de-viancy were 34 percent of the an-hedonics, 55 percent of the perceptualaberration, and 20 percent of the con-trol subjects. On a score of mean de-viancy, the perceptual aberration sub-jects exceeded the control subjects(t = 4.10, p < .001). These reportsconsisted most often of the complaintby the subject that he often fails toput words together so as to makesense. In addition, two perceptualaberration subjects said that they usewords with different meanings thanother people. Two other perceptualaberration subjects characterized theirown use of words as sometimes"weird," and another said that shemixes up syllables and first letters ofwords.

Deviant vocalization (16 percentof the anhedonic, 28 percent of theperceptual aberration, and 8 percentof the control subjects). The dif-ference between perceptual aberrationand control subjects was significant,X2 - 7.82, p < .01. This consists ofcomplaints of unclear or distortedsounds (8 percent of the anhedonic,12 percent of the perceptual aberra-tion, and no control subjects),garbled words (4 percent of theanhedonic, 5 percent of the percep-tual aberration, and no control sub-

jects), speaking too fast (2 percent ofthe anhedonic, 5 percent of theperceptual aberration, and 3 percentof the control subjects), speaking toosoftly (4 percent of the anhedonic, 5percent of the perceptual aberration,and 2 percent of the control subjects),mumbling (6 percent of the an-hedonic, 9 percent of the percep-tual aberration, and 3 percent of thecontrol subjects), and stammering (0percent of the anhedonic, 3 percentof the perceptual aberration, and 2percent of the control subjects).

Odd communication (4 percent ofthe anhedonic, 11 percent of the per-ceptual aberration, and no controlsubjects). The perceptual aberrationsubjects were more often judged oddin their communication than the con-trol subjects, exact test, p — .007.This score is for odd communicationas observed by the examiner, ratherthan as reported by the subject. Wedid not use a formal scoring schemefor this variable, but instead merelyasked the examiners to note any sub-jects whose communications werequite odd.

The perceptual aberration subjectsshowed several kinds of odd com-munication which resemble the moreseverely disordered schizophrenicspeech. They used odd phrases andvague forms of expression, whichoften leave the listener feeling that hemight be able to grasp the meaning ifhe could listen more closely. Onesubject said "\ would say the real iswhat exists and there's no way wecould come upon talking about whatexists." For some subjects, theidiosyncratic expression appeared tohave persona] meaning centered ontheir own experiences. One subjectused the word "silence" to refer tothe feeling of separation from otherpeople who are physically present, asin "\ can remember I had all thissilence," and "The silence will keeppeople away from me." Sometimes

648 SCHIZOPHRENIA BULLETIN

the unusual expressions have a stiltedquality, as in the subject who, indescribing his own problems of com-munication, said 'The way I put thewords together lacks the form of per-suasion." Many subjects misusedwords; for example, "Let me see if Ican pertain that question to anythingelse." At least one subject coined aneologism, "I could think coralog-ically things could occur."

Several subjects answered questionsin a loose associative manner so thatthey spoke of subject matter quite re-moved from the original question. Anexample is a response to the question,"Have you often felt that the worldlooks different or has changed insome way7" The subject started outappropriately by describing a visit tohis childhood home. He thenwandered free associatively, todiscuss in a sentence or two each ofthe following topics: his parents' ad-monition to eat everything on hisplate, the starving people of India,the worth of the study of economics,the price of gasoline, and the ade-quacy of the nation's energy policy.At this point the interviewer inter-rupted to ask another question.

Some subjects occasionally becameincoherent. One of the more extremeexamples is the following, "But say,in the sense of arts, you know if youwant to strip down all the sciencesand things like and in the same in-stance I think how you affect peopleand wh- how; what your influenceon this world is almost like an art initself, less independent of mathe-matics involved."

Oddness of communication is suf-ficiently marked in our subjects towarrant the development of a formalrating system. Members of our re-search team are working on the prob-lem.

Social withdrawal (32 percent ofthe anhedonic, 31 percent of theperceptual aberration, and 11 percent

of the control subjects). The anhe-donics were more often socially with-drawn than the control subjects, x2 °*6.90, p < .01, as were the perceptualaberration subjects, x2 = 6.95,p< .01. The interviewer askedseveral questions on social interests.A subject was scored as being sociallywithdrawn if he stated that he usuallyprefers to be by himself rather thanwith others, or if he declared that heseldom enjoys the company of otherpeople, or that he has little need forsocial life.

Ability to meet and get to knowpeople. This ability was scored on a3-point scale, with a score of 1 in-dicating definite inability to meet andget to know people as much as thesubject would like, a score of 2 in-dicating some such problem in thisarea, and a score of 3 indicating noproblem in this area. The meanscores were anhedonic 1.88, percep-tual aberration 2.25, and control2.21. The anhedonics differedmarginally from controls, t = 1.94,p < .06.

Poor heterosexual adjustment. Weasked each subject the number ofdates he or she had had in each year,starting with the ninth grade. A datewas defined as getting together byprearrangement with a member of theopposite sex. The median totalnumber of dates was 53 for theanhedonics, 128 for the perceptualaberration subjects, and 139 for thecontrol subjects, but the distributionswere extremely skewed. The anhe-donics reported significantly fewerdates than the control subjects, as in-dicated by a Mann-Whitney U-Test,p < .01. Among the anhedonic sub-jects, 40 percent reported that theyhad never gone steady with amember of the opposite sex. Thiscompared with 22 percent of the per-ceptual aberration and 15 percent ofthe control subjects. The differencebetween the anhedonic and control

subjects was significant, x2 = 7.91,p < .01. One might suspect thatsome of these subjects were merelylate in their development of hetero-sexual interests, and would be in-terested in the opposite sex in collegeeven though not in high school.Therefore, subjects were also asked ifthey were more interested in datingnow than in high school. The numberof subjects who had neither gonesteady nor had increased sexual in-terest as compared to high school was22 percent of the anhedonics, 5 per-cent of the perceptual aberration, and3 percent of the control subjects. Thedifference between anhedonic andcontrol subjects was significant,X2 = 8.47, p < .01.

Another way of viewing hetero-sexual interests is in terms ofpreference for spending time with theopposite sex. This preference wasrated on a 3-point scale, with a 1 in-dicating a preference not to spendmuch time now with the oppositesex, and a 3 indicating a definitedesire to spend time with the oppositesex. The mean ratings were anhe-donic 1.96, perceptual aberration2.17, and control 2.36. The anhe-donic group differed from the controlgroup, t — 2.64, p < .01.

Composite score for schizotypalfeatures. The SADS-L groups a vari-ety of schizotypal features under sixclusters, and gives 1 point for each.A score of 1 point is interpreted asevidence for "probable schizotypalfeatures" and 2 points is interpretedas "definite schizotypal features." Thesymptoms that should enter eachcluster are suggested only in loose de-scriptive terms by the SADS-L, andthe operationalism of those principlesin a scoring scheme is not specified.The scoring system that follows rep-resents our own interpretation of theSADS-L criteria for each of the sixclusters, using data from both inter-views. The data from the present

VOL 6, NO. 4, 1980 649

study were sufficient to score five ofthe six clusters. The sixth cluster, in-adequate rapport, was omittedbecause of serious problems of inter-judge reliability. One point wasassigned for each of the followingfive symptoms:

1. Feeling physically cut off fromother people, or out-of-body experi-ences, or dissociation, or deper-sonalization, or derealization, or ascore for voice experiences or otherauditory hallucinations of "4" orabove, or visual experiences rated "4"or above on our scale for psychoticand psychotic-like experiences.

2. Aberrant beliefs rated "5" orabove, or transmission of thoughtsrated "4" or above.

3. Ideas of reference; extreme sus-piciousness; or paranoid ideation.

4. Odd communication.5. Social isolation as previously

scored.

Unlike the SADS-L procedure, werated every subject on these schizo-typal symptoms regardless of whetherhe or she qualified for anotherdiagnosis.

At least two of the five schizotypalfeatures were shown by 18 percent ofthe anhedonics, 49 percent of theperceptual aberration subjects, and 3percent of the control subjects. Theanhedonics were more oftenschizotypal than the control subjects,exact test, p < .01, as were theperceptual aberration subjects, x2 =

34.01, p < .001.Using this 5-point scoring scheme,

the mean scores were anhedonics,.72; perceptual aberration subjects,-1.60; and control subjects, .36. Theanhedonics exceeded the control sub-jects (t •= 1.97, p < .05), as did theperceptual aberration subjects (t =7.35, p < .001).

Depression and Mania. The SADS-Ldiagnostic criteria were used to

evaluate the presence of manic anddepressive symptoms. A number ofour subjects qualified for major orminor depression. None qualified formanic syndrome, although a numberqualified for hypomanic episodes.

Major depressive syndrome andminor depressive disorder. The criteriafor major depressive syndrome in theSADS-L are somewhat lenient. A per-son is diagnosed as having had amajor depressive syndrome if hemeets each of three criteria. Theseare:

1. One or more distinct periods,lasting at least 1 week during whichhe was bothered by depressive or ir-ritable mood, or had pervasive lossof interest or pleasure (other than agrief reaction).

2. Sought or was referred for helpduring a dysphoric period, or tookmedication, or showed impaired func-tioning.

3. Had at least three symptomsassociated with the most severeperiod of depressed or irritable moodor loss of interest or pleasure. Thesesymptoms are (a) poor appetite orweight loss or increased appetite orweight gain, (b) trouble sleeping orsleeping too much, (c) loss of energy,easily fatigued or feeling tired, (d)loss of interest or pleasure in usualactivities or sex, (e) feeling guilty,worthless, or down on oneself, (f)trouble concentrating, thinking, ormaking decisions, (g) thinking aboutdeath or suicide, (h) being unable tosit still or having to keep moving, orthe opposite—feeling slowed down orhaving trouble moving.

The SADS-L criteria for minordepressive disorder resemble those ofmajor depressive syndrome, exceptthat the episodes must be nonpsy-chotic and need not occur in distinctperiods, and may be diagnosed withonly two of a somewhat longer list ofsymptoms under Criterion #3.

Criterion f2 is the same as for majordepression, but we interpreted itmore leniently. The SADS-L qu^s-tions and research diagnostic criteriatreat the act of talking to a friendabout one's depression as meetingCriterion #2 of seeking help. We didnot consider that talking about one's •problems with one's friends or one'sfamily was sufficient to satisfy thiscriterion for the major depressivesyndrome, but that it did for minordepressive episodes. Similarly, we in-terpreted impairment of functioningrather strictly for major depressivesyndrome, requiring impairment asserious as failure to attend school orone's job or not talking to one'sfamily for more than 1 day. Underminor depressive syndrome, thecriterion of impaired functioning wasjudged to be satisfied by lowered per-formance in work or by un-characteristic irritability or quietness.A subject could not be scored forminor depression if he was diagnosedas having had a major depressivesyndrome.

The subjects who met the criteriafor major depressive syndrome were8 percent of the anhedonic, 17 per-cent of the perceptual aberration, and3 percent of the control subjects. Theperceptual aberration group exceededthe control group on this diagnosis,X2 = 5.60, p < .02.

The subjects meeting the criteriafor minor depressive disorder were 10percent of the anhedonic, 31 percentof the perceptual aberration, and 30percent of the control subjects. Theanhedonic group included fewer suchsubjects than the control group,X2 = 5.79, p < .02, but the groupsdid not differ significantly on totalnumber of subjects diagnosed as hav-ing had either major or minor depres-sion.

Hypomanic episodes (8 percent ofthe anhedonic, 22 percent of the per-ceptual aberration, and 6 percent of

650 SCHIZOPHRENIA BULLETIN

the control subjects). The SADS-Lcriteria for hypomanic episodes are:

m

1. At least one 2-day period withelevated mood or irritability that ismore than just feeling good and thatis unrelated to drugs or alcohol in-

2. At least two manic symptomsassociated with a euphoric period orthree symptoms associated with an ir-ritable period. The symptoms include(a) increased activity or physicalrestlessness, (b) increased talka-tiveness, (c) thoughts racing or speechconfused, (d) grandiosity, (e) lessenedneed for sleep, (f) distractibility, and(g) foolish actions.

The perceptual aberration groupexceeded the control subjects on thisdiagnosis, x2 "= 5.38, p < .02.

The finding of affective symptomsin the perceptual aberration groupmay indicate that at least some ofthese subjects are at risk for affectivepsychosis. Yet, there was not astatistically significant relationshipbetween the history of affectivesymptoms and the history of psy-chotic or psychotic-like symptoms.Of 11 perceptual aberration subjectswith psychotic symptoms (at leastone score of 6 or above), eight had anaffective symptom. Of 54 perceptualaberration subjects without psychoticsymptoms, 29 had an affective symp-tom. The relationship between thetwo was not significant, </> = .14,X2 •= -69, NS. Similarly, there wasno significant relationship between af-fective symptoms and a compositescore of psychotic and psychotic-likesymptoms, <j> •» .20, x2 ** 1-72.

History of having seen a psy-chiatrist or psychologist (2 percentof the anhedonic, 14 percent of theperceptual aberration, and 3 percentof the control subjects). We askedour subjects if they had ever seen apsychologist, psychiatrist, or other

mental health professional for otherthan vocational and academiccounseling. The perceptual aberrationsubjects tended to exceed the controlsubjects on this report, x2 = 3.67,p < .06.

Two of the male perceptual aberra-tion subjects reported that they hadbeen hospitalized, one for manic-depressive psychosis and one for"nervous breakdown." The latter sub-ject described symptoms during hishospitalization which included delu-sions, hallucinations, and passivityexperiences.

Discussion

If one considers psychotic, psychotic-like, and schizotypal experiences tobe valid indicators of proneness topsychosis, then the present studyyields strong evidence for the predic-tive validity of the perceptual aberra-tion scale and suggestive evidence forthe scale of physical anhedonia. Ascompared to nondeviant controls,perceptual aberration subjectsreported many more such experi-ences, including voice experiences andother auditory hallucinations, aber-rant beliefs, visual experiences, deper-sonalization and out-of-body ex-periences, ideas of reference, extremesuspiciousness and paranoid ideation,difficulty concentrating, complaintsof mixed up speech, deviant vocaliza-tion, odd communication, aberrantvisual experiences, social withdrawal,a higher composite score for schizo-typal features, and histories of havingseen a psychologist or psychiatrist. Inaddition, the perceptual aberrationsubjects were more likely to have metthe criteria for major depressivedisorder and hypomania. In contrast,persons deviantly-Jugh on physicalanhedonia did not significantly ex-ceed control subjects on number ofpsychotic or psychotic-like ex-

periences. Nonetheless, anhedonicswere more often socially withdrawn,had fewer dates, less often wentsteady with a member of the oppositesex, did not have increased sexual in-terest since high school, and hadhigher composite scores for schizo-typal features.

Thus, the perceptual aberrationscale identifies subjects who arepsychotic-like and schizotypal. Manyof these subjects show affective symp-toms, but they are not necessarily thesame perceptual aberration subjectswho are psychotic-like. One mustconsider the possibility that theperceptual aberration scale may iden-tify two or more groups of subjectswho may be at risk for differentforms of psychosis. For example,some of them may be at risk forpsychosis that will be labeled affec-tive disorder or schizoaffective dis-order, and others may be at risk forpsychosis that will be labeledschizophrenia or schizophreniformdisorder. The anhedonic subjects donot report psychotic-like symptoms,but report more schizotypal symp-toms and are more socially isolatedand withdrawn and less interested inthe opposite sex. The anhedonics hadbeen identified by a scale of physicalanhedonia, not social anhedonia. Theitems of the scale had been chosen tominimize social content and includedno heterosexual items. The findingthat persons high on this physicalanhedonia scale were sociallywithdrawn and had reduced interestin the opposite sex probably indicatesthat a general capacity for physicalpleasure is part of the basis of bothsocial and heterosexual interaction.(We might add that many of the an-hedonics, as well as some of theperceptual aberration subjects, ap-peared to the interviewers to be emo-tionally flat, although we abandonedfor the time being an attempt to rate

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this flatness reliably.) Edell andChapman (1979) found thatanhedonics, just as perceptual aberra-tion subjects, show schizophrenic-likethought disorder on the Rorschach.We suggest that anhedonics may bemore at risk for psychosis that islabeled schizophrenia or schizophreni-form disorder than for affectivedisorder. Many of these anhedonics,if they were to become psychotic,would qualify as having had a poorpremorbid adjustment, as measuredby the Phillips Scale (Phillips 1953) orElgin Prognostic Scale (Wittman1941). The low negative correlationof our psychosis-proneness scales isconsistent with the possibility thatthey tap proneness toward differentpsychoses. These different psychosesmight cut across the DSM-11I cate-gories of psychosis.

We were surprised that the anhe-donics did not show more depressionthan controls and, in fact, reportedless minor depressive disorder. Wefound in an as yet unpublished studythat hospitalized depressed patientsscored very high on anhedonia, justas one might expect. The nearabsence of depression in our collegestudent anhedonics points to thecharacterological long-term nature oftheir pleasure deficits. They may failto report themselves as depressedalthough they always feel the waydepressed patients feel, becauseanhedonics do not recognize the de-viancy of the experience.

The importance of identifying andfollowing individuals at elevated riskfor developing psychosis has recentlyreceived widespread recognition. Canwe say that persons high in percep-tual aberration or on physicalanhedonia are prone to develop full-blown psychosis7 Only a longitudinalstudy of such deviant individuals cananswer this question convincingly.However, we view the results of the

present study as promising enough towarrant following these individualsover time.

Many of our disturbed subjects willprobably not develop more severedisorder, but may remain stable intheir symptoms, or may improve. Itwill be interesting to study the stabil-ity of these symptoms over time andto assess which of the symptomspredict greater psychopathology, andwhich are more benign.

The heuristic value of viewing psy-chotic and psychotic-like symptomsas lying on a continuous distributionof deviancy is clearly demonstrated inthis study. The richness of the datawould be lost if we viewed suchsymptoms as dichotomous events, asin conventional diagnosis. It isprecisely the attenuated forms ofpsychotic experience which indicatethat a person is "at high risk" fordeveloping psychosis, but is notpsychotic now.

We must admit to being somewhatsurprised by the relatively high fre-quency of psychotic-like experiencesin this college student population, agroup who must be assumed to befunctioning fairly well intellectually.As our sample was predominantlyfreshman and sophomores, it may bethat more of the deviant subjects thancontrol subjects will fail to graduate.Another possibility is that some psy-chotic-like experiences need not beaccompanied by intellectual disor-ganization.

Despite the large differences be-tween our control and experimentalgroups, a few control subjectsshowed the kinds of deviancies thatwe studied in the experimentalgroups. This finding indicates thatour identification of psychosis-pronesubjects is probably incomplete, andthat another kind of scale or scaleswould identify more of them.

One final point should be made.

We are well aware of the intrinsicproblems of attempting to predictrelatively uncommon events, such asthe later development of clinicalpsychosis. Meehl and Rosen (1955)elegantly demonstrated the pitfalls ofignoring base rates when makingpredictions of this nature.Nonetheless, it is our belief thatgreater understanding of the psy-chotic disorders will accrue from pro-spective studies of high-risk in-dividuals than from retrospective orcross-sectional studies of activepsychotics, in which potentially con-founding variables (e.g., medica-tions, hospitalization) often cloud theresults. Thus, we view as importantthe search for valid indices ofpsychosis-proneness. This study is astep in that direction.

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Acknowledgment

This research was supported by Re-search Grant MH-31067 from the Na-tional Institute of Mental Health.

The Authors

Loren J. Chapman, Ph.D., is Pro-fessor, William S. Edell, M.A., is agraduate student, and Jean P. Chap-man, Ph.D., is Lecturer, Departmentof Psychology, University of Wiscon-sin, Madison, Wl.

AmericanPsychopatho-logicalAssociationMeeting

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