Does childhood neglect contribute to violent behavior in adulthood? A review of possible links

Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment

Introduction

Childhood emotional abuse (CEA) is a recognized risk factor for adolescent mentalizing challenges. However, there's limited understanding about how CEA might influence personality development and elevate the risk of adolescent personality pathology. A deeper grasp of these pathways is crucial, given that adolescence is a pivotal developmental phase for identity integration, personality consolidation, and the emergence of personality disorders. As the emphasis shifts to dimensional perspectives on adolescent personality pathology, the spotlight is increasingly on adolescents' evolving personality organization (PO). Within this framework, personality disorder manifestations stem from inherent vulnerabilities in PO. A comprehensive understanding of how CEA leads to these inherent vulnerabilities in PO can inform enhanced interventions for at-risk adolescents. Nonetheless, our comprehension lacks insight into potential pathways to PO, especially those involving external factors like maltreatment and individual traits like mentalizing. This study sought to bridge these gaps by employing latent factor analysis and structural equation modeling to explore connections between emotional maltreatment, adolescent mentalizing, and PO.

Methods

A community-based cohort of 193 adolescents (aged 12-17) took part in self-report assessments: the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Reflective Functioning Questionnaire for Youth (RFQ-Y), and the Inventory for Personality Organization for Adolescents (IPO-A).

Results

The structural equation model revealed a significant direct influence of CEA on both RFQ-Confusion and PO, and a noteworthy direct effect of RFQ-Confusion on PO. Remarkably, the model accounted for 76.9% of the PO variance. CEA exhibited a significant indirect impact on PO through RFQ-Confusion, which was accountable for 52.3% of the CEA effect on PO, signifying a partial mediation by mentalizing.

Discussion

These insights carry substantial clinical implications, especially for devising integrated, trauma-informed strategies for adolescents with personality pathologies. This is particularly relevant for enhancing mentalizing and bolstering personality consolidation among adolescent CEA survivors.

Nonlinear Moderation Effect of Vagal Regulation on the Link between Childhood Trauma and Adolescent Internalizing and Externalizing Symptoms

Childhood trauma is a leading early adverse environment that increases psychopathological symptoms. Respiratory sinus arrhythmia (RSA) suppression to challenges as a marker of self-regulation is found to linearly moderate the link between early adverse experiences and psychopathological symptoms, but yielding mixed findings. The present study examined the relationships between childhood trauma and internalizing and externalizing symptoms via a 1.5-year longitudinal design and the quadratic moderation effect of RSA suppression on these relationships among adolescents. In November 2021 (T1), the final sample of 275 Chinese adolescents (Mage = 12.94, SDage = 0.79; 49.82% females) completed the short form of Childhood Trauma Questionnaire and the Achenbach Youth Self-Report-2001 and underwent a speech task during which their baseline RSA and stress exposure RSA were obtained. In June 2023 (T2), 251 adolescents completed the Achenbach Youth Self-Report-2001. Results showed that childhood trauma at T1 was positively correlated with internalizing and externalizing symptoms at T1 and T2. RSA suppression to stress quadratically moderated these associations, such that adolescents with moderate rather than higher or lower RSA suppression had the least internalizing and externalizing symptoms at T1 and T2 when exposed to childhood trauma. The findings suggest that moderate RSA suppression to stress as a marker of optimal vagal regulation buffers the risk of developmental psychopathology from early adverse experiences.

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

Introduction

Children's development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.

Methods

The study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.

Results

Consistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).

Discussion

This study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories.

Development and Initial Validation of the Neglectful Experiences and Deprivation Scale

Socioemotional deprivation, or the absence of developmentally expected social experiences, has been linked to long-lasting health and psychological outcomes. To date, current measures of socioemotional deprivation fail to capture the cumulative impact of neglectful experiences across multiple social relationships and developmental periods. The current study developed and validated the Neglectful Experiences and Deprivation Scale (NEADS) on a sample of 547 stress-exposed adults (M/SD_age=27.77/6.54 years old; 56.5% male). Exploratory and confirmatory factor analyses in independent samples revealed a three-factor solution as the best fitting model: Caregiver Deprivation (four items; e.g., abandonment), Peer Deprivation (four items; e.g., physical isolation), Romantic Partner Deprivation (four items; e.g., emotionally unavailable). Indicators of construct validity and internal consistency support the selected three-factor model. Results provide strong preliminary evidence of the validity of the NEADS for assaying the severity, developmental timing, and psychological impact of socioemotional deprivation across the lifespan.

Association of Child Sexual Abuse Victimization and Murderous Behaviors and the Mediating Role of Psychological Adjustment among College Students in China

A history of child sexual abuse (CSA) is associated with a variety of psychological issues and conduct disorders in adolescents. However, little is known about the association between CSA and its characteristics and murderous behaviors in young adults. The purpose of this study was to examine this relationship and explore the mediating effect of psychological adjustment (PA). A cross-sectional study was conducted with 4034 college students in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding the history of CSA, self-perceived PA and murderous behaviors. PA was evaluated by two of the most important indicators: resilience and emotional release. Mediation analyses were computed via parallel mediation models. Of the participants, 14.1% reported experiencing CSA. After controlling for potential confounders, CSA victimization was robustly and positively associated with murderous ideation (OR: 2.36, 95% CI: 1.77-3.14), murderous plans (OR: 4.02, 95% CI: 2.63-6.12), murderous preparation (OR: 3.87, 95% CI: 2.37-6.31), and murderous attempts (OR: 5.35, 95% CI: 3.11-9.21). CSA victimization that was persistent and of the combined contact or noncontact types greatly increased the risk of murderous behaviors. A dose-response relationship was observed between the duration of experienced CSA and murderous behaviors. Furthermore, the results of the mediation analysis revealed that PA partially mediated the relationship between CSA victimization and murderous behaviors. Therefore, PA protects against the development of murderous behaviors in abused individuals. These findings have important implications for the prevention and intervention of murderous behaviors in adolescents who experienced CSA, highlighting the importance of considering PA as a protective role in this relationship.

Does Childhood Maltreatment Lead to Low Life Success? Comparing Agency and Self-Reports

BACKGROUND

The long-term mental and physical health consequences of childhood maltreatment have been well documented. Less known are the longer-term consequences of childhood maltreatment, specifically the extent to which childhood maltreatment predicts adult life success.

OBJECTIVES

To prospectively assess the extent to which childhood experiences of physical, sexual, emotional abuse and childhood neglect predict life success at 30 years of age.

PARTICIPANTS AND SETTING

Data are from the Mater-University of Queensland Study of Pregnancy (MUSP), a pre-birth cohort study which follows children from conception to 30 years of age.

METHODS

Details of childhood maltreatment are from two sources; child safety agency notifications (and substantiations) linked to the survey data with self-reports of childhood experiences of maltreatment obtained at the 30-year follow-up using the Child Trauma Questionnaire (CTQ). Life success is a 9-item composite measure (alpha = 0.76) obtained at the 30-year follow-up. We use logistic regression models (with control for covariates) to examine the association between overall as well as specific forms of childhood maltreatment on adult life success. We further test these models using different cut-offs and propensity analyses to adjust for loss to follow-up.

RESULTS

Childhood maltreatment whether measured by agency report or self-report predicts overall low life success; agency substantiation OR = 1.88(1.14,3.08) & self-report OR = 2.60 (2.10,3.25). Self-report physical abuse, OR = 2.37(1.72,3.28); sexual abuse, OR = 2.85(2.05,3.96); emotional abuse, OR = 2.53(1.85,3.45) and neglect, OR = 2.36(1.83,3.03) all predict higher levels of low life success.

CONCLUSIONS

Our findings suggest that the long-term consequences of childhood maltreatment extend to a wide range of day-to-day circumstances and extend into mid- to later life.

The relationship between parental neglect and cyberbullying perpetration among Chinese adolescent: The sequential role of cyberbullying victimization and internet gaming disorder

Cyberbullying perpetration and victimization have been common public health issues that have impaired the development of adolescent physical and mental health. Abundant research has proven associations between negative parental factors and cyberbullying perpetration. However, there is a paucity of research exploring the impact of parental neglect on cyberbullying and its internal mechanisms. Based on the parental acceptance-rejection theory (PARTheory) and the general aggression model (GAM), the present study constructs a sequential mediation model in which parental neglect is related to adolescent cyberbullying perpetration through cyberbullying victimization and internet gaming disorder (IGD). Using random cluster sampling, a total of 699 middle school students (M _age = 14.18 years, SD = 1.22, and 324 boys) were recruited from five schools in three provinces on mainland China. The participants completed questionnaires regarding parental neglect, cyberbullying perpetration, cyberbullying victimization, and IGD. The results of structural equation modeling indicated that parental neglect was positively associated with cyberbullying perpetration. The mediating effects of cyberbullying victimization and IGD in this relationship are significant both individually and jointly. The current findings have important implications for enlightening families and schools to pay particular attention to adolescents' experiences of parental neglect and provide them with timely feedback and assistance. This will contribute to the prevention and reduction of adolescent involvement in cyberbullying perpetration.

Neglect in Childhood, Problem Behavior in Adulthood

Few studies have reported problem behaviors in adulthood related to the timing of child neglect. The objective was to examine the relationship between classes of child neglect and later behavior. The sample included 473 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); their mean age was 23.8 years. They completed an online survey regarding behaviors and experiences in early adulthood. Neglect was assessed via Child Protective Services (CPS) and self-reports of neglect. Latent class analysis (LCA) identified three classes: Late Neglect, Chronic Neglect, and Limited Neglect. There were significant differences between Limited and Late Neglect regarding later intimate partner aggression and violence (IPAV) and psychological distress, and among all classes for criminal behavior. High-risk youth experiencing neglect beginning in mid-adolescence appear especially vulnerable to later criminal behavior, psychological distress, and IPAV. Those working with such youth can help ensure that their needs are adequately met, to prevent or mitigate problems in adulthood.

Childhood Trauma and Malevolent Creativity in Chinese College Students: Moderated Mediation by Psychological Resilience and Aggression

Although a previous study has shown that childhood trauma influences malevolent creativity, aggression and psychological resilience have been linked with childhood trauma and creativity. However, little is known about the complex correlations among these factors in Chinese college students. The present study aimed to investigate the mediating role of aggression and the moderating role of psychological resilience between childhood trauma and malevolent creativity. A total of 389 undergraduates were enrolled in this cross-sectional study. The moderated mediation model was conducted to explore whether aggression mediated the correlation between childhood trauma and malevolent creativity and whether psychological resilience moderated the indirect role of childhood trauma. The results showed that childhood trauma positively correlated with aggression and malevolent creativity and was negatively associated with psychological resilience. Aggression partly mediated the association of childhood trauma with malevolent creativity. Resilience moderated the indirect effect of the mediation model, such that the indirect effect of childhood trauma on malevolent creativity through aggression increased as the level of resilience increased. The study indicated that childhood trauma exposure is associated with malevolent creativity behavior, and aggression mediated this association. The level of psychological resilience differentiates the indirect paths of childhood trauma on malevolent creativity. These results have important implications for preventing and containing expressions of malevolent creativity.

Influence of parental neglect on cyberbullying perpetration: Moderated mediation model of smartphone addiction and self-regulation

This study examines if parental neglect is significantly associated with adolescent cyberbullying perpetration, and whether this relationship is mediated by smartphone addiction. In addition, the moderation of self-regulation in the direct and indirect effects of parental neglect on cyberbullying perpetration among adolescents is determined. A random sample of 728 Chinese adolescents from Grade 10 to 12 in senior high schools respond to anonymous questionnaires regarding parental neglect, smartphone addiction, self-regulation and cyberbullying perpetration. The data are then analysed using macro PROCESS. Results reveal that adolescents who are neglected by parents are more likely to engage in cyberbullying perpetration. Smartphone addiction significantly partially mediates the above relationship. Moreover, self-regulation not only moderates the relationship of cyberbullying perpetration with parental neglect but also its association with smartphone addiction among adolescents. This study contributes to a better understanding of how parental neglect increases the risk of adolescent cyberbullying perpetration, which may be reduced through tailored interventions.

The Influence of Childhood Trauma and Family Functioning on Internet Addiction in Adolescents: A Chain-Mediated Model Analysis

OBJECTIVE

This study aimed to examine the prevalence of Internet addiction in adolescents, analyze the associations of childhood trauma, systematic family dynamics, and family functioning with Internet addiction, and investigate the mediating chain role of anxiety and depression in the relationship of childhood trauma and family functioning with adolescent Internet addiction.

METHODS

This was a cross-sectional study in which general sociodemographic data were obtained from 3357 adolescents in grades 6-12 who were assessed using psychometric instruments such as the Childhood Trauma Questionnaire, Young Internet Addiction Test, Systematic Family Dynamics Self-Rating Scale (SSFD), Family Functioning Assessment (FAD), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS).

RESULTS

(1) The prevalence of Internet addiction among adolescents was 26.09% (876/3357). The prevalence of childhood trauma was 54.96% (1845/3357), and the prevalence of Internet addiction was significantly different between adolescents who suffered childhood trauma and those who did not (χ² = 96.801, ν = 1, p = 0.000). (2) Childhood trauma and various dimensions of systematic family dynamics had a significant negative and positive relationship with poor family functioning and anxiety or depression, respectively. (3) Childhood trauma was a positive predictor of Internet addiction through the chain-mediated effect of anxiety and depression, but there were no direct effects. Poor family functioning was a positive predictor of adolescent Internet addiction, and this positive prediction was augmented by the chain-mediated effect of anxiety and depression.

CONCLUSIONS

Childhood trauma and poor family functioning or support predicted Internet addiction in adolescents, with anxiety and depression as mediators.

Relationship Between Socioeconomic Status and Win-Win Values: Mediating Roles of Childhood Neglect and Self-Continuity

The family plays a key role on the development of children. One with low socioeconomic status was more likely to suffer childhood neglect, which might impact on development of self-continuity and win-win values. Using cross-sectional data from 489 participants, this study conducted a mediation model to examine the roles of childhood neglect and self-continuity between socioeconomic status and win-win values. Our results showed that childhood neglect and self-continuity fully mediated the effect of socioeconomic status on win-win values. Specifically, socioeconomic status might affect win-win values through three roles: the individual mediating role of childhood neglect, the individual mediating role of self-continuity, and the multiple mediation roles of childhood neglect and self-continuity.

Neurobiological and epigenetic perspectives on hedonism, altruism and conscience

This article examines notions of hedonism, altruism and conscience in relation to the activity of four neurotransmitter pathways: the dopamine reward, noradrenaline fight or flight, serotonin calming and glutamine learning pathways. Associated brain areas that modulate behaviour are highlighted: the prefrontal cortex (activity planning, risk mitigation), the hippocampus (memory retrieval) and the insular cortex (integration of information to decide on action). Putative epigenetic changes influencing adult behaviours after childhood privation are discussed. Pharmacological and psychological means of mitigating harmful behaviours are summarised, alongside the ethics of epigenetic screening to predict future addictive and violent tendencies.

Alcohol, Aggression, and Violence: From Public Health to Neuroscience

Alcohol has been associated with violent crimes and domestic violence across many nations. Various etiological factors were linked to chronic alcohol use and violence including psychiatric comorbidities of perpetrators such as personality disorders, mood disorders, and intermittent explosive disorders. Aggression is the precursor of violence and individuals prone to aggressive behaviors are more likely to commit impulsive violent crimes, especially under the influence of alcohol. Findings from brain studies indicate long-term alcohol consumption induced morphological changes in brain regions involved in self-control, decision-making, and emotional processing. In line with this, the inherent dopaminergic and serotonergic anomalies seen in aggressive individuals increase their susceptibility to commit violent crimes when alcohol present in their system. In relation to this, this article intends to investigate the influence of alcohol on aggression with sociopsychological and neuroscientific perspectives by looking into comorbidity of personality or mood disorders, state of the mind during alcohol consumption, types of beverages, environmental trigger, neurochemical changes, and gender differences that influence individual responses to alcohol intake and susceptibility to intoxicated aggression.

The Centrality of Child Maltreatment to Criminology

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Respiratory sinus arrhythmia as a moderator of early maltreatment effects on later externalizing problems

Physiological regulation may interact with early experiences such as maltreatment to increase risk for behavior problems. In the current study, we investigate the role of parasympathetic nervous system regulation (respiratory sinus arrhythmia [RSA] at rest and in response to a frustration task) as a moderator of the association between early risk for maltreatment (i.e., involvement with Child Protective Services; CPS) and externalizing behavior problems in middle childhood. CPS involvement was associated with elevated externalizing problems, but only among children with average to high RSA at rest and average to high RSA withdrawal in response to frustration. Effects appeared to be specific to CPS involvement as the association between cumulative risk (i.e., nonmaltreatment experiences of early adversity) and externalizing problems was not significantly moderated by RSA activity. These findings are consistent with the theoretical idea that the consequences of early maltreatment for later externalizing behavior problems depend on children's biological regulation abilities.

Medical student learner neglect in the clinical learning environment: Applying Glaser's theoretical model

INTRODUCTION

Learner neglect is a relatively new concept in education, and no suitable framework for its exploration has been devised. The aim of this study was to determine whether an existing framework, Glaser's framework of child neglect, could be applied to learner neglect in clinical learning environments. This was a retrospective analysis of data obtained as part of a related study.

METHOD

Six focus groups were conducted with medical students in their early clinical years to explore their views of what experiences in medical education were challenging and why they presented a challenge. The transcript data were analysed using inductive content analysis, within an interpretivist approach in the development of categories. The identified categories were cross referenced with Glaser's framework categories replacing the carer with the teacher and the child with the learner.

RESULTS

Glaser's classifications of teacher (parent) behaviours were all identified in the negative aspects of medical learner clinical education including emotional unavailability/unresponsiveness, acting in a hostile manner, inappropriate inconsistent developmental interaction, failure to recognise individuality and failure to promote social adaption. Physical unavailability was identified as an additional category and is included in our proposed framework of learner neglect.

DISCUSSION

Adapting Glaser's framework was useful in considering learner neglect. Medical schools have a role in ensuring learning experiences are positive across contexts and to make explicit to teachers any behaviours that may appear as learner neglect. Applying this framework has the potential to make more explicit any subtle undermining teacher behaviours. Once explicit, there is a greater likelihood that behaviours may be reappraised both by the teacher and learner and modified to promote a more effective clinical learning experience.

Specific effects of neglect and physical abuse on adolescent aggressive behaviors by gender: A multicenter study in rural China

BACKGROUND

Neglect and physical abuse may be typical risk factors for aggressive behavior in adolescents. However, findings on their specific effects and sex differences are still unclear. This study aimed to examine the specific effects of neglect and physical abuse on adolescent aggressive behaviors and to further explore the potential sex-specific effect.

METHODS

A multicenter school-based survey was conducted in rural China. A total of 15,957 students aged 11-20 years completed self-report questionnaires to record aggressive behaviors, neglect and physical abuse, and other related information. Participants were grouped into those who experienced none, one of, or both neglect and physical abuse for statistical analyses.

RESULTS

Of the participants, 37.0% experienced both neglect and physical abuse, 30.0% experienced neglect only, and 9.8% experienced physical abuse only. Higher risk for physical aggression (OR=1.24, 95% CI=1.06-1.45), and lower risk for verbal aggression (OR=0.83, 95% CI=0.72-0.94) and hostility (OR=0.81, 95% CI=0.69-0.94) were found in the physical abuse only group as compared to the neglect only group. No sex difference was found between neglect or physical abuse and general aggressive behaviors (P>0.05), except that females were more likely to exert physical aggression than males when exposed to neglect and physical abuse (P<0.05).

LIMITATIONS

Cross-sectional design, retrospective self-report data, and not including other maltreatment subtypes.

CONCLUSIONS

Neglect and physical abuse may each have distinct sensitivity for different subtypes of aggression. Targeted treatment for diverse aggressive symptoms is suggested, and strategies to prevent both neglect and physical abuse across gender would yield comprehensive benefits.

Recognition of children's emotional facial expressions among mothers reporting a history of childhood maltreatment

Several studies have shown that child maltreatment is associated with both positive and negative effects on the recognition of facial emotions. Research has provided little evidence of a relation between maltreatment during childhood and young adults' ability to recognize facial displays of emotion in children, an essential skill for a sensitive parental response. In this study, we examined the consequences of different forms of maltreatment experienced in childhood on emotion recognition during parenthood. Participants included sixty-three mothers of children aged 2 to 5 years. Retrospective self-reports of childhood maltreatment were assessed using the short form of the Childhood Trauma Questionnaire (CTQ). Emotion recognition was measured using a morphed facial emotion identification task of all six basic emotions (anger, disgust, fear, happiness, sadness, and surprise). A Path Analysis via Structural Equation Model revealed that a history of physical abuse is related to a decreased ability to recognize both fear and sadness in children, whereas emotional abuse and sexual abuse are related to a decreased ability to recognize anger in children. In addition, emotional neglect is associated with an increased ability to recognize anger, whereas physical neglect is associated with less accuracy in recognizing happiness in children's facial emotional expressions. These findings have important clinical implications and expand current understanding of the consequences of childhood maltreatment on parents' ability to detect children's needs.

Childhood Trauma in Persons With Schizophrenia and a History of Interpersonal Violence

BACKGROUND

Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia.

METHODS

Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed.

RESULTS

SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC.

CONCLUSION

SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.

Strong Associations Between Childhood Victimization and Community Violence in Male Forensic Mental Health Patients

Background: Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients. Methods: We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence. Results: Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types. Conclusions: Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.

Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as "aggression," "aggressive behavio(u)r," "maladaptive aggression," "juvenile," and "developmental trajectory." These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.

Effects of childhood trauma on adult moral decision-making: Clinical correlates and insights from bipolar disorder

BACKGROUND

Childhood adversity has been shown to exert profound effects on basic psychological processes well into adulthood. Some of these processes, such as those related to reward and emotion, play critical roles in moral decision-making. As a population with high rates of childhood trauma as well as heterogenous clinical presentation, individuals with bipolar disorder (BD) constitute an enriched group in which to examine the correlates of trauma and other clinical variables with moral cognition.

METHODS

62 euthymic BD patients and 27 controls responded to moral dilemma scenarios and completed the Childhood Trauma Questionnaire.

RESULTS

Results revealed a main effect of diagnosis on moral decision-making only when both personal force and an intention were required, indicating a more utilitarian style in BD patients relative to controls. Several interesting patterns also emerged regardless of diagnostic status. Higher ratings of physical neglect were significantly associated with higher ratings of acceptability (a utilitarian tendency) across dilemma types, and a similar pattern was observed at the trend level for experiences of emotional neglect. Significant main effects on moral decision-making were also observed for sex, illness duration, and history of psychotic features in the BD sample.

LIMITATIONS

The present study is limited by the self-reported nature of the CTQ and by the small number of trials of moral dilemmas. In addition, practical and clinical implications of the moral dilemmas paradigm are limited due to its abstract nature.

CONCLUSIONS

Our results indicate that certain clinical features as well as childhood maltreatment (in particular neglect) may significantly impact moral decision making in adult life. Surprisingly, childhood trauma was associated with a more utilitarian style, which is in the opposite direction from previous effects shown in PTSD. Although speculative, our results suggest that there may be a protective quality associated with utilitarian moral decision-making tendencies.

Interpersonal violence: identification of associated features in a clinical sample

Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.