Schizophrenia, Delusional Symptoms, and Violence: The Threat/Control-Override Concept Reexamined

Abstract

In 1994 Link and Stueve identified a number of symptoms--called threat/control-override (TCO) symptoms--that were significantly more than others related to violence. This was confirmed by some, but not all, following studies. The contradictory results could be due to remarkable differences in sample compositions, sources used, and definitions and periods of recorded violence, but they are mainly due to problems defining the TCO symptoms. To reexamine the validity of the TCO concept from an exclusively psychopathological position, we compared in a retrospective design a sample of male offenders with schizophrenia not guilty by reason of insanity (n = 119) with a matched sample of nonoffending schizophrenia patients (n = 105). We could find no significant differences regarding the prevalence of TCO symptoms in the two groups during the course of illness. The only statistically significant discriminating factors were social origin and substance abuse. Yet, taking into account the severity of offenses, TCO symptoms emerged as being associated with severe violence. This effect is primarily attributable to the comparatively unspecific threat symptoms. Control-override, to be seen as more or less typical for schizophrenia, showed no significant association with the severity of violent behavior.

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

“…Unfailingly, comorbid substance use diagnoses are pervasive [Swanson et al, 1990]. Additional factors are (1) a diagnosis of Paranoid Schizophrenia [Modestin and Ammann, 1996]; (2) symptoms [Link et al, 1998] although not as yet firmly established [see Appelbaum et al, 2000b;Stompe et al, 2004], threat control/over-ride; (3) young age [Hodgins et al, 1996]; (4) a history of exposure to childhood abuse [Monahan et al, 2000]; (5) sustaining traumatic brain injury [Tateno et al, 2003]; and (6) involuntary admission which could occur for many different reasons (e.g., suicide risk, poor self-care) one of which could be violent behavior [Foley et al, 2005]; we therefore decided to ascertain the lifetime number of voluntary and involuntary psychiatric hospitalizations to test as a potential contributing factor.…”

Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia

“…Bjorkly, 2002aBjorkly, , 2002bFresán et al, 2005). Among people with schizophrenia, positive psychotic symptoms, predominantly delusions and hallucinations, have been found to be relevant to violent acts (Taylor, 1995;Taylor et al, 1998;Krakowski et al, 1999;Hodgins et al, 2003;Fresán et al, 2005, but for contrasting results see Stompe et al, 2004). Symptoms implicated particularly include delusions of persecution (e.g.…”

Bases psicopatológicas do crime violento: estudo caso-controle retrospectivo de pacientes delirantes criminosos e não-criminosos

“…Enquanto alguns estudos mostraram que os delírios com conteúdo de ameaça e controle podem estar relacionados com desencadeantes do comportamento violento, foi sugerido que aspectos inerentes às diferentes dimensões dos delírios pudessem estar envolvidos em alguns atos criminosos 18,21,23,24 .…”