Psychotic symptoms and violence toward others — a literature review of some preliminary findings: Part 1. Delusions

The main scope of this paper is to delineate some findings from a review of the literature concerning the possible impact of delusions on violence toward others by psychiatric patients. According to this review, studies on a possible association between delusions and increased risk of violence are scarce, but steadily growing, and have shown some interesting results. However, since delusions are also common in nonviolent psychiatric patients, there is emerging evidence that our attention should be directed to specific hallmarks of delusions that indicate an increased risk of violence. Among the main findings of the present review are: the number of empirical studies were surprisingly low; about 80% of the studies were conducted during the last 8 years; and less than one third of the studies used a prospective design. Further findings were that persecutory delusions appear to increase risk of violence in some patients; co-occurence of persecutory delusions and emotional distress may increase risk of violence; and there is limited but tentative support to the existence of an association between symptoms of perceived threat and internal control override (TCO) and violence.     

Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations

Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.     

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as “incorrigible”, but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their “most important” delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive–behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions? In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?. Copyright © 2006 John Wiley & Sons, Ltd.     

Delusions and hallucinations of cocaine abusers and paranoid schizophrenics: a comparative study

We compared delusions and hallucinations of 100 cocaine abusers and 100 paranoid schizophrenic subjects admitted to an East Texas state psychiatric hospital. Subjects in both groups feared that individuals or organized groups might harm them in some way, but delusions of the paranoid schizophrenic subjects were more often bizarre than those of the cocaine abuse subjects. "Cocaine bugs" (parasitosis) were more often found in the cocaine abuse subjects. Command hallucinations were found in both groups, but the commands of the schizophrenic group more often related to harming or killing others. Cocaine abusers had a greater frequency of visual hallucinations (47 to 7), distinguished by shadows, flashing lights ("snow lights"), objects moving and bugs crawling on the arm. Finally, the most distinguishing characteristics were identity delusions, possession delusions, grandiose delusions (other than identities and possessions), and delusions that their families were imposters (Capgras Syndrome) reported by paranoid schizophrenics. No such delusions were reported by the cocaine abusers.     

Psychological processes and paranoia: implications for forensic behavioural science

Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending.     

Risk and dynamics of violence in Asperger's syndrome: A systematic review of the literature

The main purpose of this article is to delineate findings from a review of the literature on the empirical basis for the existence of a relationship between Asperger's syndrome (AS) and violence risk. A second aim is to examine whether certain characteristics of the disorder may have a higher violence-triggering potential. Results of this review show that there are very few empirical studies that confirm a stable link between AS and violence. Only 11 studies involving 22 patients and 29 violent incidents met the criteria for inclusion in the review after the search of the literature. However, a qualitative analysis of the studies yielded some indications of possible patterns of dynamics of violence that may prove to be typical of persons with AS. A tentative comparison of AS and psychopathy indicated that there may be qualitative differences in the characteristics of violent behavior between the disorders. Suggestions for further research are presented.     

Reciprocal maturities: Spirit and psyche in pastoral counseling and spiritual direction

This article uses a model for integrating spiritual and psychological maturity (Conn, 1989) in theological anthropology to contend that there is a reciprocal relationship not only between spiritual and psychological maturity but also between pastoral counseling and spiritual direction. I review Christian spirituality in terms of maturity in relationship: to self, to others, and to God. Next is an examination of the prevailing attitude in pastoral counseling toward spirituality and spiritual direction. Then Conn's integration is assessed — of spirituality with psychology, of spiritual direction with pastoral counseling — as a combination of spiritual and hermeneutical perspectives on the maturing self.     

Missing referents, psychotic symptoms, and discriminating the internal from the externalized

The communicative efficacy of the speech of schizophrenia patients is compromised by the presence of references for which there are no referents. There is evidence that this kind of error is positively associated with the genetic substrate of schizophrenia. The present study was an effort to identify a cognitive process source of these errors by looking at their association with performance on an internal source memory task assessing the ability to remember what one has said out loud versus only thought. Their relationship to psychotic symptoms also was examined. A sample of 110 schizophrenic/schizoaffective outpatients, and 23 nonpsychiatric controls provided 10-min speech samples and completed a battery of memory tests. Patients' symptoms also were rated for severity. Patients performed more poorly than controls on the memory tests, and their speech contained much more frequent references without referents. Frequency of missing referents was associated with scores on the test of internal source memory, even after scores on tests of immediate memory, working memory, and external source memory were regressed out. Missing referents were also related to severity of hallucinations and delusions, and internal source memory performance was related to hallucinations. The findings of this study support the idea that missing referents, hallucinations, and delusions have some common process underpinnings. Impairment in internal source memory appears to be one such process.     

Violent behavior in schizophrenic patients: relationship with clinical symptoms

Considerable evidence suggests that violent behavior observed in schizophrenic patients is motivated by psychotic symptomatology. The understanding of violence in schizophrenic patients requires consideration of psychiatric symptomatology. Objective: This study investigated the relationship between violent behavior and psychiatric symptomatology in schizophrenic patients. Method: One hundred and thirteen patients were recruited. Thirteen patients were excluded due to concomitant substance abuse six months prior to the assessment. Diagnoses were based on the SCID‐I. Psychotic symptom severity was assessed with the PANSS. Violent behaviors were assessed with the OAS. Results: Violent behaviors were associated with more severe psychotic symptomatology including hallucinations, delusions, excitement, poor impulse control, and thinking disturbances. Conclusions: Patients with exacerbation of psychotic symptomatology have an increased risk of violent behavior. It is necessary to determine which subtypes of hallucinations and delusions are implicated in the association of schizophrenia and violent behavior. Violent behavior in schizophrenic patients is a heterogeneous phenomenon best explained in the context of specific symptoms associated with violence and course of illness. The retrospective assessment of the variables raises methodological questions concerning the reliability of measurement of the impact of psychotic symptoms on violence. Aggr. Behav. 00:1–10, 2005. © 2005 Wiley‐Liss, Inc.     

Violence against women: Mental health effects. Part II. Conceptualizations of posttraumatic stress

A broad range of psychological aftereffects have been noted among women who have experienced male-perpetrated violence. These symptoms vary considerably among individuals, across social contexts, and across different types of violent encounters (Coley & Beckett, 1988; Goodman, Koss, & Russo, 1992; Koss, 1988; Straus, Gelles, & Steinmetz, 1980). Nevertheless, a remarkably consistent picture of the psychological sequelae of violence—particularly sexual and physical assault—emerges from the empirical and clinical literature (Koss, 1988). In this article, we use the posttraumatic stress disorder diagnosis—a frame that captures many of the disparate symptoms described by researchers—as a basis for exploring several conceptual models that have been developed to explain women's responses to violence.     

Metacognitions in proneness towards hallucinations and delusions

The objectives of the present study were to examine the degree of co-existence of hallucinations and delusions in the nonclinical population. In addition, we wished to investigate the role of metacognitions in hallucinations and delusions. Finally, we explored the relative roles of positive and negative metacognitive beliefs in proneness to hallucinations and delusions. Three hundred and thirty-one nonclinical participants completed instruments assessing: hallucination-proneness (Launay-Slade Hallucinations Scale; LSHS), delusion-proneness (21-item version of the Peters et al. Delusions Inventory; PDI-21) and metacognitive beliefs (Meta-Cognitions Questionnaire; MCQ). Participants were successively grouped according to their scores on the LSHS and the PDI-21. Results revealed that hallucination-proneness was positively and significantly associated with delusion-proneness. Furthermore, hallucination-prone and delusion-prone participants scored significantly higher on some sub-scales of the MCQ compared to non-prone participants. Finally, multiple regression analysis revealed that positive and negative beliefs were good predictors of proneness towards hallucinations and delusions.     

暴力视频游戏接触对大学生网络攻击行为的影响：一个有中介的调节模型

以946名大学生为被试进行问卷调查,探讨暴力视频游戏接触对大学生网络攻击行为的影响机制。结果表明：(1) 暴力视频游戏接触正向预测大学生网络攻击行为;(2) 特质愤怒在大学生暴力视频游戏接触与其网络攻击行为及暴力态度的关系中均具有调节作用;(3) 暴力态度不仅部分中介了大学生暴力视频游戏接触对其网络攻击行为的影响,而且部分中介了特质愤怒与暴力视频游戏接触的交互作用对大学生网络攻击行为的影响。     

The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play?

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD—substance-abuse relation. These studies have generally found that the ADHD—substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.     

Emotional Abuse and Psychosis: A Recent Review of the Literature

This article evaluates the published empirical findings on childhood emotional abuse and its proposed relationship with psychotic symptoms. Research and governmental policy indicates that emotional abuse is present in all forms of abuse and neglect, suggesting it is the form of abuse most frequently linked to mental health problems. Literature searches were conducted in 3 peer-reviewed electronic databases and relevant papers were reviewed. Results suggest childhood emotional abuse is statistically related to psychosis in adulthood. This adds tentative support to the hypothesis that emotional abuse is related to psychotic experiences; in particular to hallucinations and persecutory delusions. A number of studies also provide tentative support to the dose–response effect proposed between cumulative trauma and a greater risk of positive psychotic symptoms.     

Self‐Control Inhibits Aggression

Aggression brings tremendous costs to individuals, relationships, and society. Yet, people behave aggressively toward strangers and close others at alarmingly high rates. The current article seeks to unlock part of the mystery of why people behave aggressively. We review evidence that self‐control failure plays an integral role in many acts of aggression and violence. We begin by reviewing theoretical models that emphasize the importance of self‐control processes in understanding aggressive and other criminal behaviors. We also discuss how a theoretical model that originally neglected self‐control processes can be extended to incorporate self‐control theorizing. We then discuss recent empirical evidence (a) showing that self‐control failure is a crucial predictor of aggression toward strangers and romantic partners and (b) identifying the neural processes relevant to the self‐control of aggression. Finally, we review evidence that self‐control processes can also explain why people engage in displaced aggression toward bystanders. By appreciating the importance of self‐control processes, researchers and laypersons can gain a better understanding of why people behave aggressively – and how aggression can be prevented.     

The False Consensus Effect and Overconfidence: Flaws in Judgment or Flaws in How We Study Judgment?

Thefalse consensus effectand theoverconfidence in judgmenteffect are often referred to as established “facts” of psychology. At present, the empirical support for these effects is inadequate and logically flawed. We argue that, absent other information, using one's own response to a situation as an observation of size 1 could be an effective use of data and could lead to anincreasein the accuracy of predicting others’ behavior. In an empirical examination of such use, we find a robustpositivecorrelation between the degree to which people believe that a majority of others are like them and their accuracy in predicting those others’ responses, whether this correlation is evaluated within items across people, across items within people, or across items across people. In addition, we show that the finding of overconfidence in judgment follows analytically from the functional relationship used to demonstrate it, a “finding” that is easily reversed by considering the inverse relationship. Specifically, we argue that regression effects account for the evidence cited in support of overconfidence. While not definitive, our empirical findings call into the question the acceptance of these two effects—as commonly defined—as facts.     

Breastfeeding and the mother–infant relationship—A review

A positive effect of breastfeeding on the mother–infant relationship is often assumed in the scientific literature, but this has not been systematically reviewed. This review aims to clarify the role of breastfeeding in the mother–infant relationship, which is conceptualized as the maternal bond toward the infant and infant attachment toward the mother. Our findings indicate that theoretical mechanisms through which breastfeeding may enhance the maternal bond or infant attachment (i.e., endocrine and sensory factors involved in breastfeeding) can be found in both humans and animal models. However, the few empirical studies investigating this association have not found convincing support for a relation between breastfeeding and the quality of the mother–infant relationship. We therefore conclude that assumptions on a positive role of breastfeeding on the mother–infant relationship are not supported by empirical evidence, and recommendation of breastfeeding should solely be based on its well-documented positive effects on infant and maternal health.     

Acting on persecutory delusions: the importance of safety seeking

OBJECTIVE: Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions. METHOD: One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts. RESULTS: Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis. CONCLUSION: Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.     

Critical Issues in Using Homework Assignments Within Cognitive-Behavioral Therapy for Schizophrenia

Presents an overview of the research findings to date and practical guidelines for the use of homework in cognitive-behavioral therapy for schizophrenia. In particular, the article outlines strategies to combat the common difficulties experienced when using homework with clients with schizophrenia and the types of homework assignments that may be most helpful. The empirical evidence suggests that cognitive-behavioral therapy incorporating homework assignments help clients to improve at least 60% more than those in treatment without homework. Despite that most therapy formulations incorporate homework as an integral component of treatment for schizophrenia, prior research has identified that practitioners consider homework to be less helpful for clients with delusions and hallucinations. Interventions to enhance homework compliance in the treatment of clients with schizophrenia are outlined.     

Assessing the effects of factors that might underlie the differential perception of acquaintance and stranger rape

There is evidence to suggest that in an acquaintance rape the victim is perceived less favorably and there is more leniency toward the perpetrator than in a stranger rape. The purpose of the present study was to assess the perceptual effects of factors that might underlie this differential perception. Victim-perpetrator attraction and ambiguity in victim's desire for intercourse were varied since both are often perceived to occur at a much higher frequency in acquaintance rape than stranger rape. The design of the study was a 3 (victim-perpetrator attraction — minimal, moderate, maximal) × 2 (ambiguity in desire for intercourse — ambiguous, relatively unambiguous) × 2 (gender of subject — male, female) factorial. The results indicated that ambiguity had a significant effect on perceptions. More specifically, perception tended to be less favorable toward the victim and more lenient toward the defendant when there was ambiguity in the victim's desire for intercourse. Additionally, when compared to females, males' perception tended to be less favorable toward the victim and more lenient toward the perpetrator. There were no other significant main effects or interactions. The implications of these findings for the differential perception of acquaintance and stranger rape are discussed.