4.2C Etiology of Offender Types Celine Tijssen (472686)
Summary | Literature
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Week 1
Darrell-Barry (2016). The relationship between paranoia and aggression in psychosis: a systematic
review.
Violence is higher in people with schizophrenia mostly occur during periods of active or untreated
psychosis → violence and aggression contributors to poor treatment.
• Aggression = behavior intended to harm, directed towards others
o Impulsive aggression = affectively driven and accompanied by higher levels of
autonomic arousal.
o Premeditated aggression = violent act that is planned and deliberately conceived.
• Violence = aggression that has extreme harm as its goal.
SO: all violence is aggression but not all aggression is violence!
• Symptoms of schizophrenia and represents the belief that one is at threat of harm or
persecution from others = paranoia, inclusive of persecutory delusions
Question: what is the relationship between paranoia and aggression in the context of schizophrenia?
• Mixed support for the association in both inpatient and community settings.
• Greater severity of paranoia was associated with increased aggression, even controlling for
impulsivity, command hallucinations, antipsychotic medication, substance misuse, age, and
gender.
• Persistently ggressive inpatients → higher paranoia scores.
• Aggression is linked with general paranoid delusions and threat-to-self-delusions.
• Decreased ability to control outward anger expression is consistent with the fact that
showing anger mediates the association between severe aggression and delusions of being
persecuted, spied on and conspired against.
SO: 2 explanations of the association → aggression as a safety behavior ánd aggression as a
retaliatory response.
Paranoid individuals have attentional bias for threat cues and proclivity to jump to conclusions →
increase paranoid individuals’ perception that a threat is present, may utilise aggression as a safety
behavior in an effort to maintain their safety and prevent threats OR responding aggressively to
perceived threats may be precipitated by a desire for retribution.
Van Dongen et al. (2014). Antisocial personality characteristics and psychotic symptoms: two
pathways associated with offending in schizophrenia
Relationship between psychosis and (violent) criminal behavior → also relationship between
schizophrenia and violent crime may be stronger than schizophrenia and non-violent crimes.
• Early starters = show anti-social personality characteristics early in life (childhood history of
conduct problems), similar to life-course-persistent. were similar to non-psychotic offenders
in most aspects of personality measured, although early-starter psychosis group was more
likely to have conduct disorder problems.
• Late starters = start offending in adulthood after the onset of a major mental disorder.
Criminal behavior is more likely to be attributable to cognitive and perceptual (positive)
symptoms of the disorder.
• Late first offenders = suddenly commit a very serious offence after the onset of their
schizophrenia.
Similar to late starters; offending associated with positive symptoms of schizophrenic
disorder, but NOT anti-social personality traits.
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,4.2C Etiology of Offender Types Celine Tijssen (472686)
Question: what is the relative role of personality and positive symptoms of schizophrenia within one
sample of patients and non-psychotic offenders?
- Early starters were similar to non-psychotic offenders in most aspects of personality
measured, although the early starter psychosis group was more likely to have had specifically
documented conduct disorder problems.
- Late starters and late first offenders were more likely to have positive psychotic symptoms
than non-offenders with psychosis.
- Early-start offenders are characterized by antisocial personality characteristic (e.g. conduct
disorder, substance use). They resemble offenders without schizophrenic disorder more than
people with schizophrenia who start offending after the clear onset of the illness and first
offenders.
Presence of psychotic symptoms pertinent to the offending did NOT distinguish the groups, 2
explanations:
1. Early starters start their offending because of early anti-social personality characteristics and
subsequently develop a schizophrenic disorder, but symptoms are coincidental to the
offending.
2. Early starters may start their offending because of anti-social personality characteristics, but
subsequent psychotic symptoms are associated with development or maintenance of the
offending.
Take home message: important implications for treatment → accommodate important differences in
the needs of offender patients.
Lau et al. (2019). Latent class analysis (LCA) identified phenotypes in individuals with schizophrenia
spectrum disorder who engage in aggressive behaviour towards others.
Schizophrenia spectrum disorders (SSD) have elevated risk of being convicted of nonviolent criminal
offences, higher risk of being convicted of being convicted of violent criminal offences and higher risk
of being convicted of homicide.
Early starters (ES): committing offence before 18 or diagnosed with conduct disorder before 15, or
offending before first evidence of a severe mental illness (SMI).
• Multiple challenges as minors: sanctions, conduct disorder, mental health treatment,
physical abuse…
• Parents use illegal substances and alcohol
• Less than 21 years old when first prodromal symptoms of an SSD are documented.
• Abuse alcohol and cannabis.
• Inpatient treatment and criminal registry entries.
• Single, unemployed and homeless.
Late starters (LS) = committing an offence after 18, or not being diagnosed with conduct disorder
before age 15, or offending after evidence of an SMI had been reported.
• Lowest probability of having experienced physical abuse as minors
• Highest probability of refraining from the use of alcohol
• Age of illness onset or diagnosis or criminal registry entry is between 21-35.
• Crimes in class 1, but fewer petty offences, fewer property offences, fewer threats.
Late late starters (LLS) OR first offenders (FO) = small group of predominantly male offenders in their
late 30s with chronic schizophrenia, but without any prior history of aggressive or antisocial
behaviour, who typically engage in homicide of those caring of them.
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, 4.2C Etiology of Offender Types Celine Tijssen (472686)
• Least probably been diagnosed with conduct disorder as minor
• Most probably use illegal substances
• Age of illness onset or diagnosis or criminal registry entry after 35.
• Previous offences mostly include sexual offences, involve threat or coercion.
Conclusion: using age at first criminal registry entry, may serve as a fair differentiator of offender
patients for future research when no more than one variable is available for subgrouping.
Hodgins et al. (2018). Chapter 10: Antisocial personality disorder.
Antisocial personality disorder (ASPD)
= pervasive pattern of disregard for
and the violation of the rights of
others, and can include a disregard of
social norms, deceitfulness,
impulsivity, consistent irresponsibly
and lack of remorse.
• Half of the adults with ASPD
met criteria for at least one
anxiety disorder.
• ASPD and borderline
personality disorder (BPD)
have distinct lines of evidence,
while BPD is primarily
characterised by affective
instability
• Half have record of criminal
offending.
• Violence towards others.
• Eivdence about ASPD is NOT including the syndrome of psychopathy.
Conduct disorder (CD) (individuals prior to age 15) = repetitive and persistent pattern of behavior in
which appropriate social norms are violated, theft, aggressive behaviors etc.
• Alcohol and illicit drugs
• Combination of CD and ADHD is associated with earlier age of onset of conduct problems.
• Prevalence of depression much higher among children with CD
• ASPD and borderline personality disorder are distinct.
• CD and conduct problems are precursors of schizophrenia.
• CD prior to the onset of schizophrenia is associated with non-violent and violent criminality
and aggressive behavior from childhood trough adulthood. Those with CD show similar
profiles of psychotic symptoms, as do other patients with schizophrenia.
o Presence of CD among those vulnerable for schizophrenia may lead to behaviors
such as daily use of cannabis that increase the risk of the onset of schizophrenia.
• Effective treatments: parent training programms, behavioral programms, interventions for
school classes.
DSM requirement that the diagnosis of ASPD is only given if CD was present prior to age 15 is
supported by a substantial body of research → evidence about ASPD does not include the syndrome
of psychopathy.
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