Schizophrenia Research 84 (2006) 305 322 www.elsevier.

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The Schizotypic Syndrome Questionnaire (SSQ): Psychometrics, validation and norms

Dirk van Kampen *
Vrije Universiteit, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands Received 4 August 2005; received in revised form 15 February 2006; accepted 15 February 2006 Available online 31 March 2006

Abstract This paper examines the psychometric properties (reliability and factor structure) and validity (relationship with various selfreport measures and SPEM dysfunction) of the SSQ or Schizotypic Syndrome Questionnaire , a 108-item inventory for the measurement of 12 prodromal or schizotypic symptoms present in Van Kampens model of schizophrenic prodromal unfolding. This paper also provides normative data for the SSQ. The SSQ demonstrates adequate reliability and breaks down into three correlated factors: negative schizotypy, asocial schizotypy and positive schizotypy. Results further attest the construct validity of the instrument. Because of the implications of the SSQ model for the definition of schizophrenia, the instruments threedimensional factor structure and the nature of one of the factors are discussed in more detail. D 2006 Elsevier B.V. All rights reserved.
Keywords: Schizophrenia prodrome; SSQ model; Schizotypy; Precursor symptoms

1. Introduction In a previous paper (Van Kampen, 2005), a model was proposed describing the temporal unfolding of the schizophrenic prodrome. Starting with a survey of the literature which indicated that negative prodromal symptoms (such as social withdrawal and general decreased drive) usually precede psychotic-like and psychotic features (e.g., Cameron, 1938; Lencz et al., 2004; Ha fner et al.,

* Tel.: +31 20 5988876; fax: +31 20 59888758. E-mail address: d.van.kampen@psy.vu.nl. 0920-9964/$ - see front matter D 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2006.02.011

1995; Gross and Huber, 1989; Meares, 1959; Yung and McGorry, 1996), and particularly taking note of Docherty et al.s (1978) observation of a regular and sequential unfolding of onset stages in the process of schizophrenic decompensation, 12 prodromal symptoms were selected that were believed to constitute a network of causal relationships , not only between negative and psychotic-like symptoms, but also between these symptoms and antisocial features of schizotypy (see, e.g., Kretschmer, 1942; Heston, 1970; DeLisi, 2004). The assumption of causality was based (among other things) on Allen et al.s (1997) description of an inward flight process leading to a change in the

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sense of self (depersonalization) and reality (derealization), and on Kretschmers (1942) observation of a transition over time from hypersensitivity (e.g., shyness) to (different forms of) insensitivity (e.g., hostility and a passive lack of feeling). In addition, the selected symptoms, which resemble the Grundsymptome (fundamental symptoms) supposed by Kraepelin (1913) and Bleuler (1911) to accompany the whole evolution of dementia praecox/schizophrenia, were found to represent the full range of Yung and McGorrys (1996) comprehensive list of prodromal features, suggesting that a definition of the schizophrenic prodrome might be proposed in which the main precursor symptoms are held to determine each other in terms of cause and effect. Such a definition is not far from Kraepelins (1913, p. 766) dtemporalT characterization of dementia simplex as the first non-psychotic period of dementia praecox that is only characterized by the presence of fundamental symptoms. The 12 symptoms proposed by Van Kampen (2005) to give a temporal and causal definition of the schizophrenic prodrome (and the labels introduced to denote these symptoms) are: social anxiety (SAN), active isolation (AIS), living in a fantasy world (FTW), affective flattening (AFF), egocentrism (EGC), hostility (HOS), feelings of alienation (ALN), perceptual disturbances (PER), delusional thinking (DET), suspicion (SUS), apathy (APA) and cognitive derailment (CDR). Measuring these symptoms in a general population sample of 392 subjects using a specially constructed inventory, i.e., the SSQ or Schizotypic Syndrome Questionnaire , the proposed network of causal relationships between the 12 symptoms was tested by means of LISREL-8 (Jo reskog and So rbom, 1995). It was the reading of the prodromal literature to ddetectT the specific cause effect relationships that laid the basis for constructing a new schizotypy instrument instead of relying on existing instruments that do not always exactly measure the variables included in these relationships. The use of a normal sample was based on Bleulers (1911) observation that negative, psychotic-like and psychotic symptoms of schizophrenia may also be exhibited within normal limits. A similar view was defended by Van Os et al. (1999) and Johns and Van Os (2001) who discuss psychosis as an extreme of continuous variation in several dimensions of psy-

chopathology, notwithstanding that some form of discontinuity, which shows itself in a threshold effect, might also exist (see, e.g., Claridge, 1994; Van Os, 2003). Although the causal network as originally proposed (see Van Kampen, 2005, Fig. 3) resulted in a mediocre fit, several pathways were added to the model, finally resulting in fit values (RMSEA, CFI and SRMR) that, according to Hu and Bentlers (1999) joint criteria clearly indicated the models ability to reproduce the observed variancecovariance matrix. The extra pathways were mainly selected to mimic prodromally the classic distinction between paranoid and non-paranoid schizophrenia that has been found helpful in schizophrenia research (e.g., Goldstein et al., 1968). Replication of the model in a second normal sample of 379 subjects led to an even better fit. The model finally selected, with the standardized pathway coefficients found in the combined sample of 771 subjects, is depicted in Fig. 1. The ordering of the symptoms in this figure is also determined by their place in Docherty et al.s (1978) scheme of onset stages in schizophrenia. However, the particular arrangements in time (indicated, for instance, by the length of the arrow between SAN and CDR) were not included in the LISREL testing. Because a model with adequate fit values can only be considered to be dnot-disconfirmedT (see, e.g., Breckler, 1990), the models plausibility was further investigated in a study by Van Kampen et al. (in preparation) in which IRAOS data assembled in the Age-Beginning-Course study of schizophrenia (e.g., Ha fner et al., 1995) were used in an attempt to validate the SSQ model in a sample of first-episode patients with schizophrenia. The dtranslationT of the 12 SSQ symptoms in terms of the IRAOS variables was not always easy (and proved even impossible in the case of EGC), but nevertheless the temporal positions of the selected IRAOS variables were found to nearly always correspond with the dcause effect positionsT in Fig. 1. Furthermore, the LISREL testing of the SSQ model (deleting three minor pathways) conducted on IRAOS clusters and variables that were selected to indicate the SSQ symptoms resulted in a satisfactory fit, particularly if the dtranslational problemsT mentioned above are taken into account.

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Fig. 1. The SSQ model with the standardized pathway coefficients as observed in the combined sample. SAN = social anxiety, AIS = active isolation, AFF = affective flattening, APA= apathy, ALN = alienation, FTW = living in a fantasy world, EGC = egocentrism, SUS = suspicion, HOS = hostility, CDR = cognitive derailment, PER = perceptual disturbances, DET = delusional thinking. The numbers 1, 2, 3 and 4 refer to the first four onset stages (slightly modified; see Van Kampen, 2005) in Docherty et al.s (1978) scheme describing the process of psychotic decompensation in schizophrenia.

Given the positive results obtained with the LISREL testing, and noting that the SSQ symptoms PER, DET and CDR (that, according to Fig. 1, emerge at the end of the prodromal period) are subclinical or attenuated psychotic phenomena, several conclusions were reached that relate to the implications of the model for the study of schizophrenia. It was noted, for instance, that the process of prodromal unfolding (or positivation ) as depicted in Fig. 1 may not halt on the emergence of psychoticlike symptoms but may also encompass the final stages of the positivation process characterized by the occurrence of hallucinations, delusions and/or formal thought disorder. The additional pathways (that seem to start with PER, DET and CDR) implied by this view were not tested by Van Kampen (2005), but the fact that psychotic-like prodromal features are known to enhance the risk of conversion to psychosis (Chapman et al., 1994; Kwapil et al., 1997; Miller et al., 2002; Woods et al., 2001) supports the possibility of such an extension. Furthermore, the three extra dpsychoticT pathways allow to distinguish between what we have termed minor and major schizophrenia, the former (or simplex form of that disorder) defined only in terms of the prodromal

symptoms depicted in Fig. 1 and the latter (or fullblown form of schizophrenia) as the dschizophrenic prodrome with psychosisT. Hence, the SSQ model may not only reflect a temporal and causal definition of the schizophrenic prodrome, but may also enable to establish a dependable description of the fullblown form of schizophrenia. Both the minor and the major form of schizophrenia are thereby reminiscent of Kraepelins (1913) description of dementia praecox , as several features typical for that disease, such as an early and insidious onset (e.g., Fenton and McGlashan, 1991), a more enduring course (Gupta et al., 1997) and poor outcome (Addington et al., 2003), are strongly associated with the presence of negative symptoms that appear to have a prominent place in Fig. 1. In this context, it is also of interest to note that, although hallucinations and other psychotic symptoms are nowadays usually considered to be highly characteristic for schizophrenia, this view dismisses the fact that these features are far from pathognomonic (e.g., Peralta and Cuesta, 1999; Pope and Lipinsky, 1978) and have been found (save, perhaps, hallucinations with complete sensory distinctness and certain delusions of influence; see Kendler, 1986) to be unrelated to the core symptoms

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(Tsuang et al., 2000) or Grundsymptome (Kraepelin, 1913) of schizophrenia and to their underlying causes (Tsuang et al., 2001). Another inference that was drawn relates to the fact that the model presented in Fig. 1, with the three extra pathways included, offers a dimensional representation of both minor and major schizophrenia, because each SSQ scale measures a continuum, most of which probably embrace normality. On the other hand, the model also refers to a specific syndrome or symptom complex in which the symptoms themselves are believed to causally determine each other. The dimensional part of this view agrees with recent criticisms of the categorical models of classification (First, 2003; Krueger, 2002). However, the SSQ model (with its demonstrated pattern of symptom relationships) is also critical of Boyles (1990) assertion that Kraepelin never observed any set of regularities for inferring dementia praecox, and of Bentall et al.s (1988) claim that the concept of schizophrenia must be abandoned as an invalid construct, pursuing instead the study of separate symptoms. Therefore, a dimensional representation was believed to go hand in hand with a model describing a specific symptom complex. Based on the promising results obtained in the LISREL testing and the implications of the SSQ model for the definition and study of schizophrenia, it seems worthwhile to present information about the Schizotypic Syndrome Questionnaire as a measurement device for the 12 symptoms in the SSQ model. The present article addresses the following topics: (a) the reliability of the SSQ scales for negative, positive and asocial schizotypy (indexed by Cronbachs a coefficient); (b) the determination of the SSQs correlational and factorial structure, the latter one based on a principal components analysis with oblimin rotation at the scale-level of that instrument; (c) validity findings in studies that investigated hypothesized relationships between the SSQ scales and factors on the one hand, and several criterion measurese.g., Raines (1991) Schizotypal Personality Questionnaire and the SPEM-RMS deviation score for eye vs. target positionon the other; and (d) the establishment of norms for the SSQ, separate for females and males in two different age groups.

2. Methods 2.1. Subjects and procedure Nearly all results presented in this paper were obtained from the above-mentioned sample of 771 general population subjects. This sample, called the HGA sample (see also Van Kampen, 2005), was drawn from the patient files of five general practitioners in Haarlem (H), four in Gouda (G) and five in Amsterdam (A). Originally, 2893 subjects (most aged between 20 and 59years) received a letter from their general practitioner requesting them to fill in the SSQ. This questionnaire was usually sent to them in addition to the 4DPT or Four-Dimensional Personality Test (Van Kampen, 1997, 2000); however, in a smaller subgroup of HGA subjects, this was done together with Raines (1991) Schizotypal Personality Questionnaire or SPQ in a Dutch translation by Vollema (see, e.g., Vollema and Hoijtink, 2000). The sample of SSQ plus 4DPT respondents consisted of 697 subjects; the sample of SSQ plus SPQ respondents of 74 subjects. The total group of 771 HGA subjects was composed of 457 females, 280 males and of 34 subjects of unknown sex and age; the mean age of this sample was 36.67 years with a standard deviation (S.D.) of 10.32 years. Addressing a subsample of 495 HGA subjects with the request not only to fill in the SSQ and the 4DPT but also to participate in a Smooth Pursuit Eye Movements (SPEM) experiment (see, e.g., Syzmanski et al., 1991), 140 subjects were found willing to participate in that study. As reported below, a subgroup of only 40 subjects (sample S) from this group (with a mean age and S.D. of 37.35 F 6.97 years) was used to examine the actual SPEM data. Finally, in an additional sample (sample E) of 216 general population subjects aged 18 to 60 years (established after originally approaching 653 subjects drawn from the patient files of 4 general practitioners in Eindhoven), the SSQ was administered together with the DES-II or Dissociative Experiences Scale-II (Carlson and Putnam, 1993) in a Dutch translation by Boon and Draijer (1995), the 5DPT or Five-Dimensional Personality Test , a successor of the 4DPT (Van Kampen, submitted for publication), and the Creative Experiences Questionnaire (CEQ) constructed by Merckelbach et al. (1998). The subjects in this sample (136

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females, 78 males and 2 subjects with sex unknown) had a mean age of 42.54years (S.D. 10.86 years). 2.2. Self-report and SPEM measures The SSQ or Schizotypic Syndrome Questionnaire consists of 12 separate scales that measure the prepsychotic or dprodromalT symptoms selected for the SSQ model. Each of the 12 scales comprises nine items in the form of statements about behavior and feelings, amounting to a total of 108 items. The items are answered on a four-point scale (by drawing a circle around YES, yes, no or NO) indicating the degree to which each statement applies to the subject. The SSQ scales were subsequently developed in three samples of, respectively, 381, 265 and 329 general population subjects drawn from the patient files of 11 general practitioners from the Dutch towns Apeldoorn and Breda, two general practitioners from Leiden and five from Haarlem (see Van Kampen, 2005). The PER and DET scales are essentially short versions of Chapman et al.s (1980) Perceptual Aberration Scale and Eckblad and Chapmans (1983) Magical Ideation Scale. In the construction of the SSQ, only those items were selected for which it could be demonstrated that the corrected item-total correlations for the items belonging to a scale were always higher than the correlations of the same items with each of the remaining scales. This was done to safeguard the conceptual clarity of each scale as much as possible. The SSQ items are listed in Appendix A. The Four-Dimensional Personality Test (4DPT; Van Kampen, 1997) and the Five-Dimensional Personality Test (5DPT; Van Kampen, submitted for publication) were developed with the aim to identify basic dimensions of normal personality as seen from a clinicaltheoretical perspective. In agreement with Eysencks (1994) view that a basic personality factor must form part of a general nomological network, but also criticizing both his dgenotypicT and dphenotypicT theories about P or psychoticism (e.g., Eysenck, 1992; Van Kampen, 1993), five fundamental dimensions of personality were postulated, namely insensitivity (S), extraversion (E), neuroticism (N), orderliness (G) and absorption (A). In the construction of the two instruments, emphasis was on the selection of only

those items that resulted in invariant factors with respect to several sample parameters, both dexternalT ones (e.g., sex and age) and the measured dimensions themselves (dinternalT parameters). Theoretically, this was substantiated by criticisms of idiographically oriented researchers that the loadings obtained in factor analysis may only apply to people in general, but not necessarily to (subgroups of) individual persons (Bakan, 1969; Lamiell, 1981; Van Kampen, 2000). The dimensions S, E, N and G are measured by 16-item scales in the 4DPT, the same dimensions plus A by 20-item scales in the 5DPT. In both cases, the items must be answered by YES or NO. Data on the internal consistency, factor structure and validity of the various scales are presented elsewhere (Van Kampen, 1997, submitted for publication); in brief, the scales of the two inventories are nearly orthogonal, demonstrate adequate testretest and Cronbach a reliabilities, and correlate as expected with many other scales and instruments, like the NEO-FFI (Costa and McCrae, 1992), the DAPP-BQ (Livesley and Jackson, 2002), the CATI (Coolidge, 1984) and Thalbournes (1998) Transliminality Scale. In the HGA and E samples, the 4DPT and 5DPT were administered because the schizoid, schizotypal or pre-schizophrenic personality was reported (e.g., Blais, 1997; Bleuler, 1972; Ross et al., 2002; Slater, 1953) to be characterized by features resembling high N, S and A positions, and a low position on E. Hence, most or even all SSQ scales were expected to correlate positively with the 4DPT and 5DPT dimensions N, S and A, negatively with E and dzeroT with G. The Schizotypal Personality Questionnaire (SPQ) was developed by Raine (1991) as a screening instrument for the detection of schizotypic personality characteristics in both normal and psychiatric outpatient populations. The questionnaire with 74 dichotomous items may also be used as a screening device to investigate whether a person satisfies the DSM-IIIR criteria of schizotypal personality disorder (American Psychiatric Association [APA], 1987). The SPQ, which consists of nine scalesideas of reference (IOR), excessive social anxiety (ESA), odd beliefs or magical thinking (OBM), unusual perceptual experiences UPE), odd or eccentric behavior (OEB), no close friends (NCF), odd speech (ODS), constricted affect (CAF) and suspiciousness (SUS)that

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refer to the nine DSM-III-R SPD criteria, breaks down into three factors of cognitive-perceptual deficits (e.g., IOR and UPE), interpersonal deficits (e.g., ESA and NCF) and disorganized (OEB and ODS). The Dutch version of the SPQ (Vollema and Hoijtink, 2000) might also be scored for a slightly different set of three factorspositive schizotypy, negative schizotypy and disorganizationstemming from a slightly different set of 10 scales, formed by splitting the original ideas of reference scale into two scales: referential thinking (RET) and delusional mood (DEM). The SPQ in the above-mentioned sample of 74 subjects was scored for both the nine original and the RET and DEM scales. The SPQ was mainly administered because of the possibility to compare our own SSQ definition of schizotypy (or prodromal features) with a description that is based on the dofficialT DSM-III-R criteria of schizotypal personality disorder provided by the American Psychiatric Association. Of course, the SPQ was also expected to correlate as a validity measure with the SSQ. The Dissociative Experiences Scale-II (DES-II; Carlson and Putnam, 1993) is a 28-item self-report measure of the frequency of dissociative experiences. Respondents are asked to indicate on an 11-point scale, ranging from 0% to 100%, what percentage of the time each experience happens to them. Besides the total scale, three subscales may be scored: amnesia, depersonalization/derealization and absorption/imagination. In the Dutch translation of the DES-II (Boon and Draijer, 1995), these scales are scored according to the dstandardT three-factor solution proposed by Carlson et al. (1991); accordingly, these scales consist, respectively, of eight, six and nine items. Although in some factor analytic studies, particularly in nonclinical samples, no evidence was found to support the use of these or similar subscales, a three-factor model was clearly supported in a series of confirmatory factor analyses of competing factor models in two nonclinical samples conducted by Stockdale et al. (2002). Hence, in the E sample, the dstandardT three-factor solution was also applied. The DES-II was administered because of the frequently reported association between schizotypyespecially of the positive type and dissociative tendencies (e.g., Irwin, 2001; Merckelbach et al., 2000; Pope and Kwapil, 2000; Startup, 1999). Moreover, Schneiderian first-rank symptoms, once supposed to be pathognomonic for schizophrenia

(see, e.g., Schneider, 1950, p. 138), were found to be common in dissociatively disordered patients (e.g., Ellason and Ross, 1995; Kluft, 1987; Ross et al., 1990), which led to the situation that as many as 25 50% of patients diagnosed with dissociative identity disorder had been previously given a diagnosis of schizophrenia (see, e.g., Putnam et al., 1986; Ross and Norton, 1988; Ross et al., 1990). With respect to the separate dissociation scales, a correlation between DES-II depersonalization/derealization and SSQ-ALN (alienation) was anticipated. The Creative Experiences Questionnaire (Merckelbach et al., 1998, 2001) is a brief 25-item measure of fantasy proneness. The concept of fantasy proneness has been linked to a broad range of phenomena, including absorption, dissociation and schizotypy (see, for reviews, Kihlstrom et al., 1994; Lynn and Rhue, 1988). The association between fantasy proneness and schizotypy (Merckelbach et al., 2000; Rhue and Lynn, 1987) led to the administering of the CEQ in the Eindhoven study. The CEQ was constructed by Merckelbach et al. (1998) because the Inventory of Childhood Memories and Imaginings (ICMI; Wilson and Barber, 1981) that is usually relied on to measure fantasy proneness was found to exist in several versions with almost no information on their psychometric properties. In a study by Merckelbach et al. (1998), the CEQ appeared to be strongly correlated with a concurrent measure of fantasy proneness. Furthermore, as expected, substantial correlations emerged between the CEQ on the one hand, and absorption, dissociation and schizotypy [measured by the Claridge Schizotypal Personality Scale (STA; Claridge and Broks, 1984)] on the other. SPEM or Smooth Pursuit Eye Movement dysfunction, although not a necessary or sufficient condition in defining the genetic liability for schizophrenia (see Hanson et al., 1990), can be considered one of its most dependable biological markers (Syzmanski et al., 1991). As such, these impairments are present in both schizophrenic patients and their relatives (e.g., Lipton et al., 1983). Moreover, SPEM dysfunctions are also correlated with several self-report dimensions associated with both negative and positive, and asocial (nonconforming) schizotypy (Vollema et al., 1999). However, as opposed to the fact that the genetic vulnerability to schizophrenia may manifest itself particularly in negative symptoms (see above),

D. van Kampen / Schizophrenia Research 84 (2006) 305322 Table 1 SSQ: Cronbachs a coefficients a -T SAN AIS CDR AFF PER FTW SUS APA ALN DET EGC HOS 0.87 0.85 0.91 0.91 0.79 0.88 0.87 0.89 0.88 0.77 0.77 0.79 a -F 0.87 0.84 0.90 0.91 0.76 0.88 0.88 0.89 0.88 0.76 0.77 0.79 a -M 0.87 0.85 0.91 0.91 0.83 0.87 0.84 0.89 0.87 0.76 0.77 0.78 a -Y 0.87 0.85 0.90 0.88 0.73 0.88 0.88 0.88 0.86 0.73 0.74 0.78

311

SPEM dysfunction had its strongest weighted mean correlation with scales for positive schizotypy and its weakest one with negative schizotypy scales. In our investigation (see also Van Kampen and Deijen, in preparation), the subjects were instructed to follow a horizontally moving target under three conditions of speed: low speed (58/s), medium speed (108/s) and high speed (208/s). We opted for a rather global measure of SPEM dysfunction, the root mean square deviation score (RMS) for eye vs. target position. No RMS values were calculated if the pupil size was less than 2mm or when the target reached one of the turning points on the horizontal line. Moreover, RMS data were dismissed in case of too many eye blinks. The angle between the eye and the turning point was 158. Although originally 140 persons were willing to cooperate in the SPEM study, the final sample comprised only 40 subjects (see above). After identifying 33 individuals with scores of at least one standard deviation above the mean on the general SSQ factor (see below) and selecting a comparison group of 33 subjects with scores between 1 S.D. and + 1 S.D., 66 persons were invited to participate in the study. Of these subjects, only 47 agreed to come to our laboratory. Due to the occurrence of eye blinks and other disturbing factors, dependable SPEM data could only be obtained for 40 subjects: 19 individuals with elevated scores on dgeneral schizotypyT and 21 persons with dnormalT scores.

a -O 0.88 0.84 0.90 0.92 0.81 0.88 0.86 0.90 0.89 0.79 0.80 0.79

T, F, M, Y and O refer to the total sample and the subsamples females, males, younger and older subjects.

3. Results 3.1. Reliability and factor structure Table 1 shows the Cronbach a reliabilities of the 12 SSQ scales as calculated in both the total HGA sample of 771 normal subjects and in the subsamples females, males, younger (age 1635, n = 386) and older (age 3659, n = 351) subjects. The reliabilities are quite satisfactory, with a coefficients ranging from 0.77 to 0.91 in the total sample and from 0.73 to 0.92 in the four subsamples. Moreover, the results are similar for females and males, and for younger and older subjects. However, the level of alpha reliabilities is not uniformly high, with somewhat lower values for PER, DET, EGC and HOS.

Table 2 presents the intercorrelations of the SSQ scales in the total sample, the relation of these scales with sex (F = 2, M = 1) and age (and GSS, see below), and the loadings (structure matrix) of the symptom scales on the (correlated) factors OF1, OF2 and OF3 that emerged in the total sample after oblimin rotation with Kaiser normalization of the three principal components that had eigenvalues greater than 1. OF1 is particularly characterized by loadings from AFF, ALN and SAN, OF2 by loadings from HOS and SUS, and OF3 by a loading from DET. It seems obvious that these SSQ factorsthat we have interpreted as Negative Schizotypy/Prodromal Features (OF1), Asocial Schizotypy/Prodromal Features (OF2) and Positive Schizotypy /Prodromal Features (OF3) are similar to the well-known schizotypy dimensions anhedonia, cognitive disturbances, impulsive nonconformity and unusual experiences (see Claridge et al., 1996; Vollema and Van den Bosch, 1995), although in the SSQ the factors anhedonia and cognitive disturbances fuse into one dimension (OF1). Because of the significant and relatively substantial correlations of r = 0.52 between OF1 and OF2, r = 0.34 between OF1 and OF3, and r = 0.24 between OF2 and OF3, Table 2 shows also the first unrotated or general SSQ factor (GF), with loadings ranging from 0.61 for EGC to 0.85 for ALN. At the level of the individual SSQ items, this general factor can be adequately measured by 26 items, constituting the General Schizotypy Scale or GSS with Cronbachs a coefficient in the total sample being 0.95. In Appendix A, the numbers of these items are underlined.

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Table 2 SSQ: scale intercorrelations, relationships with sex, age and GSS, oblimin rotated (OF) and general (GF) factor loadings SAN SAN AIS CDR AFF PER FTW SUS APA ALN DET EGC HOS Sex Age GSS 0.76** 0.60** 0.58** 0.46** 0.37** 0.53** 0.55** 0.61** 0.38** 0.36** 0.48** 0.08* 0.03 0.76** AIS 0.54** 0.60** 0.43** 0.38** 0.62** 0.49** 0.54** 0.38** 0.47** 0.54** 0.07 0.14** 0.73** 0.56** 0.47** 0.39** 0.46** 0.51** 0.57** 0.47** 0.34** 0.40** 0.01 0.09* 0.68** 0.58** 0.35** 0.51** 0.63** 0.75** 0.45** 0.39** 0.47** 0.06 0.13** 0.89** 0.41** 0.38** 0.48** 0.69** 0.62** 0.36** 0.40** 0.02 0.15** 0.66** 0.43** 0.38** 0.48** 0.55** 0.40** 0.38** 0.12** 0.06 0.47** 0.46** 0.51** 0.42** 0.45** 0.68** 0.05 0.11** 0.62** 0.67** 0.39** 0.33** 0.45** 0.08* 0.06 0.77** 0.61** 0.40** 0.48** 0.01 0.10** 0.89** CDR AFF PER FTW SUS APA ALN DET EGC HOS OF1 0.83 0.77 0.76 0.85 0.68 0.41 0.61 0.79 0.85 0.53 0.37 0.53 OF2 0.55 0.70 0.43 0.44 0.32 0.53 0.81 0.39 0.43 0.43 0.79 0.85 OF3 0.12 0.09 0.32 0.34 0.69 0.71 0.20 0.31 0.57 0.83 0.36 0.24 GF 0.78 0.78 0.73 0.80 0.72 0.62 0.74 0.73 0.85 0.69 0.61 0.71

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0.40** 0.40** 0.06 0.02 0.57** 0.57** 0.16** 0.01 0.47** 0.12** 0.01 0.57**

(a) Oblimin rotated factor loadings z 0.60 are printed in boldtype. (b) The factors OF1, OF2 and OF3 explain 70.7% of the total variance. * p b 0.05 (two-tailed). ** p b 0.01 (two-tailed).

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3.2. Validity findings With respect to the validity of the SSQ, four separate studies were conducted. In the first and second validation study using, respectively, a sample of 697 HGA responders and a sample of 216 E subjects (see above), the SSQ was correlated with, respectively, the 4DPT (Van Kampen, 1997) and its successor, the 5DPT (Van Kampen, 2005). Furthermore, in the E sample, the SSQ was correlated with the Dissociative Experiences Scale-II (DES-II; Carlson and Putnam, 1993) and with the Creative Experiences Questionnaire (CEQ; Merckelbach et al., 2001). As pre-schizophrenic individuals were postulated in the 4- and 5DPT models to be characterized by high scores on S, N and A and low scores on E (see above), the SSQ scales were expected to correlate positively with S, N and A, and negatively with E. More specifically, given the factor analytic results for the SSQ listed in Table 2, positive correlations were expected between S and the asocial scales of the SSQ, N and the negative SSQ scales, and A and the positive SSQ scales, as well as a negative correlation between E and the negative SSQ scales, and zero correlations between all SSQ scales and G. Table 3 shows that these expectations are clearly corroborated. With respect to the 4DPT, for instance, the average correlations for S and N with the asocial

(SUS, EGC and HOS) and negative (SAN, AIS, AFF, ALN, APA and CDR) prodromal scales were 0.55 (range 0.430.63) and 0.54 (range 0.460.61), respectively, and the average correlation for E with the negative SSQ scales was 0.43 (range 0.310.65) (all p values b 0.01). Except for a low, but significant, negative correlation between APA and G, all correlations with G turned out to be not departing from zero. Similar results were obtained for the 5DPT, albeit that the (significant) correlations between the positive SSQ scales (PER, FTW and DET) and A appeared to be relatively low, with r values ranging from r = 0.29 to r = 0.44 ( p b 0.01). Table 3 also shows that the SSQ scales do correlate with the DES-II total, amnesia, depersonalization/derealization and absorption/imagination and CEQ scores. This seems especially true for the positive SSQ scales PER and DET, although relatively high correlations are also obtained for ALN, FTW and CDR. Equally as expected, the ALN scale of the SSQ correlates most highly (r = 0.62, p b 0.01) with DES-II depersonalization/derealization. The high correlations of the SSQ scales with DES absorption compared with the correlations of these scales with 5DPT absorption are due to the fact that the DES-II AB scalewhich correlates only by r = 0.34 ( p b 0.01) with 5DPT Ais also correlated with 5DPT N (r = 0.36) and 5DPT S (r = 0.28, p b 0.01). In fact, it is only the multiple correlation between the DES

Table 3 Correlations between SSQ scales and scales of the 4DPT (n = 669675), 5DPT, DES and CEQ (n = 204213) SAN 4DPT AIS CDR AFF PER FTW SUS APA ALN DET EGC HOS

S 0.29** 0.39** 0.21** 0.30** 0.21** 0.31** 0.43** 0.28** 0.29** 0.30** 0.58** 0.63** E 0.65** 0.59** 0.35** 0.35** 0.22** 0.17** 0.29** 0.34** 0.31** 0.11** 0.20** 0.23** N 0.61** 0.46** 0.54** 0.52** 0.41** 0.30** 0.50** 0.56** 0.56** 0.35** 0.22** 0.45** G 0.03 0.06 0.00 0.03 0.01 0.05 0.06 0.23** 0.04 0.04 0.04 0.03 5DPT S 0.23** 0.38** 0.33** 0.40** 0.30** 0.30** 0.45** 0.39** 0.33** 0.30** 0.62** 0.61** E 0.51** 0.49** 0.23** 0.29** 0.12 0.01 0.26** 0.31** 0.26** 0.07 0.11 0.19** N 0.57** 0.50** 0.57** 0.60** 0.38** 0.31** 0.52** 0.60** 0.57** 0.36** 0.32** 0.45** G 0.01 0.11 0.06 0.01 0.01 0.14* 0.09 0.23** 0.06 0.03 0.02 0.00 A 0.11 0.08 0.10 0.17* 0.29** 0.44** 0.16* 0.16* 0.29** 0.39** 0.12 0.13 DES-II TO 0.41** 0.30** 0.51** 0.48** 0.57** 0.52** 0.43** 0.44** 0.64** 0.63** 0.31** 0.35** AM 0.30** 0.20** 0.44** 0.37** 0.45** 0.38** 0.32** 0.32** 0.51** 0.52** 0.25** 0.27** DE 0.41** 0.23** 0.42** 0.41** 0.58** 0.38** 0.36** 0.36** 0.61** 0.57** 0.19** 0.28** AB 0.37** 0.34** 0.51** 0.52** 0.54** 0.60** 0.48** 0.46** 0.62** 0.61** 0.33** 0.38** CEQ 0.32** 0.29** 0.35** 0.41** 0.51** 0.61** 0.38** 0.40** 0.56** 0.63** 0.34** 0.32** S = insensitivity, E = extraversion, N = neuroticism, G = orderliness, A= absorption, TO = total score DES, AM = amnestic dissociation, DE = depersonalization/derealization, AB = absorption. * p b 0.05. ** p b 0.01.

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absorption scale and the 5DPT scales A, N, S and G that in a stepwise regression analysis proved to be of a more substantial level (R = 0.51). In the third validation study, using a subsample of 74 HGA subjects (sample S), meaningful correlations were obtained between the scales and factors of the SSQ and the scales and factors of Raines (1991) Schizotypal Personality Questionnaire (SPQ). It was found, for instance, that the sum of the PER, FTW and DET scores (representing the SSQ factor positive schizotypy) correlated highly (r = 0.75, p b 0.001) with the SPQ factor cognitive-perceptual deficits, which is characterized by loadings from IOR (ideas of reference), OBM (odd beliefs/magical thinking), UPE (unusual perceptual experiences) and SUS (paranoid ideation). Similarly, the SSQ factor negative schizotypy, indexed by the sum of the SAN, AIS, AFF, ALN, APA and CDR scores, correlated highly (r = 0.86, p b 0.001) with the SPQ factor interpersonal deficits, that has saturations on ESA (excessive social anxiety), NCF (no close friends), CAF (constricted affect) and SUS (suspiciousness). The two remaining factors, asocial schizotypy (SSQ) and disorganized (SPQ), do not strongly overlap as regards content, which agrees with the somewhat lower correlation ( r = 0.55, p b 0.001) between both dimensions. The results in Table 4 also show that those symptom scales of the SSQ and SPQ that seemingly relate to the same content are often correlated with each other; we may mention
Table 4 Correlations between SSQ and SPQ scales (n = 5864) SAN IOR ESA OBM UPE OEB NCF ODS CAF SUS RET DEM 0.40** 0.83*** 0.12 0.17 0.26* 0.73*** 0.50*** 0.61*** 0.68*** 0.43*** 0.16 AIS 0.32* 0.63*** 0.13 0.13 0.34** 0.81*** 0.40** 0.72*** 0.66*** 0.36** 0.09 CDR 0.37** 0.52*** 0.44*** 0.43*** 0.31* 0.51*** 0.73*** 0.54*** 0.57*** 0.32** 0.26* AFF 0.38** 0.58*** 0.37** 0.32* 0.41** 0.69*** 0.60*** 0.68*** 0.58*** 0.38** 0.18** PER 0.53*** 0.53*** 0.35** 0.48*** 0.52*** 0.49*** 0.44*** 0.37** 0.54*** 0.48*** 0.46*** FTW 0.45*** 0.21 0.42** 0.50*** 0.49*** 0.13 0.51*** 0.08 0.31** 0.37** 0.36**

here, in particular, the correlations between SAN (social anxiety) and ESA (excessive social anxiety) (r = 0.83), AIS (active isolation) and NCF (no close friends) (r = 0.81), CDR (cognitive derailment) and ODS (odd speech) (r = 0.73), AFF (affective flattening) and CAF (constricted affect) (r = 0.68), and the two SUS scales (suspicion and suspiciousness) (r = 0.67, all p values b 0.001). However, somewhat lower correlations than suggested by the scale labels are also apparent. This relates, for instance, to the still highly significant ( p b 0.001) correlations between DET and OBM (odd beliefs or magical thinking) (r = 0.56) or between PER and UPE (unusual perceptual experiences) (r = 0.48). Although Table 4 shows that the SSQ scales for which counterparts exist in the SPQ exhibit moderate to strong convergent validity, the SSQ and DSM-III-R definitions of schizotypy (or schizotypal personality disorder)the latter largely coinciding with the DSM-III-R criteria list of schizophrenic prodromal features (see APA, 1987, p. 194)converge only in part. Stepwise regression analyses with the SSQ scales as dependent variables and the nine original SPQ scales as potential predictors reveal that the main difference between both operationalizations lies in the inclusion in the SSQ of the FTW (fantasy world) and HOS (hostility) scales. Whereas all other SSQ scores can be predicted with multiple correlations ranging from 0.64 to 0.90 (mean R = 0.75), the R values in the case of FTW (R = 0.59) and particularly HOS (R = 0.53) were

SUS 0.33** 0.43*** 0.16 0.10 0.31** 0.41** 0.35** 0.44** 0.67*** 0.36** 0.16

APA 0.36** 0.52*** 0.39** 0.37** 0.26* 0.49*** 0.56*** 0.37** 0.41** 0.34** 0.28*

ALN 0.54*** 0.65*** 0.48*** 0.54*** 0.59*** 0.59*** 0.69*** 0.46*** 0.59*** 0.50*** 0.38**

DET 0.49*** 0.35** 0.56*** 0.58*** 0.58*** 0.19 0.48*** 0.18 0.50*** 0.42** 0.50***

EGC 0.40** 0.29* 0.19 0.31* 0.65*** 0.27* 0.43*** 0.35** 0.31** 0.42** 0.26*

HOS 0.34** 0.31** 0.29* 0.19 0.38** 0.38** 0.45*** 0.45*** 0.45*** 0.37** 0.14

IOR = ideas of reference, ESA= excessive social anxiety, OBM = odd beliefs or magical thinking, UPE = unusual perceptual experiences, OEB = odd or eccentric behavior, NCF = no close friends, ODS = odd speech, CAF = constricted affect, SUS = suspiciousness, RET = referential thinking, DEM = delusional mood. * p b 0.05. ** p b 0.01. *** p b 0.001.

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relatively weak. The absence of a hostility scale in the SPQ seems also partly responsible for the fact that a factor corresponding with asocial schizotypy (SSQ) or impulsive nonconformity (e.g., Claridge et al., 1996) was not found in the SPQ. In the last validation study (see also Van Kampen and Deijen, in preparation), 19 subjects with high schizotypy scores on the general SSQ factor (GF; see Table 2) were compared with 21 subjects with average schizotypy scores in terms of the mean RMS deviation score for eye vs. target position under the conditions of low target speed (58/s: RMS-L), medium speed (108/s: RMS-M) and high speed (208/s: RMS-H). Although the mean RMS-L, RMS-M and RMS-H deviation scores were higher in subjects with high scores on schizotypy, the differences using one-sided t -tests were not significant ( p values 0.15, 0.17 and 0.08, respectively). Because, however, in each condition 1 or 2 persons had outlying RMS scores, three additional comparisons were made, comparing 19 high GF subjects with 19 average GF subjects in the low speed condition, 18 high GF subjects with 20 average GF subjects in the medium speed condition, and 19 high GF subjects with 20 average GF subjects in the high speed condition. The group scoring high on general

schizotypy showed significant impairments (t -tests, one-sided) compared to the average schizotypy group in global SPEM functioning in the low ( p = 0.01) and high speed ( p = 0.03) conditions. For the medium speed condition, only a trend ( p = 0.09) was observed. 3.3. Norms Noting the positive results mentioned above and the significant but weak correlations between several SSQ scales and sex or age (see Table 2), norms were established for four different subgroups in the HGA sample: (a) females, 1637 years; (b) males, 16 37years; (c) females, 3859 years; and (d) males, 38 59years. Weighting the answers YES, yes, no and NO with, respectively, 4, 3, 2 and 1 points, Table 5 lists the norms (means and standard deviations) obtained in these groups, as well as the standard errors of the means and the skewness and kurtosis of the various scales.

4. Discussion Some clear statements can be made concerning the main results reported in this paper. First, the Schizo-

Table 5 Norms and distribution information for the SSQ scales in four general population (aged-grouped) subsamples: females, 1637 (n = 269); males, 1637 (n = 162); females, 3859 (n = 188); and males, 3859 (n = 118) SAN F, 1637 years m S.E.M. S.D. Skewness Kurtosis m S.E.M. S.D. Skewness Kurtosis m S.E.M. S.D. Skewness Kurtosis m S.E.M. S.D. Skewness Kurtosis 15.27 0.34 5.49 0.93 0.46 14.52 0.42 5.31 1.02 0.53 15.93 0.47 6.39 0.87 0.03 14.67 0.51 5.44 0.81 0.47 AIS 14.31 0.28 4.51 0.91 0.35 15.08 0.41 5.17 1.14 1.31 15.67 0.40 5.36 0.80 0.36 16.29 0.52 5.53 0.64 0.33 CDR 15.12 0.34 5.48 1.10 1.09 15.35 0.46 5.84 1.00 0.59 16.29 0.49 6.57 0.72 0.29 16.18 0.56 6.01 0.80 0.11 AFF 12.49 0.29 4.62 1.90 4.00 13.73 0.44 5.55 1.39 1.32 14.79 0.49 6.64 1.09 0.31 14.65 0.63 6.72 1.29 0.81 PER 10.51 0.16 2.62 2.56 7.41 10.61 0.22 2.83 2.84 10.68 11.47 0.26 3.54 1.84 3.46 11.70 0.41 4.35 2.01 3.93 FTW 15.78 0.35 5.59 0.77 0.18 17.05 0.51 6.47 0.60 0.37 15.27 0.44 5.97 0.98 0.42 17.06 0.59 6.32 0.66 0.24 SUS 17.40 0.37 5.93 0.55 0.30 17.43 0.46 5.73 0.71 0.15 18.17 0.47 6.34 0.35 0.68 19.59 0.52 5.51 0.36 0.20 APA 15.08 0.34 5.49 1.18 1.24 14.39 0.44 5.55 1.42 1.98 16.42 0.50 6.72 0.74 0.37 14.96 0.54 5.74 1.00 0.33 ALN 12.29 0.27 4.31 1.52 1.86 12.20 0.34 4.24 1.49 1.84 13.37 0.41 5.56 1.36 1.31 13.34 0.50 5.34 1.31 0.93 DET 11.63 0.20 3.29 1.56 2.18 11.91 0.28 3.58 1.49 1.64 11.79 0.28 3.81 2.49 9.65 12.46 0.39 4.14 1.41 1.29 EGC 13.10 0.22 3.46 1.07 0.76 13.86 0.28 3.57 0.83 0.55 12.77 0.27 3.63 1.25 2.32 14.63 0.41 4.39 0.55 0.38 HOS 17.43 0.31 5.02 0.56 0.03 18.14 0.36 4.53 0.30 0.08 17.05 0.37 4.91 0.46 0.14 19.06 0.53 5.58 0.51 0.12

M, 1637 years

F, 3859 years

M, 3859 years

m = mean, S.E.M. = standard error of mean, S.D. = standard deviation.

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typic Syndrome Questionnaire (SSQ), which was constructed to build a model for the temporal unfolding of the schizophrenic prodrome, appears to be reliable. Using Cronbachs a coefficient to assess this characteristic, all 12 scales of the SSQ had adequate reliabilities ranging (in the total HGA sample of 771 normal subjects) from 0.77 to 0.91, with a mean a coefficient of 0.85. For females, males, subjects aged 1635 years and subjects aged 36 59 years, similar results were obtained. Secondly, the SSQ was found to break down into three (correlated) factors of negative , asocial and positive schizotypy that are in agreement with the (primarily) negative (SAN, AIS, AFF, ALN, APA and CDR), nonconforming (SUS, EGC and HOS) or psychotic-like (PER, FTW and DET) nature of the 12 prodromal symptoms that were originally selected based on the clinical literature to build the SSQ model. The correlations between the factors (ranging from 0.24 to 0.52) reflect the fact that all 12 SSQ scales were significantly intercorrelated. Thirdly, concerning the validity of the SSQ, meaningful correlations were found between the SSQ scales and several other inventories, viz. Raines (1991) Schizotypal Personality Questionnaire (SPQ), the 4DPT (Four-Dimensional Personality Test ) and 5DPT (Five-Dimensional Personality Test ), both constructed by Van Kampen (1997, submitted for publication), the Dissociative Experiences Scale-II (DES-II; Carlson and Putnam, 1993), and Merckelbach et al.s (2001) CEQ or Creative Experiences Questionnaire . It emerged, for instance, that the SSQ scales for which counterparts exist in the SPQ (e.g., SSQ cognitive derailment and SPQ odd speech) are often highly correlated, although it was also apparent that the SPQ definition of schizotypy (which strictly follows the nine DSM-III-R criteria for schizotypal personality disorder) does not completely coincide with the SSQ characterization of schizotypy. Also, as expected, there were positive correlations between the psychotic-like scales of the SSQ and 5DPT absorption (A), DES-II dissociative tendencies and CEQ fantasy proneness, whereas the negative SSQ scales correlated with neuroticism (N) and low extraversion (E), and the asocial SSQ scales with S or insensitivity (4- and 5DPT). Besides confirming relationships with other self-report instruments, the validity of the SSQ was demonstrated by the fact that impairments in global SPEM functioning, a marker for the genetic liability to

schizophrenic breakdown (Syzmanski et al., 1991), occurred in a small group of subjects who scored at least one standard deviation above the mean on the general factor of the SSQ, compared with a group scoring average on that factor. Despite the straightforward conclusions listed above, some topics related to the SSQ need further comment. First, the principal components analysis of the 12 SSQ scales led to the extraction of only three factors instead of the familiar four-factor structure of schizotypy that is usually referred to in the clinical literature (e.g., Vollema and Van den Bosch, 1995; Claridge et al., 1996). However, seeing that the SSQ factors asocial schizotypy and positive schizotypy are similar to the dliterature dimensionsT impulsive nonconformity and unusual experiences, and noting that the remaining SSQ factor (negative schizotypy ) must be considered a blend of anhedonia and cognitive disturbances, the discrepancy between both factor models becomes less important. Nevertheless, in choosing between the two representations, the three-dimensional SSQ structure seems more dependable because the four dimensions reported in the literature are simply based on factor analyses of more or less daccidentalT scales, whereas the symptom scales of the SSQ refer to a model with a status confirmed by LISREL. Another difference between both factor representations is that the SSQ factors do not demonstrate orthogonality, whereas the four-dimensional structure is often assumed to be non-oblique. However, the oblique factor structure of the SSQ does agree with Ha fner et al.s (1995) findings in the ABC study of schizophrenia, albeit that these latter findings only concern the relationship between positive and negative symptoms. Moreover, the assumption of orthogonality in the case of the four-dimensional representation seems unjustified. Even corroborating to some extent the SSQ structure, positive correlations were reported by Mason (1995) in a series of confirmatory factor analyses between anhedonia and cognitive disturbances (confirming our factor negative schizotypy), as well as between the dimensions cognitive disturbances, impulsive nonconformity and unusual experiences. We may also note in this context that the observed loadings of SSQ PER (perceptual disturbances) on both positive and negative schizo-

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typy probably reflect the finding that emotions are strongly influential with respect to the emergence of psychotic phenomena (see, e.g., Freeman and Garety, 2003). Furthermore, uncorrelated positive and negative symptom factors are only found in the acute stage of the illness at the time of (first) hospital admission, not in the prodromal stage or after neuroleptic treatment (Lo ffler and Ha fner, 1999). One further comment relates to the second SSQ dimension, asocial schizotypy, because this factor, albeit under the usual designation impulsive nonconformity (Claridge et al., 1996), was often considered to be of only marginal relevance to schizotypy. This situation stems from the fact that impulsive nonconformity has much in common with Eysencks P or psychoticism dimension (Eysenck and Eysenck, 1976; Eysenck, 1992), a dimension that has been criticized because of its weak theoretical status (Claridge, 1981; Van Kampen, 1993, 1996) and for its antisocial, nonconformist and impulsive content that caused Zuckerman et al. (1988) to label the P scale of the Eysenck Personality Questionnaire (Eysenck and Eysenck, 1975), a measure of psychopathy instead of psychosis-proneness. However, in Eysencks (1992) view, the many studies that indicate that high P scores can be found in criminals and other nonpsychotic individuals with socially deviant behavior (see, for a summary, Eysenck and Gudjonsson, 1990) actually support the validity of the P scale for, according to his theory about P, socially deviant or psychopathic behavior is based on the same genotype as schizophrenia and manic-depressive illness. Although it seems clear that schizophrenia and manicdepression are genetically at most slightly related (see Kendler and Diehl, 1993; Van Kampen, submitted for publication), and that several forms of antisocial or psychopathic conduct lie outside the schizophrenic spectrum, it must be emphasized that there is a connection between schizophrenia on the one hand, and certain psychopathic behaviors (including violence, drug abuse and criminality) on the other (Modestin and Ammann, 1996; Swanson et al., 1990; Tengstro m and Hodgins, 2002; Smit et al., 2004). Indeed, from this perspective and in agreement with Eysenck, antisocial behavior may not only be present in schizophrenia, but may even give a clue to its etiology (DeLisi, 2004). For instance, Jablensky et al. (2004) concluded that dearly offending and/or a

history of substance abuse may be prodromes or early manifestations of schizophrenic illnessT. Given this evidence, the introduction in the SSQ of a factor asocial schizotypy seems warranted.

Acknowledgements The author would like to thank the following general practitioners for their willingness to cooperate with this study: A.J. Blocks, A. van Dijk, J.C. Houtman, R. Verdonk, P. de Jong, P. Mennink, P.U. van Loon (Apeldoorn), P. Carol, M.P. Frankenhuis, P. Klinkhamer, E.J. Quadekker (Breda), A. Goslinga, Y. Groeneveld (Leiden), D.H. Arentz, S.G.Ph. Faber, W.R. van Kempen, G.J. Thomassen, D.E.A. Wijs (Haarlem), I.D. Anselrode, A.M. Boonacker, P.M. Leusink, F.O.J. van der Steen (Gouda), W. Blaauw, W. van Kernebeek, M.M.P. Seebregts, E.R.F. Zipper, H.W. van Zoest (Amsterdam), J.P. Dijkmans, I. Smeele, D.J.C. Heijl and V.J.G.M. de Kort (Eindhoven).

Appendix A. SSQ items

SAN 1 13 25 37 49 61 73 85 97 2 14 26 38 50 62 74 86 98 I often feel frightened when somebody asks me something unexpectedly. It scares me if somebody I dont know suddenly enters my room. I am afraid to make friends with people. I am anxious to act spontaneously in the company of others. I usually have great difficulty in adapting to other people. I become afraid when people come close to me. Even in the company of people I know well I sometimes feel uncomfortable. I am often very shy in the company of other people. Actually, I am afraid of people. I do not want to have anything to do with other people. In discussions, I often show very little of myself. I limit my contact with other people to what is absolutely necessary. I refuse to be involved with others. I prefer to keep my distance from others. I avoid friendship with other people. I do not like people to come too close to me. There are only a few people with whom I want to have contact. I prefer to avoid people.

AIS

318 CDR 3 15 27 39 51 63 75 87 99 AFF 4 16 28 40 52 64 76 88 100 5 17 29 41 53 65 77 89 101

D. van Kampen / Schizophrenia Research 84 (2006) 305322 I often find that other people have difficulty understanding my words. I find it difficult to express myself clearly in a discussion. I often do not know how to express my ideas in words. Occasionally, I use words inappropriately in a sentence. Sometimes, I am unable to make sense of my own words. It sometimes appears as if I get bogged down in my own words. The meaning of what I say is often unclear to others. The words I use are often not precise. I notice that I am sometimes not fully aware of what I am talking about. I tend not to experience strong emotions. Sometimes, I am devoid of all feeling. Sometimes, nothing affects me. Sometimes, I do not experience any joy or sorrow. I appear to have lost the ability to have any feeling. I feel inside as cold as ice. I cannot get emotionally excited anymore. Sometimes, I feel completely empty inside. I am at times unable to feel anything. Occasionally, parts of my body seem to be dead or unreal. Occasionally, I feel that my arms or legs have momentarily grown in size. At times, I have momentarily felt that the things I touch stick to my body. Sometimes, I feel that everything around me is wobbling or tilting. Ordinary colors sometimes seem too bright (without me taking drugs). I sometimes have the feeling that my hands or feet are far away. Sometimes, ordinary things, like tables and chairs, appear strange to me. My hearing is sometimes so sensitive that ordinary sounds become uncomfortable. Over a stretch of several days, I sometimes have such a heightened awareness of sights and sounds that I cannot shut them out. I can create a completely private world in my own thoughts. In my fantasies, I can make anything happen. Sometimes, I am entirely wrapped up in a world of fantasy. In my fantasies, my wishes are often satisfied. In my fantasies, I tie all sort of things together as it pleases me. If something cannot be actualized in reality, I realize it in fantasy. 78 90 102 SUS 7 19 31 43 55 67 79 91 103 APA 8 20 32 44 56 68 80 92 104 9 21 33 45 57 69 81 93 105 10 My ideas actually constitute a separate reality. In my fantasies, the world becomes more beautiful. I am sometimes so engaged in my daydreams that I experience reality as disrupting. I tend to be suspicious of other people. I am rather distrustful. Most people pretend to be friendlier than they really are. I often notice that people talk about me behind my back. I am rather distrustful of most people. Many people cannot be trusted. When it comes to the crunch, very little can be expected from people. The only person you can really trust is yourself. I sometimes wonder whether people mean what they say. I often neglect my work. I often feel weak and listless. I lack perseverance most of the time. Even the slightest effort tires me. Sometimes, days pass without me really doing anything. I often cannot get myself going. I have very little energy. Often, I leave things unfinished. Every effort puts too great a strain upon me. It sometimes seems as if I am a prisoner in my own world. It sometimes feels as if I live in a glass house. My surroundings sometimes seem unreal to me. The things around me sometimes appear unreal. It sometimes seems as if there is a wall between me and my surroundings. At times, there seems to be no contact with my surroundings. Sometimes, the people around me appear to be puppets. Sometimes, when I look in the mirror, I see a stranger. I sometimes feel alienated from myself. Occasionally, I have the silly feeling that a TV or radio broadcaster knew that I was listening to him or her. I sometimes feel that messages are hidden for me in the way things are arranged, as in a shop window. I am sometimes influenced by the hand movements of strangers. I sometimes have a feeling of gaining or losing energy when certain people look at me or touch me. Occasionally, I have the feeling that certain thoughts of mine really belong to someone else. I have sometimes felt that I might cause something to happen just by thinking too much about it.

PER

ALN

DET

22

FTW

6 18 30 42 54 66

34 46 58 70

D. van Kampen / Schizophrenia Research 84 (2006) 305322 82 At times, I have the feeling that a message in the newspaper, or a talk on the radio, was meant especially for me. I think it is possible to change something in your environment simply by thinking that it will happen. I think you can win in a game of chance by concentrating beforehand on its outcome. It seems quite natural to me that people should serve me and satisfy my needs. Actually, I only like myself. People sometimes say that I am only interested in myself. I think that people should give special consideration to my wishes. Actually, I am only interested in myself. In conversations, I often consider only my own point of view. I think that some people consider me to be a selfish person. I do not like doing things for other people. I usually follow only my own desires in what I do. I often dislike others. Sometimes, I can be quite sarcastic. I foster a grudge against people who have wronged me. Other people have little to contribute to me. I sometimes behave very hostile towards people. I find fault with other people quite easily. I am often in a bad mood. I am rather quick to criticize people. I find it difficult to forgive other people.

319

94

106 EGC 11 23 35 47 59 71 83 95 107 HOS 12 24 36 48 60 72 84 96 108

Underlined item numbers refer to items in the General Schizotypy Scale (GSS).

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