The authors propose a new theoretical construct for understanding the risk of violent behavior by psychiatric patients: the aggressive attributional style. They propose that a cognitive style characterized by external hostile attributions increases the risk of violence by mentally ill persons. To evaluate this hypothesis, they administered several self-report measures relevant to the aggressive cognitive style, as well as measures of violent behavior in the community, to 110 psychiatric inpatients. Higher scores on several indicators of the aggressive attributional style were associated with violence. Multivariate logistic regression analyses showed that the relationship between attributional style and violence held up when demographic and diagnostic characteristics and impulsiveness were controlled. The authors discuss implications for development of cognitive interventions to reduce violence risk.

The results support the clinical utility of asking about command hallucinations when assessing the risk of violence in patients with major mental disorders.

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