Comparison of impulsivity and agression levels with childhood trauma, attachment style, insight and perceived social support in psychotic patients applicants referred to forensic psychiatry outpatient clinic and healthy controls

Purpose: The aim of this study is to compare the impulsivity and aggression levels of the patients with psychotic characteristics who were referred to the forensic psychiatry outpatient clinic, and healthy controls, in terms of childhood trauma, attachment style, insight and perceived social support. It was also planned to investigate the factors associated with violence in patients with psychotic features who admitted to the forensic outpatient clinic with violent crime. For this purpose, answers to the following questions were sought: 1. Whether the level of impulsivity and aggression and the repetition of crime was high in patients with psychotic characteristics who had committed violent crime, 2. Whether the level of impulsivity and aggression of individuals increases as the severity of childhood trauma increases -especially when exposed to certain types of abuse (e.g. sexual and physical abuse)- and if these people have committed violent crimes, the number and severity of the crime is higher or not, 3. Whether high level of unsecure and anxious attachment styles and low level of insight are related with level of childhood trauma and its certain types (e.g. sexual and physical abuse), 4. Whether unsecure and anxious attachment styles, low level of insight and low level of social support are related with higher level of impulsivity, higher level of aggression, violent crime and repitation of violent crime. Materials and Methods: The sample of the study consists of 32 violent crime commited patients with psychotic features who applied to the Forensic Psychiatry Outpatient Clinic of Abant Izzet Baysal Psychiatry Hospital and 32 healthy controls. In addition, Sociodemographic data form, Retrospective Explicit Aggression Scale, Barratt Impulsivity Scale, Childhood Mental Trauma Scale, Adult Attachment Style Scale, Multidimensional Perceived Social Support Scale, Buss-Perry Aggression Scale were administered to all participants. The Taylor Crime Violence Rating Scale and the Scale for Assessing the Three Components of Insight were applied only to patients with psychotic characteristics who committed a violent crime. Kolmogorov - Smirnov test, independent groups t-test , Mann-Whitney U test, Spearman correlation and multiple linear regression methods were conducted properly to analyze the data. Results: The retrospective violence levels of the psychotic patients who committed violent crimes in the study were found to be higher than the healthy controls. The impulsivity and aggression levels of the patient group were also significantly higher than the healthy controls. In terms of childhood trauma scale averages, it was found that patients with psychotic features got higher scores than the control group. Individuals in the control group perceived more social support than the patient group. In the comparisons between the two groups in terms of attachment types, it was observed that the patient group developed more insecure and anxious-avoidant attachment, while those in the control group developed more secure attachment. The Taylor crime violence rating scale score of patients with psychotic characteristics who have committed a violent crime is 2.09 ± 0.68 and the score of the scale for evaluating the three components of insight is 10.37 ± 4.72. No relationship was found between the childhood trauma, impulsivity, aggression levels; and the number and severity of the crime. No significant relationship was found between the attachment styles, insight, impulsivity, aggression levels; and the number and severity of the crime. Conclusion: According to the results of our study, the impulsivity and aggression levels of psychotic patients who have committed violent crimes are higher than healthy controls. This indicates the necessity to intervene in patients' impulsive and aggressive behaviors when dealing with psychotic diseases. In addition, the fact that criminals with psychotic diseases developed insecure attachment compared to the healthy group indicates the role of dysfunctional relationships with the mother in infancy on the basis of both criminal behavior and susceptibility to psychotic diseases. Similarly, it is a striking finding of our study that certain types of childhood traumas increase both criminal behavior and susceptibility to psychotic diseases. It is also a remarkable finding that the patient group perceived lower social support than the healthy group. Keywords: Psychotic disorder, violence, impulsivity, social support, insight, trauma, attachment.