Psychological framework to understand interpersonal violence by forensic patients with psychosis

Sinéad Lambe, Kate Cooper, Seena Fazel, Daniel Freeman

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited.

Aims
To develop a testable psychological framework explaining violence in psychosis – grounded in patient experience – to guide targeted treatment development.

Method
We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis.

Results
Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour.

Conclusions
The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.
Original languageEnglish
Pages (from-to)47-54
Number of pages8
JournalThe British Journal of Psychiatry
Volume224
Issue number2
Early online date20 Oct 2023
DOIs
Publication statusPublished - 29 Feb 2024

Bibliographical note

Data availability
The data are not publicly available because they contain information that could compromise the privacy of research participants. The data may be made available from the corresponding author, S.L., on reasonable request.

Funding
The study was funded by a National Institute for Health and Care Research (NIHR) Doctoral Fellowship awarded to S.L. (NIHR301483). It was also supported by the NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005).

Funding Information:
The study was funded by a National Institute for Health and Care Research (NIHR) Doctoral Fellowship awarded to S.L. (NIHR301483). It was also supported by the NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005).

Data Availability Statement

The data are not publicly available because they contain information that could compromise the privacy of research participants. The data may be made available from the corresponding author, S.L., on reasonable request.

Keywords

  • Keywords:
  • Psychotic disorders/schizophrenia
  • forensic psychiatry
  • qualitative research
  • risk assessment
  • violence

ASJC Scopus subject areas

  • Psychiatry and Mental health

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