ORIGINAL ARTICLE
Creativity and Psychopathology
Higher Rates of Psychosis Proneness and Nonright-Handedness
Among Creative Artists Compared to Same Age and Gender Peers
Antonio Preti, MD,*† and Marcello Vellante, BPsych*
Abstract: Creative people have been found to score higher on
psychopathologic scales in standardized tests, particularly on the
scales that measure traits of psychoticism, and to be more likely to
report an excess of nonright handedness compared with controls.
However, results are inconsistent across surveys and methodologies,
and the contribution of substance abuse has rarely been measured. In
this study, 80 creative artists were compared with 80 matched
noncreative controls on the Annett Hand Preference Questionnaire
(HPQ), the Peters et al. Delusions Inventory, and the General Health
Questionnaire. Creative artists were statistically more likely to admit
the use of the left hand on the HPQ, with more widespread left hand
use reported by artists involved in the creative activities traditionally
associated with the right hemisphere (music and painting). They also
scored higher on the Peters et al. Delusions Inventory independently
from the level of psychopathology (measured with the General
Health Questionnaire), from their laterality score (measured with the
HPQ), and from their higher use of both licit and illicit drugs.
Key Words: Creativity, delusions, substance abuse, psychosis,
handedness.
(J Nerv Ment Dis 2007;195: 837– 845)
C reative individuals often report odd sensory and percep-
tual experiences, and cognitive similarities have been
observed between creative and schizophrenic individuals,
such as loose associations, broad attentional focus, ability to
connect novel information, and so on (Cattell and Drevdahl,
1955; Dykes and McGhie, 1976; Richards, 2001; Rothen-
berg, 1990; Woody and Claridge, 1977). Past studies found
creative individuals scoring higher on psychopathologic
scales in standardized tests, particularly on the scales that
measure traits of psychoticism (Brod, 1997; Burch et al.,
2006; Nettle and Clegg, 2006; Schuldberg, 1988). However,
results are inconsistent across surveys and methodologies,
and the contribution of substance abuse was rarely measured,
*Department of Psychology, University of Cagliari; and †Genneruxi Medical
Center, Cagliari, Italy.
Send reprint requests to Antonio Preti, MD, Centro Medico Genneruxi, via
Costantinopoli 42, I-09129 Cagliari, Italy. E-mail: apreti@tin.it.
Copyright © 2007 by Lippincott Williams & Wilkins
ISSN: 0022-3018/07/19510-0837
DOI: 10.1097/NMD.0b013e3181568180
The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007
despite some studies reporting higher rates of substance-
related problems among creative people (Schildkraut et al.,
1994; Wills, 2003), and the evidence of important links
between substance abuse and psychosis proneness (Arsene-
ault et al., 2002; Stefanis et al., 2004).
The reporting of delusion-like or hallucinatory experi-
ences is predictive of the future development of a mental
disorder in the spectrum of psychosis (Chapman et al., 1994;
Kwapil et al., 1997; Miller et al., 2002), but the exact nature
of this kind of unusual subjective experiences in the general
population is still disputed (Bell et al., 2006; Preti et al.,
2007a). In the past, it was argued that higher reporting of
unusual subjective experiences by people diagnosed with
schizophrenia rests on their higher frequency of abnormal
hemispheric lateralization (Dragovic and Hammond, 2005;
Satz and Green, 1999; Sommer et al., 2001). In schizophre-
nia, several studies reported an excess of nonright handed-
ness, decreased language lateralization on the dichotic listen-
ing paradigm, and decreased or reversed anatomic asymmetry
(Dragovic and Hammond, 2005; Satz and Green, 1999; Som-
mer et al., 2001). In the general population, mixed handed-
ness is more common in people who score high on measures
of psychosis proneness and schizotypy (Chapman and Chap-
man, 1987; Kim et al., 1992; Preti et al., 2007c; Richardson,
1994; Shaw et al., 2001).
Among creative people, too, some reports found an
excess of nonright handedness compared with controls
(Aggleton et al., 1994; Hassler and Gupta, 1993). Nonright
handedness can be conceived as a marker of disrupted brain
lateralization in cognitive functions, which, in turn, would
lead creative people to report higher rates of unusual subjec-
tive experiences, although these are not themselves a marker
of psychosis. As a matter of fact, the evidence is sparse but
convergent that neurodevelopmental abnormalities, as in-
dexed by obstetric complications, are implicated in both
schizophrenia and atypical handedness (Cannon et al., 2002;
McKeever et al., 1995; Preti and Miotto, 2005; Richardson,
1994; Sperling et al., 1999). Atypical hemispheric lateraliza-
tion, as measured by nonright handedness, would increase the
chance that the perceptual abnormalities—induced by sub-
stance use and/or faulty reasoning prompted by psychological
distress—result in hallucinatory-like experiences and delu-
sion-like beliefs, and act as a moderator on the effects raised
by substance use and/or psychological distress (Fig. 1).
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FIGURE 1. Model describing the impact of creativity (predictor) on the reporting of unusual subjective experiences (outcome)
through the mediator effect of substance use and psychological distress. Atypical hemispheric lateralization (as measured by
nonright handedness) is expected to increase the chance that substance use and/or psychological distress would lead to the
reporting of unusual subjective experiences, acting as a moderator on the risk of unusual subjective experiences raised by sub-
stance use and/or psychological distress.

The Peters et al. Delusions Inventory (PDI), aimed at
investigating psychosis proneness in the general population,
proved able to measure this kind of unusual subjective expe-
riences with enough validity and reliability. It was also found
reliable enough and valid in distinguishing people diagnosed
with a psychotic disorder from putatively healthy people
(Peters et al., 1999, 2004; Preti et al., 2007b), and predictive
of the risk of future psychosis diagnosis, at least in the
spectrum of affective disorders (Verdoux et al., 1999). This
study set out to investigate whether the reporting of unusual
subjective experiences, measured with the PDI, is related to
nonright handedness in creative people, taking into account
levels of psychopathology and substance use. To measure
psychological distress, we used the 12-item version of the
General Health Questionnaire (GHQ), a self-compiled ques-
tionnaire aimed at exploring the psychic distress of a clini-
cally relevant nature (Goldberg, 1972; Politi et al., 1994);
experience with psychoactive substances was evaluated by
direct questioning. To analyze mediational paths, we relied
on the bootstrapped sampling distribution models developed
by Preacher and Hayes (2004) and the related SPSS compat-
ible software. Bootstrapping relies on sample data only, with
no recourse to distributional assumptions, which should allow
unbiased testing of models.
METHODS
Participants
The study was approved preliminarily by the ethical
board on clinical investigation of the Department of Psychol-
ogy of the University of Cagliari. This ethical board evaluates
all planned studies involving human subjects with respect to
their usefulness, no harm whatsoever for participants, and
evidence that the study does not expose the involved subjects
to negative stigma or to any prejudice.
One hundred sixty participants completed the question-
naires, 80 of whom were professionally involved in a creative
artistic activity (30 musicians, 25 painters, and 25 writers)
and 80 subjects practiced noncreative professions.
Criteria for inclusion in the index group (hereinafter
“artists”) were: to be involved in an artistic profession requir-
ing the production of brand-new, original works, to have been
regularly paid for this activity, to have been exposed to public
judgment of the produced works via an exhibition (for paint-
ers), public execution of musical compositions (for musi-
cians), and publication of books (for writers). A great major-
ity of artists were also carrying on another profession at the
time of the investigation. Most were teachers in their specific
field of expertise; painters were teaching at a local school of
art, musicians taught at a local conservatory, and writers were
often teachers in humanities.
Criteria for inclusion in the contrast group (hereinafter
“controls”) were: to be involved in a profession requiring the
repetition of activities that contain no element of innovation;
to have never been paid for a creative work, in any field; to
have never been exposed to public judgment of any creatively
produced work, in any field. Controls were mostly teachers in
the field of humanities or sciences at the local secondary
school or else they were technicians or white collars in a
major national telecom company.
All subjects were Italians and based in the area of
Cagliari or Sassari, the 2 largest towns of Sardinia, a major
island of Italy. The mean age was 41.7 years (SD ⫽ 14.7;
median ⫽ 39) among artists, and 48.4 years (SD ⫽ 7.7;
median ⫽ 50) among controls. Table 1 lists the major
sociodemographic characteristics of the sample.
Measures
Each participant was guaranteed confidentiality of the
investigation and subsequently received a booklet containing
the questionnaires listed here below, which they were asked
to complete.
The 12-Item GHQ
This scale is a 12-item self-report questionnaire on
which respondents rate the degree of their psychological
distress—according to the major symptoms area of mental
disorders— on a 4-point scale (“not at all,” “less than usual,”

838 © 2007 Lippincott Williams & Wilkins

The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007
TABLE 1. General Characteristics of the Sample (N ⫽ 160)
Creative People (n ⴝ 80)
Sociodemographic Group n (%)
Gender
Male 50 (62.5)
Female 30 (37.5)
Age
20–35 37 (46.2)
36–50 18 (22.5)
⬎51 25 (31.3)
Highest level of parental education
Lower than high school diploma 34 (42.5)
High school diploma 25 (31.3)
College graduate or higher 21 (26.3)
Marital status
Unmarried 46 (57.5)
Occupational status
Unemployed or retired 15 (18.7)
Employed 65 (81.3)
“more than usual,” and “rather more than usual”). Partici-
pants marked the presence or the absence of 12 different
symptoms within the past 4 weeks (Goldberg, 1972; Politi et
al., 1994). Sample items are “Have you recently been feeling
unhappy and depressed?” “Have you recently lost much sleep
over worry?” and “Have you recently felt you couldn’t
overcome your difficulties?” For the purpose of this study,
the respondents who marked any statement (e.g., “Have you
recently lost much sleep over worry?”) in the scale applying
to them “rather more than usual” or “more than usual” scored
1, whereas those reporting “less than usual” or “not at all”
scored 0 (so called “0-0-1-1 method,” maximum score ⫽ 12);
this scoring method proved reliable enough to discriminate
people suffering from a mental disorder from putatively
healthy subjects (Politi et al., 1994). The aggregate scores
equal to 4 or higher (out of 12) typically classify cases of
common mental disorder, including adjustment disorders or
stress reactions. The validity, internal consistency, and test-
retest reliability of the Italian version of the GHQ-12 had
been confirmed in studies that also proved its validity as a
screening instrument for mental disorders (Politi et al., 1994).
In the sample, reliability of the GHQ-12 measured by Cron-
bach ␣ was 0.86.
The PDI
This questionnaire was designed to measure unusual
subjective beliefs and experiences pertaining to the dimen-
sion of delusional ideation, in the general population (Peters
et al., 2004). The 21 original questions are derived from items
used in the Present State Examination (Wing et al., 1974) to
assess delusional symptoms, but they are mitigated by, and
aim at exploring, a lifetime experience using the introductory
expression “do you ever feel as if . . .” (e.g., “Do you ever
feel that you are especially close to God?” “Do you ever feel
as if someone is deliberately trying to harm you?”). The
doubting form of the queries was thought appropriate to
© 2007 Lippincott Williams & Wilkins
Creativity and Psychosis Proneness
Controls (n ⴝ 80)
n (%) Statistics
␹2关1兴 ⫽ 6.41, p ⫽ 0.011
33 (41.2)
47 (58.8)
␹2关2兴 ⫽ 31.03, p ⫽ 0.0001
6 (7.5)
36 (45.0)
30 (37.5)
␹2关2兴 ⫽ 18.64, p ⫽ 0.0001
55 (68.7)
22 (27.5)
3 (3.8)
␹2关1兴 ⫽ 18.98, p ⫽ 0.0001
18 (22.5)
␹2关1兴 ⫽ 14.62, p ⫽ 0.0001
0 (0.0)
80 (100.0)
explore feelings and beliefs concerning experiences that are
not necessarily within the dimension of psychopathology.
The Italian version of the PDI (Preti et al., 2002) proved able
to discriminate patients diagnosed with psychosis from con-
trols devoid of mental disorders with a sensitivity ⫽ 0.74 and
a specificity ⫽ 0.79 (AUC ⫽ 0.815) (Preti et al., 2007b). In
the sample, reliability of the PDI measured by Cronbach ␣
was 0.73.
The Annett Hand Preference Questionnaire
Annett Hand Preference Questionnaire (HPQ) was de-
signed to elicit hand preference from a list of twelve major
actions, 6 that can be done with 1 hand (primary actions) and
6 requiring the use of both hands, with 1 hand doing the main
part of the action (nonprimary actions) (Annett, 1970). Sub-
jects are asked if they preferentially use the right hand, the
left hand or either in the following actions: writing, throwing,
wielding a racket, striking a match, hammering, and brushing
teeth (primary actions), using scissors, threading a needle,
sweeping with a broom, using a shovel, dealing cards, and
opening a jar (nonprimary actions). A total laterality score is
obtained by summing up all left-hand replies on the queries
(0 –12), and it is intended to measure a shift from dextrality in
the subject, according to Annett’s shift theory of a genetic
balanced polymorphism for cerebral dominance (Annett,
1995). Subjects were also assigned to 1 of 3 major groups:
fully dextral, when subjects reported a preference for the right
hand in performing the 6 primary actions; fully sinistral,
when subjects reported a preference for the left hand in
performing the 6 primary actions; ambidextral or mixed when
subjects were inconsistent in reporting a preference for the
hand that performs the 6 primary actions, i.e., they reported a
preference for 1 hand in some of the 6 primary actions, and
for the other hand on some other actions, or mark 1 or more
“either” answers to the query. The scale had been consistently
used and tested for reliability and theoretical validity, and it
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Preti and Vellante The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007
is one of the most commonly used and highly respected
inventories to investigate handedness (Annett, 1995; Bishop,
1990). In the sample, reliability of the HPQ measured by the
Cronbach ␣ was 0.96.
Experience with psychoactive substances was evalu-
ated by direct questioning. The participants were asked
whether they had ever used any psychoactive substance taken
from a list including alcohol, nicotine, cannabis, ecstasy,
LSD, amphetamine and their derivatives, heroin, cocaine,
solvents. Rating was allowed on a 3-point rating system (0 ⫽
never; 1 ⫽ yes, until 1 year ago or more; 2 ⫽ yes, still now,
in the last 30 days). Two scores were produced: an estimation
of past experimentation with the substance (subjects ticking
1); and an estimation of current use (subjects ticking 2).
These scores were summed up too, to produce a total score on
the use of substances (drugs), with higher scores correspond-
ing to a greater experimentation with psychoactive sub-
stances: we also derived a licit score for current use of alcohol
and nicotine (in a yes or no format), and a total illicit score for
current use of cannabis, heroin, cocaine, amphetamine, and
psychedelic substances (again, in a yes or no format).
Statistical Analysis
All data were coded and analyzed using the SPSS. All
tests were 2-tailed, with a conservative ␣ ⫽ 0.01 due to
multiple statistical analyses. Effect size was measured by
Cohen d (standardized mean difference, the difference in
means divided by within-group standard deviation; d around
0.20 ⫽ small effect, d around 0.50 ⫽ medium effect, and d
around 0.80 ⫽ large effect) (Cohen, 1988).
To investigate the intervening effect of a mediator
variable, to the extent that it accounts for the relation between
the predictor and the criterion, we used a mediational path
model according to Baron and Kenny (1986). The media-
tional hypothesis reflects causal hypotheses about variables;
in this approach, the relationship between an independent
variable and a dependent variable is decomposed into direct
and indirect (mediated) effects. Mediation implies a causal
hypothesis whereby an independent variable causes a medi-
ator, which, in turn, causes a dependent variable: when the
effects of the candidate mediator are controlled, a previously
significant relationship between the predictor and the out-
come of interest is significantly reduced or abolished (MacK-
innon et al., 2002). In moderated mediation, the strength of
the indirect effect (i.e., the one caused through the mediator)
depends on the level of a third factor (moderator) acting on
the chain of causation (Figure 1).
To test our mediation hypotheses, we used the boot-
strapped sampling distribution models developed by Preacher
and Hayes (2004) by resorting to the related SPSS-compati-
ble software (www.quantpsy.org/). Bootstrapping is accom-
plished by taking a large number of samples of size n (where
n is the original sample size) from the data, sampling with
replacement, and computing the indirect effect according to
the specified hypothesis, in each sample. In other words, in
bootstrapping the sample is conceptualized as a pseudopopu-
lation that represents the broader population from which the
sample was derived, and the sampling distribution of any
statistics can be generated by calculating the statistics of
840
interest in multiple resamples of the data set. This method is
particularly suited to test mediational hypotheses in small
samples (Preacher and Hayes, 2004), as the one involved in
this study. We used a 95% bootstrapped confidence interval
(CI) to test for statistically significant levels of the indirect
effects of mediators: whenever CIs did not include the zero
point (i.e., they were both positive or negative), the effects
reached a statistically significant level; if it did not happen
(i.e., the CIs were 1 positive and 1 negative), the effects did
not reach a statistically significant level.
RESULTS
General Characteristics of the Sample
The sample included a higher fraction of men among
artists than in controls: 50 (62.5%) versus 33 (41.2%), ␹2,
with Yates correction ⫽ 6.40, df ⫽ 1, p ⫽ 0.011.
Artists were, on average, younger than controls: t ⫽
3.57; p ⫽ 0.001. They were also more likely to be unmarried
(⫼2, with Yates correction ⫽ 18.98; df ⫽ 1; p ⫽ 0.0001), to
rate themselves as unemployed or retired (⫼2, with Yates
correction ⫽ 14.62; df ⫽ 1; p ⫽ 0.0001), and to come from
families where 1 parent had a university degree or a higher
level of education (⫼2 ⫽ 18.64; df ⫽ 2; p ⫽ 0.0001). Artists
were more likely to be an only child: 11 (13.8%) versus 0
(0%); and to be childless: 49 (61.3%) versus 16 (20%).
Measures of Psychopathology
Among artists, mean scores for PDI were 5.3 (SD ⫽ 3.1;
median ⫽ 5; mode ⫽ 5; min ⫽ 0, endorsed by 10%; max ⫽ 14,
endorsed by 1%); among controls, mean scores for PDI were
3.3 (SD ⫽ 2.5; median ⫽ 3; mode ⫽ 2; min ⫽ 0, endorsed
by 14%; max ⫽ 11, endorsed by 1%). Artists scored higher
on the PDI than controls (Student t test, after Levene correc-
tion (df ⫽ 158): 4.52; p ⫽ 0.0001; Cohen d ⫽ 0.71). Artists
had no higher scores than controls on the GHQ: 1.7 (SD ⫽
2.4) versus 1.8 (SD ⫽ 2.9), Student t test, after Levene
correction (df ⫽ 158): 0.86; p ⫽ 0.38. On the whole, those
who scored higher than the suggested cutoff on the GHQ-12
were 12 artists (15%), and 16 controls (20%) (p ⫽ 0.56).
Across the sample we detected no link between sex,
age, or level of parental education, on the one hand, and
GHQ-12 or PDI scores on the other.
Artists were statistically more likely to have experi-
enced both licit and illicit psychotropic substances compared
with controls (Table 2). On the whole, they were barely more
likely to be current users of licit drugs (alcohol and nicotine)
than controls: 51 (64%) versus 38 (47%), chi square, with
Yates correction ⫽ 3.64, df ⫽ 1, p ⫽ 0.054. On the other
hand, they were more consistently current users of illicit
drugs than controls: 15 (19%) versus 1 (1%), chi square, with
Yates correction ⫽ 11.73; df ⫽ 1; p ⫽ 0.001.
Male sex and younger age were statistically related to
illicit drugs use and to greater experimentation with psycho-
active substances (p ⬍ 0.0001).
Handedness
Controls were more likely to report a right-hand pref-
erence on the HPQ. As a consequence, their laterality score
© 2007 Lippincott Williams & Wilkins
The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007 Creativity and Psychosis Proneness

TABLE 2. Pattern of Psychoactive Substance Use in Our Sample: All Comparisons, df ⫽ 2

Artists (n ⴝ 80) Controls (n ⴝ 80) Statistics
Past Use (%) Current Use (%) Past Use (%) Current Use (%) ␹ 2
p
Alcohol 30 60 42 40 6.56 0.038
Tobacco 46 30 39 25 2.97 0.22
Marijuana or hashish 25 19 7 1 26.43 0.0001
Cocaine 11 0 1 0 6.82 0.022
Amphetamine or ecstasy 11 0 1 0 6.82 0.022
Nonprescribed sedative 9 1 5 2 1.17 0.55
LSD or hallucinogens 12 1 1 0 9.03 0.011
Heroin or opiates 2 0 0 0 2.02 0.15
Inhalants 2 0 1 0 0.34 0.56

on the HPQ was sensibly lower than among artists: 0.2 (SD ⫽ (drugs) associated to higher scores on the PDI. Artists had
1.14) versus 1.6 (SD ⫽ 3.6), t ⫽ ⫺3.41, df ⫽ 158, p ⫽ 0.001. higher scores on the PDI, even taking sex and age into
The very large standard deviation in the laterality score account. When taking the role of the 3 putative mediators into
among artists is a reflection of a statistically higher rate of account, the direct effect of being an artist decreased on PDI,
nonright handedness among them. Among artists, 65 were but still the link remains statistically significant (Table 3).
fully dextral (81%), 5 were fully sinistral (6%), and 10 Only the measure of experimentation with substances (drugs)
ambidextral or mixed (12%). Among controls, instead, 78 exerted a statistical effect as a mediator in the links between
were fully dextral (97%), 0 fully sinistral (0%), and 2 ambi- group membership and PDI: both singularly (Bootstrapped
dextral or mixed (3%). The difference was statistically sig- 95% CI ⫽ 0.13– 0.93), and in combination with the GHQ-12
nificant: ⫼2 ⫽ 11.51, df ⫽ 2, p ⫽ 0.003. scores (95% CI ⫽ ⫺0.96 to ⫺0.06), or with the laterality
Writers had no fully sinistral, and 5 ambidextral or score (95% CI ⫽ 0.19 –1.10). The fit of the model is sub-
mixed hand (20%) subjects; painters had 3 ambidextral (12%) stantial and accounts for about 23% of the variance in the
and 2 fully sinistral (8%) subjects; musicians had 2 ambidex- distribution of variables in the sample.
tral (6%) and 3 fully sinistral (10%) subjects. As for controls, Atypical hemispheric lateralization, as indexed by the
there was 1 ambidextral (3%) among teachers in humanities laterality score of handedness, might still exert a moderating
(n ⫽ 30), and another 1 (3%) among teachers in sciences action on the impact of substance use on the chance of reporting
(n ⫽ 30). Technicians or clerks (n ⫽ 20) were all fully dextral.
In the sample as a whole, there were no links between
laterality and sex, age, or level of parental education. Those
classified as ambidextral or mixed handed were more likely to TABLE 3. Mediational Analysis of the Links Between
endorse the items on the PDI positively (4.7 ⫾ 1.9) than those Creativity and Unusual Subjective Experiences (Model 1.
Criterion*)
classified as right handed (4.3 ⫾ 3.1) or left handed (4.4 ⫾
3.2), but the difference was not statistically significant (nor on Coefficient SE t p
ANOVA: F ⫽ 0.11; df ⫽ 2/157; p ⫽ 0.89; neither on Profession to mediators (a paths)
Kruskal–Wallis test. ␹2 ⫽ 0.43, df ⫽ 2, p ⫽ 0.80). GHQ ⫺0.12 0.45 ⫺0.28 0.77
Drugs 0.83 0.31 2.65 0.0088
Mediational Paths Laterality 1.38 0.45 3.02 0.0029
We explored the hypothesis that higher psychopathol- Direct effects of mediators on PDI (b paths)
ogy (as measured by GHQ-12 scores), use of psychotropic GHQ ⫺0.12 0.08 ⫺1.61 0.10
substances (as measured by our drugs score), and/or a greater Drugs 0.57 0.11 4.95 0.00001
shift from dextrality (as measured by our laterality score) Laterality ⫺0.80 0.07 ⫺1.01 0.30
related to and influenced the reporting of psychotic-like Total effect of profession on PDI
beliefs and convictions on the PDI in our sample. We sur- Profession 2.32 0.48 4.80 0.00001
mised that psychological distress, experimentation with drugs Direct effect of profession on PDI through GHQ, drugs and laterality
and/or shift from dextrality would serve as mediators between Profession 1.94 0.45 4.08 0.0001
group membership (artists vs. controls) and psychotic-like Partial effect of control variables on PDI
subjective convictions and experiences. In consideration of Sex (m ⫽ 1) ⫺1.34 0.45 ⫺2.95 0.0036
gender and age differences in group membership, all analyses Age 0.04 0.01 2.22 0.0275
were done taking sex (males ⫽ 1; females ⫽ 0) and age into
*Dependent ⫽ PDI, independent ⫽ profession, (artists ⫽ 1; controls ⫽ 0),
account as a covariate. mediators ⫽ psychopathology (GHQ), substance use (drugs), laterality. Statistical
The results confirmed that artists had higher rates of controls: sex, age. Sample size ⫽ 160. Fit of the model R2 ⫽ 0.26 adj. R2 ⫽ 0.23, F ⫽
substance use and laterality scores than controls. Results also 9.06, df ⫽ 6/153, p ⬍ 0.0001.
No. bootstrap resamples ⫽ 5000.
indicated that female sex and experimentation with substance

© 2007 Lippincott Williams & Wilkins 841

Preti and Vellante The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007

higher PDI scores, as depicted in the model reported in Figure their having greater current psychopathology than noncreative
1. We explored the hypothesis with a moderated mediation people, nor does it depend on some unusual brain lateralization
model whereby being an artist is linked to a higher chance of of cognitive functions among artists compared with nonartists.
substance use, which, in turn, leads to a higher reporting of Instead, the use of psychoactive substances partially explains
psychotic-like experiences and beliefs on the PDI, with hand- artists’ higher scores on the PDI when compared with controls.
edness (laterality) moderating the impact of substance use, However, greater reporting of unusual subjective experiences by
i.e., making it more likely that substance use results in higher artists remains significant on a statistical ground even when sex,
PDI scores. In this model, we find that our measure of age, and experimentation of licit and illicit psychoactive sub-
atypical brain specialization, based on handedness (lateral- stances are taken into account.
ization), did not interact with substance use (drugs) in ex- Artists reported a different pattern of hand preference
plaining PDI scores, but “lateralization” was statistically compared with controls: they were more likely to admit the use
significant in producing a conditional indirect effect with the of the left hand in some hand-performed actions than nonartists.
mixed-handed having the greater effect (Table 4). This corresponds to a higher prevalence of nonright handedness
among artists than controls, with left handers (fully sinistral)
DISCUSSION among musicians and painters only, and none among controls.
We found that creative artists were statistically more Neurologic studies suggest that there exist clear differences in
likely to report unusual subjective experiences of a delusion- the abilities involved in artistic performances, putatively linked
like nature when compared with a contrast group of nonar- to the specific brain areas involved in the creative process (areas
tists. This result lends support to past studies reporting higher of language, vision, hearing, and so on). Injuries in the nondomi-
schizotypy scores in artistic and creative people (Burch et al., nant hemisphere devastate artistic skills, even in previously
2006; Götz and Götz, 1979; Merton and Fisher, 1999; talented artists, but injury to the dominant hemisphere can leave
O’Reilly et al., 2001; Pearson and Clayden, 1982). the same skills relatively intact (Miller et al., 1998). Consider-
In our study, artists reported higher scores on the PDI, able evidence indicates that lesions to the right hemisphere
a questionnaire aimed at investigating psychosis proneness in disrupt painting and musical skills more severely than compa-
the general population, independently from their level of rable lesions in the left hemisphere (Alajouanine, 1948; Basso
psychopathology, measured by the GHQ-12, or from their and Capitani, 1985; Beatty et al., 1994; Miller et al., 2000). The
laterality score on the HPQ, a measure of hand preference higher preference for the left hand in some, or all, hand-
thought to be a reflection of brain hemispheres specialization performed actions investigated by Annett’s HPQ among musi-
(Annett, 1995). The higher reporting of unusual subjective cians and painters, therefore, could truly reflect more involve-
experiences by creative artists, therefore, is not a reflection of ment of the right hemisphere in their artistic professional
activities, and not merely the result of greater development of
both-hand skills due to their profession (this, however, may be
TABLE 4. Moderated Mediation Analysis of the Links true for musicians).
Between Creativity and Unusual Subjective Experiences Atypical hemispheric lateralization, as measured by the
(Model 2. Criterion*) HPQ, moderated the links between substance use and the
Coefficient SE t p reporting of unusual subjective beliefs on the PDI, with
mixed-handedness exerting the greatest effect (though at a
Mediator variable model (effects on substance use)
barely significant statistical level, bootstrapped p ⫽ 0.021).
Constant 4.21 0.64 6.50 0.00001
Past studies found that the use of psychoactive substances
Profession 0.83 0.31 2.65 0.008
might increase the chance of reporting unusual beliefs of a
Sex (m ⫽ 1) 1.03 0.30 3.41 0.0008
psychotic-like nature, particularly when it concerns cannabis
Age ⫺0.04 0.01 ⫺3.74 0.0003
abuse (Arseneault et al., 2002; van Os et al., 2002). It cannot
Dependent variable model (effects on PDI)
be excluded that the use of psychoactive substances might
Constant 0.58 1.06 0.55 0.58
intensify its propsychotic influence in a brain already affected
Profession 1.97 0.47 4.11 0.0001
by minimal neurodevelopmental abnormalities.
Drugs 0.53 0.12 4.35 0.00001
According to Annett (1998), a balanced genetic poly-
Laterality ⫺0.13 0.14 ⫺0.93 0.35
Drugs ⫻ laterality 0.02 0.04 0.54 0.58
morphism with heterozygote advantage would rule the dis-
Sex (m ⫽ 1) ⫺1.29 0.45 ⫺2.83 0.0052
tribution of hand preference, influenced by a gene for left
Age 0.04 0.01 2.19 0.029
hemisphere advantage. Nevertheless, the resulting right shift
Conditional indirect effects at specific values of the moderator (effects of
in hand skills would also imply random accidents of devel-
substance use on PDI) opment affecting individuals by chance, as evident in studies
Right handed 0.41 0.21 1.92 0.053 on twins showing monozygotic twins with opposite handed-
Mixed handed 0.45 0.19 2.30 0.021 ness: the mixed handed, more than the left handed, would be
Left handed 0.50 0.26 1.91 0.055 the result of accidental events affecting growth in uterus. In
fact, atypical cerebral asymmetry may result from the influ-
*Dependent ⫽ PDI. Independent ⫽ profession (artists ⫽ 1; controls ⫽ 0).
Mediators ⫽ substance use (drugs). Moderator ⫽ laterality. Statistical controls: sex, ence of both epigenetic and genetic factors, influencing neu-
age. Sample size ⫽ 160. rodevelopment and leading both to neurodevelopmental dis-
No. bootstrap resamples ⫽ 5000.
orders, such as dyslexia, autism, and schizophrenia, and

842 © 2007 Lippincott Williams & Wilkins

The Journal of Nervous and Mental Disease • Volume 195, Number 10, October 2007
increasing certain aspects of creativity (Smalley et al., 2005).
However, different hemisphere specialization and greater use
of drugs are not the reason for the higher reporting of unusual
subjective experiences on the PDI by artists compared with
controls. Even taking the laterality score and experimentation
with psychoactive substances into account, artists still score
higher on the PDI than nonartists.
The influence of some unmeasured factor on this result
cannot be excluded: in our study, artists were more prone to
discuss the meaning of the queries on the PDI than nonartists,
and were also more likely to offer alternative interpretations
of the single queries, which they also saw as trying to detect
unusual but feasible experiences, whereas nonartists invari-
ably interpreted queries as aiming at attributing a score on a
mental-health pathology. This attitude might be a reflection
of lower social desirability in artists, who are known to be
less concerned with norms and rules (Barron and Harrington.
1981; Burch et al., 2006). In fact, artists may have surmised
from the nature of the PDI questions (investigating unusual
and uncommon experiences and beliefs) that their role was to
endorse more eccentric or unconventional responses on the
PDI. On the other hand, the questions of the GHQ-12 (con-
cerning more common experiences, such as having poor sleep
and the like) might have not evoked unconventional answers,
thus limiting differences between groups. In our study, in-
deed, artists and controls did not differ on a well-validated
screening instrument for the identification of psychopathol-
ogy (GHQ-12). This is at odds with past studies reporting a
higher prevalence of lifetime mental disorders among cre-
ative people (Akiskal and Akiskal, 1988; Andreasen, 1987;
Lauronen et al., 2004; Ludwig, 1994). To reconcile the
discrepancy of our results with past investigations, we can
surmise that the resorting to self-report questionnaires in
identifying the presence of psychopathology might have lim-
ited the finding of differences by group. The GHQ-12 is
effective in ascertaining current psychopathology, but its
temporal window is limited to 4 weeks. The results of
empirical research now suggest, unambiguously, that promi-
nent social and artistic creativity is associated primarily with
affective, and more specifically with bipolar affective ill-
nesses (Lauronen et al., 2004; Rihmer et al., 2006). Subjects
with bipolar disorder can oscillate between depression and
hypomania or mania episodes, but those who carry on pro-
ductive lives, as is the case of our group of artists, are more
likely to benefit from longer euthymic phases. In a recent
study including 49 subjects with bipolar disorder, for exam-
ple, participants were administered creativity measures dur-
ing their euthymic phase: they scored significantly higher on
a measure of creativity, the Barron-Welsh Art Scale, com-
pared with healthy controls, with scores in the range of those
reported by creative subjects devoid of current psychiatric or
substance abuse problems; on the other hand, their scores on
a widely used measure of depressive symptoms, the Beck
Depression Inventory, were largely below those normally
encountered in clinical depression, averaging 4 ⫾ 3.8 (Santosa
et al., 2006). Because we were unable to administer any
diagnostic interview to our subjects, we could have missed
past episodes of psychopathology in our participants. The
© 2007 Lippincott Williams & Wilkins
Creativity and Psychosis Proneness
PDI, instead, given the nature of its queries (“do you ever feel
as if . . .”), taps into lifetime experiences and patients with
bipolar disorder were found to score on the PDI as high as
patients diagnosed with schizophrenia (Preti et al., 2007a).
Besides the exclusive relying on self-report question-
naires, another limitation restricts the generalization of the
findings of this study: the small sample size. Small sample
size is an unavoidable consequence of professional creativity
being rare in the general population: therefore, the study of
the psychological and cognitive correlates of creativity in
professional artists, the “creative” by antonomasia, will al-
ways face this restriction. Moreover, despite being curious by
nature, creative people are also rather reluctant to expose
themselves to investigation: the use of anonymous self-report
questionnaires was the best solution to respect the desire of
many of the participants to this study to avoid too an invasive
inquiry on their private psychological domains.
In conclusion, the results of this study confirm the links
between creativity and the reporting of unusual subjective be-
liefs and experiences that can be assimilated to delusion-like
thoughts. We also found that creative artists are more likely to
report a preference for the left hand in manual activities, with
more left-hand reporting among the artists involved in creative
activities traditionally associated with the right hemisphere
(Basso and Capitani, 1985; Mead and McLaughlin, 1992; Miller
et al., 2000; Vogt and Magnussen, 2005). The corroboration of
the findings with laboratory measurements of both creativity and
cognitive functions is required before the implication of these
results can be taken for granted.
ACKNOWLEDGMENTS
The authors thank Ms. Vittoria Rubino for her help in
the revision of the English translation and Dr. Kristopher J.
Preacher for his helpful suggestions.
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