A systematic review of the relationship between impulsivity and violence in persons with psychosis: Evidence or spin cycle?

Individual differences in impulsive traits have been associated with a number of deviant behaviors, and impulsivity has been assumed to play a critical role in the manifestation of violent and other criminal behavior. Despite frequent citations of a positive association between impulsivity and violence in persons with psychosis, conflicting findings in the research literature elicited this systematic review. The main aims were to examine the empirical evidence of the association and to determine whether the research design and measurement used were sufficient for testing a possible causal relationship. Two types of empirical evidence were searched for in keeping with the traditional trait-state dichotomy: documentation of the direct impact of impulsivity on carrying out the violent act (state), and documentation of elevated levels of impulsivity in a person and increased occurrence of violent acts (trait). Searches that were conducted in six databases resulted in one study that supported the association and three that did not. Only 2 out of 22 estimates obtained from bivariate analysis indicated evidence of an impulsivity–violence link. No single study had a design that yielded data on a direct impact of impulsivity on carrying out the violent act (i.e., the state aspect of the association).     

Gef?hrliche N?he

The author examines the association between trauma and psychosis. To illustrate this he presents clinical examples of active and passive experiences of violence by adult psychotic patients, for whom forerunners in the form of childhood experiences of violence were found in some psychoanalytical treatments. They take place in traumatic relationships. Recent empirical studies have shown that trauma plays an influential role in the pathogenesis of schizophrenia. Traumatic relationships have a contradictory structure which possesses an impressive similarity to the schizophrenic dilemma of adult psychotics. The author therefore considers the schizophrenic dilemma as an introspective manifestation of a traumatic relationship, a part of the violent nature of psychiatric institutions as re-enactment of the traumatic relationship.     

Psychotic dream-related aggression: A critical review and proposal

The relationship among parasomnias, sleep-related violence (SRV), and psychosis has neither been reported nor studied. The authors introduce the phenomenon of psychotic dream-related aggression (PDRA) and, through a review of the research on manifest dreams, the continuity of thinking across the sleep–wake cycle, and SRV, argue for its inclusion alongside the parasomnias of DSM-IV. Five cases are presented that illustrate this phenomenon, usually a male diagnosed with paranoid schizophrenia whose violent act toward another was closely associated with the manifest content of his nocturnal dreams and his inability to test reality. Differential diagnostic criteria are proposed to separate PDRA from other parasomnias that may be related to violence. Treatment and forensic implications are discussed.     

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.     

Suicidal and violent behavior: The role of anger,emotion dysregulation,and impulsivity

Suicidality and violence are serious public health problems. A rich literature supports the relationship between suicidality and violence, including common associations with trait anger. However, less is known about how trait anger may facilitate these behaviors. Two potential mechanisms in this relationship are emotion dysregulation and impulsivity, both of which are linked to increased anger, suicidality, and violence. We investigated anger as a common underlying factor for both suicidal and violent behavior, and emotion dysregulation and impulsivity (i.e., negative and positive urgency) as potential mediators in this relationship. Results demonstrate that trait anger was associated with both suicidal and violent behavior. Further, emotion dysregulation mediated the anger and suicidal behavior relationship whereas both negative and positive urgency mediated the anger and violent behavior relationship. Although trait anger may be a common underlying factor for both suicidal and violent behavior, the nature of these relationships seems to vary significantly.     

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.     

Testing the specificity postulate of the violence graduation hypothesis: Meta-analyses of the animal cruelty–offending relationship

The violence graduation hypothesis assumes a direct causal link between animal cruelty and interpersonal aggression. This hypothesis is based on two postulates: (1) that animal cruelty precedes interpersonal aggression, and (2) that the effect is specific to violent forms of antisocial behavior. The current study was designed to test the second of these two postulates: i.e., specificity. Comparing reports of prior animal cruelty in violent and non-violent prisoners and patients, a 14-study meta-analysis revealed that the violent group was significantly more likely to have a history of animal cruelty than the non-violent group. Although this seemed to support the violence graduation hypothesis, uncontrolled differences between the violent and non-violent groups provide an alternative explanation of these results. In a second meta-analysis using a different set of studies (k = 5), animal cruelty was found to correlate as well with non-violent offending as it did with violent offending in male and mixed gender samples. These latter results suggest that at least in males, the animal cruelty–offending relationship is not specific to violence and that theories other than the violence graduation hypothesis may be required to explain the modest association that exists between animal cruelty and violent offending.     

Does violence beget violence? A critical examination of the literature

Critically examines the "violence breeds violence" hypothesis broadly defined. Organized into seven sections, the literature review includes (a) the abuse breeds abuse hypothesis; (b) reports of small numbers of violent/homicidal offenders; (c) studies examining the relationship of abuse and neglect to delinquency, (d) to violent behavior, and (e) to aggressive behavior in infants and young children; (f) abuse, withdrawal, and self-destructive behavior; and (g) studies of the impact of witnessing or observing violent behavior. A detailed discussion of methodological considerations and shortcomings precedes the review. The author concludes that existing knowledge of the long-term consequences of abusive home environments is limited and suggests that conclusions about the strength of the cycle of violence be tempered by the dearth of convincing empirical evidence. Recommendations are made for further research.     

Effects of cultural themes in psychotic symptoms on the diagnosis of schizophrenia in African Americans

Cultural themes focusing on race-related issues and religiosity were identified via content analysis in the delusions and hallucinations of a sample of 118 African American psychiatric patients. The purpose of the study was to determine whether cultural themes in psychotic symptoms influence the diagnosis from different sources (i.e., chart, SCID, and best estimate) of schizophrenia for Black patients. It was hypothesized that the best estimate diagnoses of cultural experts would diagnose schizophrenia in African Americans more frequently when they exhibit race-related themes in their psychotic symptoms. It was also hypothesized that diagnosis of the paranoid subtype would yield a stronger difference among the sources than the broader category of schizophrenia. The results did not support the hypotheses. Implications for understanding the relationship between culture and psychosis among African Americans are discussed.     

Exposure to Violence and Socioemotional Adjustment in Low-Income Youth: An Examination of Protective Factors

Using a sample of 391 low-income youth ages 13–17, this study investigated the potential moderating effects of school climate, participation in extracurricular activities, and positive parent–child relations on associations between exposure to violence (i.e., witnessing violence and violent victimization) and adolescent socioemotional adjustment (i.e., internalizing and externalizing problems). Exposure to violence was related to both internalizing and externalizing problems. High levels of participation in extracurricular activities and positive parent–child relations appeared to function as protective factors, weakening the positive association between exposure to violence and externalizing problems. Contrary to prediction, school climate did not moderate associations between exposure to violence and socioemotional adjustment. Further, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems.     

Film violence and young offenders

Recent assertions have been made that viewing violent material on film and video may influence children and adolescents who commit violent acts. It has also been proposed that heavy exposure to television violence in childhood is associated with violent crime as an adult, although others have emphasized that experiencing “real” violence as a child has a much greater effect on aggressive predispositions. Ways in which screen violence can effect behavior includes: imitation of violent roles and acts of aggression, triggering aggressive impulses in predisposed individuals, desensitizing feelings of sympathy towards victims, creating an indifference to the use of violence, and creating a frame of mind that sees violent acts as a socially acceptable response to stress and frustration. It is argued that young offenders may like violent videos because of their aggressive background and behavioral tendencies. Whether such tastes reinforce violent behavior and increase the frequency of aggressive acts and antisocial behavior is open to question. This question needs an urgent answer given the availability of violent video film either to be viewed in the home environment appropriately (i.e., the whole film in real time) or inappropriately (i.e., from one violent scene to the next viewed in slow motion and freeze-frame).     

At Both Ends of the Gun: Testing the Relationship Between Community Violence Exposure and Youth Violent Behavior

Much psychological inquiry has focused on understanding the contribution that exposure to urban violence makes to violent behavior among youth. However, other ways in which these variables may be related have been largely overlooked. This study compared four alternative social–ecological models of the link between community violence exposure and violent behavior to determine the degree to which (1) community violence exposure contributes to violent behavior, (2) violent behavior contributes to community violence exposure, (3) both are consequences of common antecedents, and (4) both are manifestations of the same higher order construct. Two hundred and seventy-seven adolescent offenders were interviewed about family, neighborhood, cognitive, and peer characteristics, in addition to violent behavior and community violence exposure. Results suggest that a plausible way to understand the association between community violence exposure and youth violent behavior is to consider both as representations of a general involvement in violence.     

Thinking About the Future as a Way to Succeed in the Present: A Longitudinal Study of Future Orientation and Violent Behaviors Among African American Youth

Previous research has linked higher levels of hopelessness about one's future to violent behavior during adolescence; however, little is known about this relationship over time for adolescents. Using growth curve modeling, we tested the association between future orientation and violent behavior across the high school years of adolescence in a sample of African American youth (n = 681). Variation based on demographic characteristics (i.e., sex, SES, previous violence) was explored. At baseline, differences in violent behavior varied by demographic characteristics. Overall, violent behavior decreased with age. Higher levels of future orientation were associated with greater decreases in violent behavior over time. Demographic characteristics were not associated with change in violent behavior overtime. Our findings suggest that future orientation can act as a promotive factor for at risk African American youth. Interventions that help support the development of future goals and aspirations could play a vital role in violence prevention efforts.     

The effects of violent video games on adolescents: The overlooked influence of development

Recent acts of extreme violence involving teens and associated links to violent video games have led to an increased interest in video game violence. Research suggests that violent video games influence aggressive behavior, aggressive affect, aggressive cognition, and physiological arousal. Anderson and Bushman [Annu. Rev. Psychol. 53 (2002) 27.] have posited a General Aggression Model (GAM) to explain the mechanism behind the link between violent video games and aggressive behavior. However, the influence of violent video games as a function of developmental changes across adolescence has yet to be addressed. The purpose of this review is to integrate the GAM with developmental changes that occur across adolescence.     

Social anxiety and the shame of psychosis: a study in first episode psychosis

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.     

Movement abnormalities predict conversion to Axis I psychosis among prodromal adolescents

Evidence suggests that movement abnormalities are a precursor of psychosis. The link between movement abnormalities and psychotic disorders is presumed to reflect common neural mechanisms that influence both motor functions and vulnerability to psychosis. The authors coded movement abnormalities from videotapes of 40 adolescents at risk for psychosis (designated prodromal on the Structured Interview for Prodromal Symptoms; T. J. Miller et al., 2002). Following initial assessment, participants were evaluated for diagnostic status at 4 times annually. Ten participants converted to an Axis I psychosis (e.g., schizophrenia) over the 4-year period. Comparisons of converted and nonconverted participants at baseline indicated that the groups did not differ on demographic characteristics or levels of prodromal symptomatology, but those who converted exhibited significantly more movement abnormalities. Movement abnormalities and prodromal symptoms were strongly associated and logistic regression analyses indicated that abnormalities in the face and upper body regions were most predictive of conversion. Findings suggest that individuals with elevated movement abnormalities may represent a subgroup of prodromal adolescents who are at the highest risk for conversion. The implications for neural mechanisms and for identifying candidates for preventive intervention are discussed.     

Movement abnormalities and the progression of prodromal symptomatology in adolescents at risk for psychotic disorders

The link between movement abnormalities and psychotic disorders is presumed to reflect common neural mechanisms that influence both motor functions and vulnerability to psychosis. The prodromal period leading to psychotic disorders represents both a viable point for intervention and a developmental period that, if studied, could shed light on etiology; however, no published studies have examined the temporal progression of this link. A group with high levels of prodromal symptomatology (i.e., adolescents with schizotypal personality disorder [SPD]; n = 42) and both psychiatric controls (with other personality disorders or conduct disorder [OD]; n = 30) and nonpsychiatric controls ([NC]; n = 49) were recruited. Videotapes of structured psychiatric interviews were coded for movement abnormalities by raters blind to participants' diagnostic status, and follow-up assessments were conducted 1 year later. Controlling for psychotropic medications, the authors found that adolescents with SPD exhibited significantly more motor abnormalities in the face and upper body than did OD and NC controls. At baseline, movement abnormalities were positively correlated with the severity of positive, negative, and total prodromal symptoms. Within the SPD group, baseline movement abnormalities predicted symptom severity 1 year later. Movement abnormalities represent an early risk indicator that may be predictive of later symptom severity and potentially of psychosis onset.     

A review of the role of empathy in violence risk in mental disorders

Despite an established link between certain mental disorders and violence, the origins of this are not always clear. Recent work has suggested a role for social cognition deficits in this relationship. We conducted a systematic literature search using EMBASE, SCOPUS, PsychINFO, Science Direct and Ovid Medline databases and search terms relating to empathy, violence and mental disorders. 15 studies were classified as assessing either theory of mind (ToM) (n = 6) or facial affect recognition (FAR) (n = 10). Better mentalizing ability may be linked with violence. Violent patients with schizophrenia perform worse than those with personality disorder, but outperform their non-violent counterparts on complex theory of mind tasks. Six studies examined facial affect recognition in violent psychopathy patients, three of which found impairments in high psychopathy patients. Four studies investigated FAR in violent schizophrenia patients, who again tended to outperform non-violent patients, though the evidence for specificity of emotion remains mixed. Empathy may play a mediating role in the relationship between violence and mental disorder. Current findings are limited by methodological inconsistencies. Future studies would benefit from more comprehensive assessments of violence and co-morbidities, and more standardized measures across studies.     

Women who perpetrate intimate partner violence: A review of the literature with recommendations for treatment

The purpose of this article is to review the literature on women as perpetrators of violence in their intimate relationships (i.e., domestically violent women) and summarize the scant literature on intervention programs for these women. Particular attention is paid to the cultural influences that shape our conceptualization of “domestic violence” and the fact that empirical research suggests that domestic violence has been falsely framed as exclusively male initiated violence. The article concludes with a discussion of the similarities and differences between male and female domestic violence offenders and identifies areas where treatment for female offenders might be improved.