Sahabettin Cetin, Nazlı Kapubagli-Cetin, Gülfizar Sözeri-Varma, Tugce Toker-Ugurlu
Department of Psychiatry, Pamukkale University Faculty of Medicine, Denizli, Turkey.
Freelance Physician, Denizli, Turkey.
Crim Behav Ment Health. 2025 Aug;35(4):187-196. doi: 10.1002/cbm.70002. Epub 2025 Jul 19.
Childhood traumas and low theory of mind abilities have been shown to be associated with violence, crime and schizophrenia. Understanding the factors that predispose to violent behaviour by patients with schizophrenia is important for treatment and safety.
To investigate relationships between childhood trauma, theory of mind and violent behaviour in patients with schizophrenia and in a healthy comparison sample. Our hypothesis was that patients with schizophrenia who had been violent would be more likely to have a history of childhood trauma and show impairments in theory of mind impairments than either non-violent patients with schizophrenia or healthy non-violent people.
In a cross-sectional design, we recruited 30 patients with schizophrenia who had a history of violent crime, 50 patients with schizophrenia but no history of violence and 50 healthy people without history of violence. Each participant completed the positive and negative syndrome scale, childhood trauma questionnaire, the reading the mind in the eyes test and the hinting task.
Patients were significantly more likely to be male, without employment and on low income than healthy controls with a suggestion of the violent patient group being worst off. Childhood trauma history and theory of mind tests distinguished the schizophrenia groups from healthy controls but not from each other. Logistic regression analysis, comparing the schizophrenia groups only, confirmed that male sex and number of prior hospitalisations were the only two characteristics that independently distinguished the violent from the non-violent groups with schizophrenia.
Childhood trauma histories and theory of mind test results differed only between people with schizophrenia and healthy prosocial adults of similar age, but did not distinguish between the violent and non-violent people with schizophrenia. Whereas a pathway to violence in the context of schizophrenia from early trauma through impaired reading of others' emotions seems plausible, it still lacks evidence. Our findings suggest good reason to assess and treat impairments of emotional perception and processing in people with schizophrenia, but that the need is unlikely to be specific to those who become violent. This needs further research with larger samples.
童年创伤和低心理理论能力已被证明与暴力、犯罪和精神分裂症有关。了解精神分裂症患者暴力行为的诱发因素对治疗和安全至关重要。
调查童年创伤、心理理论与精神分裂症患者以及健康对照样本中暴力行为之间的关系。我们的假设是，有暴力行为的精神分裂症患者比无暴力行为的精神分裂症患者或健康的非暴力人群更有可能有童年创伤史，并表现出心理理论缺陷。
采用横断面设计，我们招募了30名有暴力犯罪史的精神分裂症患者、50名无暴力史的精神分裂症患者和50名无暴力史的健康人。每位参与者完成阳性和阴性症状量表、童年创伤问卷、读心术测试和暗示任务。
与健康对照组相比，患者更有可能为男性、无工作且收入低，暴力患者组情况似乎最差。童年创伤史和心理理论测试区分了精神分裂症组与健康对照组，但精神分裂症组之间没有差异。仅比较精神分裂症组的逻辑回归分析证实，男性和既往住院次数是仅有的两个能独立区分有暴力行为和无暴力行为的精神分裂症组的特征。
童年创伤史和心理理论测试结果仅在精神分裂症患者与年龄相仿的健康亲社会成年人之间存在差异，但无法区分有暴力行为和无暴力行为的精神分裂症患者。虽然从早期创伤通过他人情绪解读受损导致精神分裂症患者产生暴力行为的途径似乎合理，但仍缺乏证据。我们的研究结果表明，有充分理由评估和治疗精神分裂症患者的情绪感知和处理障碍，但这种需求不太可能仅限于那些有暴力行为的患者。这需要更大样本的进一步研究。
