Background: Paranoid ideation and sleep problems are both prevalent in samples with psychotic disorders, and each is associated with impairment in social functioning. We sought to determine how paranoid ideation and sleep problems manifest in social behaviors and if these behaviors lead to social rejection from others.

Methods: This study examined the associations between paranoid ideation, sleep problems, social behaviors, and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Participants completed assessments related to paranoid ideation, sleep problems, and social functioning. We also examined behavioral ratings of social skills and displays of facial affect, and we assessed naive observers’ reactions towards participants.

Results: Greater paranoid ideation was related to observers reporting more negative reactions towards participants. Path analysis indicated that paranoid ideation was associated with observers reporting less willingness to interact with participants through poorer overall social skill. Sleep problems were also related to observers’ negative reactions towards participants, but this association was not related to social behaviors. Finally, paranoid ideation and sleep disturbance were associated with poorer real-world social functioning.

Conclusions: Paranoid ideation may manifest in social behaviors that evoke social rejection from others, which may contribute to paranoid beliefs being exacerbated or maintained. Further, sleep problems are linked to some facets of social rejection. Clinical interventions for paranoid ideation should address problematic social behaviors and sleep problems because they may contribute to social rejection and poor real-world social functioning.