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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy Personality and Individual Differences 49 (2010) 419–424 Contents lists available at ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid Primary and secondary negative schizotypal traits in a large non-clinical sample Alex S. Cohen *, Russell A. Matthews Department of Psychology, Louisiana State University, United States a r t i c l e i n f o Article history: Received 10 June 2009 Received in revised form 24 March 2010 Accepted 13 April 2010 Available online 5 May 2010 Keywords: Schizotypy Negative Schizophrenia Deficit Apathy Anhedonia Social Anxiety Depression Functioning a b s t r a c t The negative symptoms of schizophrenia reflect behavioral and affective deficits and are etiologically heterogeneous, reflecting either ‘‘primary” (i.e., apathy) or ‘‘secondary” sources (e.g., depression, anxiety, medication side effects). This distinction is critical for understanding treatment response, illness course and a host of neurocognitive, neurobiological and functioning variables in schizophrenia. Negative schizotypy, defined in terms of subclinical negative traits, occurs in a sizeable portion of the adult population and is associated with increased risk for developing schizophrenia-spectrum disorders as well as a host of neurocognitive and functional anomalies. It is, as yet, unclear whether primary and secondary sources characterize negative schizotypy in a similar manner as schizophrenia. The present study contrasted putative ‘‘primary” (i.e., apathy) and ‘‘secondary” (i.e., depression and anxiety) causes in their relationships to negative schizotypy and quality of life in a sample of 1356 non-clinical adults. Our data suggests that negative schizotypy reflects two distinct ‘‘mechanisms”, one involving a putatively primary source (i.e., social anhedonia) and the other reflecting a putatively secondary one (i.e., depression). These primary and secondary mechanisms were separately important for understanding quality of life impoverishments. Implications of a ‘‘two-process” model of negative schizotypy are discussed. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction Negative symptoms, defined in terms of expressive and experiential deficits, reflect integral features of schizophrenia-spectrum pathology in that they are associated with poor prognosis and a range of neurocognitive, pathophysiological, and functional maladies (Blanchard & Cohen, 2006). Subclinical ‘‘negative symptoms” that occur in non-clinical populations are also important for understanding the disorder as they often predate onset of psychosis by years (Walker, Grimes, Davis, & Smith, 1993) and are predictive of future schizophrenia-spectrum pathology (Gooding, Tallent, & Matts, 2005; Kwapil, 1998). Accordingly, these negative traits are thought to reflect a latent vulnerability marker of the genetic liability to schizophrenia-spectrum disorders – also known as ‘‘schizotypy” (e.g., Docherty & Sponheim, 2008; Meehl, 1962 but see Meehl, 1990). In patients with schizophrenia, negative symptoms reflect behaviors and subjective states that are etiologically heterogeneous – a fact that has greatly complicated our understanding of them (Carpenter, Heinrichs, & Wagman, 1988). The present project examined the degree to which heterogeneity is also a feature of psychometrically-identified negative schizotypy. * Corresponding author. Address: Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70808, United States. Tel.: +1 225 578 7017; fax: +1 225 578 4125. E-mail address: [email protected] (A.S. Cohen). 0191-8869/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.paid.2010.04.010 Carpenter et al. (1988) outline two general classes of negative symptoms in schizophrenia patients: those that are ‘‘primary” (i.e. ‘‘core” or ‘‘deficit” symptoms) and those related to depression, anxiety, medication side effects, chronic social isolation and other ‘‘secondary” causes (Carpenter et al., 1988; Kirkpatrick, Buchanan, Ross, & Carpenter, 2001). Secondary negative symptoms, which may present similarly to primary ones during cross-sectional assessment, are generally thought to be more transient, or exogenous in nature. Conversely, core negative symptoms are meant to capture Kraepelin’s dementia praecox construct (Carpenter et al., 1988) reflecting a ‘‘weakening of those emotional activities which permanently form the mainspring of volition” and characterized by ‘‘extinction of affection for relatives and friends, of satisfaction in their work and vocation. . . [that is] the first and most striking symptom of the onset of the disease.” (Kraepelin, 1971). In this regard, the weakening of emotional activities, or ‘‘apathy” (Cohen, Minor, & Najolia, in press) as it has been referred to, is postulated to be a critical and enduring feature of the disorder (Kirkpatrick et al., 2001). To date, well over a hundred peer-reviewed studies support the importance of primary negative symptoms in schizophrenia (e.g., Kirkpatrick et al., 2001). There is good reason to suspect that both primary and secondary causes contribute to negative schizotypy in a similar manner as in schizophrenia. Although it is unlikely that negative schizotypy reflects side effects from antipsychotic medications or chronic institutionalization, symptoms of clinical distress such as Author's personal copy 420 A.S. Cohen, R.A. Matthews / Personality and Individual Differences 49 (2010) 419–424 depression and anxiety are common in schizotypy (Cohen, Leung, Saperstein, & Blanchard, 2006; Lenzenweger & Loranger, 1989) and could conceivably manifest in negative schizotypal traits (e.g., ‘‘interacting with others is too anxiety provoking”, ‘‘I am too depressed to smile”). Conversely, schizotypal negative traits might also resemble primary/‘‘core” negative symptoms in that they reflect apathy, particularly in social situations. Social anhedonia – defined as a diminished capacity to experience pleasant emotions in social interactions, has long been thought central to negative schizotypy (Meehl, 1962 but see Meehl, 1990). In support of the distinction between primary and clinical distress-related symptoms within schizotypy, several recent studies report that anxiety/depression and social anhedonia reflect separable constructs in healthy adults (Brown, Silvia, Myin-Germeys, Lewandowski, & Kwapil, 2008; Chmielewski & Watson, 2008; Lewandowski et al., 2006). However, their respective contributions to the broader construct of negative schizotypy have yet to be elucidated. In this paper, we postulate that the structure of negative schizotypal traits is similar to that seen in schizophrenia more generally, – defined in terms of separate ‘‘primary” and ‘‘secondary” pathways. The ‘‘apathy” postulated to reflect primary negative symptoms warrants elaboration as its nature has yet to be fully elucidated. A notable ambiguity concerns the degree to which apathy extends to both pleasant attitudinal domains (e.g., ‘‘I don’t receive pleasure from interacting with others”) and unpleasant ones (e.g., ‘‘It doesn’t bother me to interact with others during conflicts or arguments”) as is explicitly stated in the deficit syndrome definition (Kirkpatrick et al., 2001).1 Studies employing symptom and trait affectivity instruments to explore this issue generally find decreased pleasant and increased unpleasant experiences (Horan, Blanchard, Clark, & Green, 2008) in both schizophrenia and schizotypy as a group. However, the question of whether a subgroup of patients shows a unilateral declination in emotional experience is more complicated. There is evidence suggesting that deficit patients show higher levels of self-reported social anhedonia (Horan & Blanchard, 2003) and lower levels of suspiciousness, social anxiety and other unpleasant social-based emotions (Kirkpatrick et al., 2001). As yet, the degree to which negative schizotypy reflects diminished emotional range in both pleasant and unpleasant domains remains unclear – a secondary issue examined in the present study. Finally, it is important to understand negative schizotypy within the context of ‘‘real world” functioning and quality of life. Negative symptoms, compared to other symptoms of the disorder, are integral for understanding both schizophrenia and schizotypy because they are linked to impaired social functioning and impoverished quality of life (Malla et al., 2004). Interestingly, examinations of deficit symptoms (Horan & Blanchard, 2003) and clinical distress (Reine, Lançon, Tucci, Sapin, & Auquier, 2003) in patients with schizophrenia have revealed that they are both associated with poorer functioning and impoverished quality of life. Insofar as deficit symptoms and clinical distress are mutually exclusive, this raises questions about whether their effects on ‘‘real world” variables reflect distinct pathways. We are aware of no studies to separately evaluate the potential differential contributions of primary versus secondary negative schizotypal traits to quality of life – another knowledge gap addressed in the present study. The present study examined affective, symptom, and functional variables in a sample of 1356 young adults recruited from a college 1 Our use of the term apathy here is meant to include both pleasant and unpleasant domains. We conceptualize pleasant social apathy as being identical to social anhedonia, and for purposes of this article, will use the terms interchangeably. We do note that social anhedonia is not synonymous with negative schizotypy, rather, that it is one potential indicator of negative schizotypy. This is important to note as we evaluate the social anhedonia literature which often employs social anhedonia as a proxy for negative schizotypy. setting. Examination of a non-clinical sample allows for understanding latent schizophrenia vulnerabilities in a population whose insight is, by and large, not demonstrably impaired. Moreover, as noted above, the potential confounds of some secondary causes of negative symptoms, such as environmental deprivation and medication side effects, are reduced allowing for a clearer view of clinical distress symptoms. College samples are commonly used for schizotypy research, and it is worth noting that nearly a quarter of college students with psychometrically-identified schizotypy recruited as part of a ten-year longitudinal study met criteria for a schizophrenia-spectrum disorder by study’s end (Kwapil, 1998). Thus, schizotypy, as measured in a college sample, is by no means benign. Our first aim was to examine potential primary (i.e., apathy) and secondary causes (i.e., clinical distress) of negative schizotypal traits. Second, we determined the relative contributions that primary and secondary negative schizotypal traits make to quality of life. Through both of these analyses, we sought to disentangle the relative importance of pleasant versus unpleasant apathy as components of primary negative schizotypal traits. 2. Methods 2.1. Participants Potential participants were undergraduate students (n = 8591) who were contacted via email to participate in an on-line survey and offered a chance to win monetary compensation as part of a lottery (10 prizes of $25us). Embedded within this survey were a consent form, basic demographic questions, and measures of schizotypal symptomatology, clinical symptomatology, apathy, and quality of life. The response rate was 17% (n = 1507). Of these responses, 9% (n = 138) of the questionnaires was discarded because of incomplete responses (n = 141) or questionable validity (n = 10; detailed below). The final dataset included 1356 participants. Demographic and descriptive variables are included in Table 1. This study was approved by the appropriate Human Subject Review Board and all subjects offered informed consent prior to completing the surveys. 2.2. Measures 2.2.1. Schizotypal symptoms Schizotypal symptoms were assessed using the brief Schizotypal Personality Questionnaire (Raine & Benishay, 1995), a Table 1 Means and standard deviations for the demographic and descriptive statistics (n = 1356). Demographic variables Data Possible range Age % Female Ethnicity % Caucasian % African American % Asian-American % Hispanic % Other Negative schizotypal traits Potential secondary sources Depression Anxiety Potential primary sources Pleasant apathy Unpleasant apathy Quality of life Objective quality of life Subjective quality of life 19.18 ± 2.03 65% 18–51 – – 81.7% 8.4% 3.1% 3.2% 3.6% 6.18 ± 3.57 0–16 10.71 ± 4.82 9.78 ± 4.09 6–30 6–30 11.26 ± 4.27 21.59 ± 3.29 1–31 1–31 47.93 ± 5.04 25.46 ± 5.80 1–65 1–42 Author's personal copy A.S. Cohen, R.A. Matthews / Personality and Individual Differences 49 (2010) 419–424 22-item measure that has demonstrated adequate psychometric properties in a number of prior schizotypy studies (e.g., Axelrod, Grilo, Sanislow, & McGlashan, 2001). The SPQ items are organized into one of nine subscales that mirror the diagnostic criteria of DSM-IV schizotypal personality disorder (American Psychiatric Association, 1994). The original brief-SPQ employs a forced choice ‘‘yes” or ‘‘no” response format. To address concerns that dichotomous response formats are insensitive to degrees of symptom severity, we adopted a 5-point Likert scale system that has been employed in recent research using the Full SPQ (Wuthrich & Bates, 2005). Response options ranged from ‘‘Strongly Disagree” to ‘‘Neutral” to ‘‘Strongly Agree”. The Likert scale version of the full SPQ has shown high convergence and improved internal reliability (a = .95) when administered in either computer or standard paper and pencil versions compared to the original version (Wuthrich & Bates, 2005). Informed by a recent item-level factor analysis of the full SPQ (Chmielewski & Watson, 2008), we defined negative schizotypy in terms of the ‘‘No Close Friends” and ‘‘Constricted Affect” items (a = .76). Although some prior research has indicated that these scales load on a more general ‘‘Interpersonal” factor along with ‘‘Social anxiety” and ‘‘Suspiciousness” subscales, (e.g., (Raine, Reynolds, Lencz, & Scerbo, 1994), we excluded these subscales in an attempt to capture traits not overtly contaminated by depression, social anxiety, or other obvious secondary psychopathological states. Internal consistency was good for each of the subscales (i.e., Cronbach’s a for the Cognitive-Perceptual factor = .79, for the Interpersonal factor = .86, and for the Disorganization factor = .83), Prior studies have demonstrated high convergence with the full SPQ measure, convergence with other measures of schizotypal traits, and good reliability (Cohen, Matthews, Najolia, & Brown, in press; Raine & Benishay, 1995). The psychometric properties of this scale from this study are presented as part of a larger investigation into the SPQ (Cohen, Matthews et al., in press). 2.2.2. Quality of life A modified version of Lehman’s Quality of Life brief interview (Lehman, 1995), covering the prior month, was used. Presented in this study is a summary score reflecting 23 objective quality of life items covering seven domains (i.e., home, daily activities, family, social, financial, health and legal concerns). These items cover objectively anchored assessments of behavior (i.e., ‘‘How often do you make plans ahead of time to do something with a friend?”) and access to resources (i.e., ‘‘In the past month, did you have enough money for fun activities?”). A separate summary score reflecting nine items assessing subjective satisfaction across these seven domains (using a standardized 7-point Likert scale) is included in the revised brief QOL. The brief QOL has been used in over a 100 peer-reviewed studies to date, and has demonstrated acceptable psychometric properties (Lehman, 1995; Cohen & Davis, 2009). The newer modified version of the QOL has also been used in prior research (e.g., Bellack, Bennett, Gearon, Brown, & Yang, 2006). Although these measures are typically used in patient studies, prior research has supported their use in university samples (Cohen & Davis, 2009). Internal consistency for the subjective scale from this study was good (Cronbach’s a = .82), and adequate for the objective scale (Cronbach’s a = .53). Increasing scores reflect better functioning. 2.2.3. Potential secondary negative trait sources As asserted by the manifest schizophrenia literature (Kirkpatrick et al., 2001), potential secondary negative schizotypy trait sources were measured by depression and anxiety. The ‘‘Depression” and ‘‘Anxiety” subscales from the Brief Symptom Inventory (Derogatis & Melisaratos, 1983), a self-report measure of psychiatric symptomatology with extensive use in prior studies, were 421 employed. Symptoms were rated on a 4-point Likert scale reflecting the prior month epoch. Increasing scores reflect increasing symptom severity. The BSI has been used in hundreds of published research studies, and has demonstrated good reliability and convergent validity (see Derogatis & Melisaratos, 1983). Internal consistency for these scales from our study was good (i.e., Cronbach’s a for anxiety = .88, depression = .83). 2.2.4. Potential primary negative trait sources Social apathy, a construct considered primary in theories of negative symptoms (Kirkpatrick et al., 2001), was employed here as a measure of primary negative trait sources. Unfortunately, we were unable to identify a suitable existing measure of social apathy that included matched measures of pleasant and unpleasant domains, thus we developed a measure for the purpose of this study, called the Explicit Social Attitudes Scale (Cohen, Beck, Najolia, & Brown, 2010). Participants were asked to separately rate pleasant (i.e., ‘‘How pleasant do you feel towards these people?”; a = .72) and unpleasant (i.e., ‘‘How unpleasant do you feel towards these people?”; a = .70) trait apathy to six social domains (i.e., parents, authority figures, friends, intimate significant others, strangers, passing associates using a 6-point Likert scale from ‘‘very pleasant/unpleasant” (coded ‘‘1”) to not at all pleasant/unpleasant” (coded ‘‘5”) to ‘‘n/a – I don’t have any of these individuals in my life” (coded ‘‘6”). For the present study, we report separate total scores of pleasant and unpleasant items with increasing scores reflecting increasing apathy. Good reliability and convergent validity for this measure has been demonstrated in a larger sample of non-clinical adults (Cohen et al., 2010).2 2.2.5. Infrequency scale To screen out responders who provided random or grossly invalid responses, we included four questions from the Infrequency Scale (Chapman & Chapman, 1983). Individuals who endorsed two or more infrequency items were excluded from this study. 2.3. Analyses The analyses were conducted in three steps. First, we sought to ascertain the relationships between primary sources (i.e., apathy), secondary sources (i.e., depression/anxiety), negative schizotypy (from the SPQ), and quality of life scores by inspecting a zero-order correlation matrix. Second and third, we determined the relative contributions of primary and secondary sources to schizotypy negative traits and to subjective and objective quality of life by examining the standardized beta weights from linear regressions. As part of these analyses, pleasant and unpleasant social apathy, two potential primary sources, were considered separately. 3. Results 3.1. Zero-order correlations Zero-order correlations are presented in Table 2. There are four noteworthy findings. First, negative schizotypy scores significantly corresponded to increasing severity of depression and anxiety symptoms (two secondary negative trait sources) at a medium effect size level (using Cohen, 1988). Second, negative schizotypy scores were significantly related to both pleasant and unpleasant 2 A portion of subjects (n = 314) indicated they did not have any significant-others in their lives. These individuals had significantly more negative symptoms (t’s > 3.48, p’s < .01), depression (t[1354] = 2.21, p < .05), and worse social functioning (t’s > 14.15, p’s < .001) but not more anxiety (t[1354] = .75, p = .45) than the rest of the sample. None of the results of this study changed in any meaningful way when these subjects were excluded from the analyses. Author's personal copy 422 A.S. Cohen, R.A. Matthews / Personality and Individual Differences 49 (2010) 419–424 1. 2. 3 4 5 6 Unpleasant social apathy was associated with better subjective quality of life. The total variance explained by these variables was 19% for objective and 49% for subjective quality of life. 1.00 – – – – – 4. Discussion .52 .42 1.00 .69 – 1.00 – – – – – – .48 .31 .39 .39 .25 .37 1.00 .19 – 1.00 – – .40 .52 .31 .59 .18 .50 .40 .53 .16 .40 1.00 .39 Table 2 Zero-order correlation matrix for the variables examined in this study (n = 1356). Schizotypy Traits 1. Negative Traits Potential secondary sources 2. Depression 3. Anxiety Potential primary sources 4. Pleasant Apathy 5. Unpleasant Apathy Quality of life 6. Objective 7. Subjective The present data provides insight into the nature of negative schizotypy. There are three important findings from this study. First, similar to what is observed in schizophrenia more generally, negative schizotypy appears to reflect at least two separate mechanisms, one characterized by primary sources, defined in terms of a trait-like social apathy/anhedonia, and secondary sources, defined in terms of clinical distress. The constructs of social anhedonia and depression appear to be particularly important for understanding negative schizotypy. Insofar as they made distinct contributions to negative schizotypy, they appear to be distinct. Second, negative schizotypy does not appear to be associated with a unilateral declination in social experience, but rather appears to be characterized by social anhedonia and increased unpleasant emotions. Finally, a range of primary and secondary negative schizotypy sources are each important for understanding both objective and subjective quality of life. This finding is consistent with others (Cohen & Davis, 2009) in highlighting the deleterious effects of negative symptoms even at the subclinical level. Given that clinical distress, as a secondary source, and social anhedonia, as a primary source, demarcate distinct pathways to negative schizotypy, an important unknown issue regards the degree to which they reflect different illness courses. We would hypothesize that social anhedonia reflects a more ‘‘primary” stable trait (Blanchard, Horan, & Brown, 2001) such that social anhedonia reflects a risk marker specific to deficit schizophrenia – characterized by enduring and idiopathic negative symptoms. In support of this, individuals high in social anhedonia show more pronounced schizoid symptoms at three (Gooding et al., 2005) and 10 year (Kwapil, 1998) follow-up assessments compared to individuals high in positive schizotypy. Similarly, individuals identified as having deficit symptoms early in the course of their illness tend to show chronic deficit symptoms over a 20-year epoch (Strauss, Harrow, Grossman, & Rosen, in press). We further hypothesize that secondary negative traits, those related to depression or anxiety are more transient in nature and tend to demarcate a dramatically different illness expression – one with a more paranoid, schizoaffective or otherwise non-deficit psychotic flavor. If correct, these hypotheses suggest that distinguishing between primary and secondary negative schizotypal traits, just as in schizophrenia, is important for understanding the type of illness that may manifest. In short, primary versus secondary traits may signal fundamentally distinct conditions. All values statistically significant p < .05. apathy scores (both primary negative trait sources), with the correlation magnitude being stronger for pleasant than unpleasant scores (Fisher r-to-z comparisons; all z’s > 30.34. p’s < .001). Third, negative schizotypy scores (from the SPQ) were associated with poorer subjective and objective quality of life at a medium to large effect size. Fourth, each of the potential primary (i.e., apathy) and secondary (i.e., depression/anxiety) negative schizotypy scores were significantly associated with poorer objective and subjective quality of life, although these effect sizes ranged from small to large. 3.2. Primary versus secondary underpinnings of negative schizotypal traits Table 3 contains the results of the regressions employing negative schizotypy scores as the dependent variables. The largest independent contributions to the variance in negative schizotypy were made by depression symptoms (a secondary source) and pleasant social apathy (a primary source), with anxiety symptoms and unpleasant social apathy explaining a statistically significant but more modest amount of independent variance. Overall, the four predictor variables explained 38% of the variance in negative symptom scores. 3.3. Primary versus secondary underpinnings of quality of life The regressions employing quality of life as the dependent variable are also included in Table 3. The variance in both objective and subjective quality of life scores were most explained by pleasant social apathy (a primary source) and depression (a secondary source), with anxiety (a secondary source) and unpleasant social apathy (a primary source) contributing a more modest amount. Table 3 Regression analyses examining the relative contributions of unpleasant affect and apathy to negative and psychotic schizotypy symptoms and quality of life. Standardized beta weights (b) and partial correlation values (rpartial) are reported here. Predictor variables Dependent variables Negative schizotypy R2 = .38 F [4, 1351] = 206.61*** ** *** Objective quality R2 = .19 F [4, 1351] = 77.58*** Subjective quality R2 = .49 F [4, 1351] = 329.70*** b rpartial b rpartial Potential secondary sources Depression Anxiety .21*** .09** .24 .09 .20*** .05 .15 .04 .28*** .16*** .26 .15 Potential primary sources Pleasant apathy Unpleasant apathy .27*** .11*** .36 .11 .36*** .04 .32 .04 .35*** .17*** .41 .21 p < .01. p < .001. rpartial b Author's personal copy A.S. Cohen, R.A. Matthews / Personality and Individual Differences 49 (2010) 419–424 In terms of the primary negative traits examined here, social apathy was not global in nature but specific to pleasant domains. Unpleasant social apathy, which is theorized to be a feature of deficit schizophrenia (Kirkpatrick et al., 2001), was actually inversely related to negative schizotypy. This highlights the importance of social anhedonia, as opposed to a more general social apathy, as a constituent of negative schizotypy. At the neurobiological level, this would suggest that circuits responsible for unpleasant social experience are preserved whereas those involving hedonic emotions from social situations are compromised in some capacity. It is worth noting that although patients with schizophrenia, as a group, also show high levels of social anhedonia on trait questionnaires and symptom-rating scales, they do not show commiserate hedonic deficits during laboratory mood induction procedures (Cohen & Minor, 2010). Evidence for ‘‘in the moment” hedonic deficits in schizotypy is mixed with one laboratory study reporting normal emotional modulation in individuals with social anhedonia (e.g., Gooding, Davidson, Putnam, & Tallent, 2002) although an experience sampling methodology study in this same population reported hedonic deficits (Brown et al., 2008). It will be critical for future research to employ multi-modal assessments to clarify the affective underpinnings of negative schizotypy, particularly as it pertains to social domains. The present study was limited in some respects. First concerns its reliance on self-report measures, which are problematic in that they provide information on only subjective-perceived attitudes. Clinical ratings, although costly for a sample size this large, would be an important adjunct for use in further research. Second, the data examined here were cross-sectional in nature and thus limited for understanding how various symptoms unfold over time. Longitudinal assessment, particularly as individuals progress through the window of risk, are essential for future research enterprises. Third, the sample was based solely on college students. As noted above, this is common in schizotypy research and there is a large body of research documenting that college students with schizotypy show a host of ‘‘schizophrenia-like” maladies. Nonetheless, it is possible that the results do not generalize to all individuals with schizotypal traits. Finally, generalizability concerns are raised in that only a minority of individuals approached to complete the survey actually completed it. It is unclear how our sample is similar to the broader population. It could be the case that individuals with more psychopathology were more likely to participate and are thusly, overrepresented in our sample. Alternatively, individuals with underlying psychopathology may have been reluctant to complete the study due to paranoia, depression or other conditions. 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