Decades of research have displayed a robust relationship between schizophrenia and enhanced aggression, with the majority of studies focusing on the role of co-morbid Axis-I disorders, including drug- and alcohol abuse, psychosis and arious other socio-demographic and clinical variables. However, only a few studies have examined the role of mentalizing abilities and personality pathology severity, and none have examined the role of attachment representations known to play a role in aggression. Furthermore, there is a paucity of research that differentiates between premeditated and impulsive aggression in schizophrenia. To this end, we conducted a cross-sectional study including 108 patients with schizophrenia to explore if a specific combination of mentalizing abilities, attachment representations and personality pathology severity pertain to premeditated aggression, controlling for essential clinical and socio-demographic variables. Findings reveal that a constellation of diminished mentalizing abilities, attachment pattern characterized by positive self-representations and negative representations of the other, and severe personality pathology, was associated with premeditated aggression. These results suggest that risk assessment of pathological aggression as well as future intervention programs targeted at reducing severe aggression in schizophrenia could benefit from including psychological functions such as mentalizing, as well as assessing personality pathology severity and attachment representations.
International Journal of Forensic Mental Health, 2013, Vol 12, Issue 2, p. 126-138