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Background The coexistence of self-harm and aggression, which is referred to as dual-harm, is commonly seen in forensic population. Self-harm and aggression have often been studied separately, previous studies on risk factors of aggression or self-harm mainly focused on childhood adversities, emotional regulation, impulsivity and psychopathology, given their importance in the two behaviors. However, the factors associated with dual-harm remain unclear. This study aimed to explore potential risk factors associated with co-occurring self-harm among individuals with serious aggressive behaviors. Methods This multi-center, cross-sectional case-control study was conducted from May 2013 to January 2016 and involved seven qualified forensic institutes located in seven provinces in China. Participants were individuals with serious aggressive behaviors and were suspected to have mental disorders. Lifetime history of self-harm was obtained by a self-report questionnaire, and serious aggressive behaviors were assessed with the use of participants’ forensic archive. Sociodemographic and clinical information were collected using a self-designed standardized data collection form, and childhood adversities was assessed using a clinician-rated scale designed by our research team. The Psychopathy Checklist-Revised (PCL-R) was used to assess psychopathic traits and the Brief Psychiatric Rating Scale (BPRS) was used to assess psychiatric symptoms of the participants. Univariate and multivariate logistic regression analyses were performed to analyze the relevant factors for dual-harm. Results A total of 423 individuals with serious aggressive behaviors were enrolled in the current study. Of them, 74 (17.5%) with self-harm history assigned into the dual-harm group (D-H) and 349 (82.5%) without self-harm history assigned into the aggression-only group (A-O). According to the binary logistic regression analysis, current diagnosis of mood disorder (OR = 3.2, 95%CI: 1.2–8.5), child abuse (OR = 2.8, 95%CI: 1.3–6.2), parental death (OR = 3.0, 95%CI: 1.2–7.5), and the score of the affective subscale in BPRS (OR = 1.7, 95%CI: 1.3–2.4) were significantly associated with dual-harm. Conclusions Our study suggested the necessity of integrated evaluation of self-harm among individuals with serious aggressive behaviors. Childhood adversities and psychiatric symptoms in this population require special attention.

Backgroud: The coexistence of self-harm and aggression, which is referred to as dual-harm, is commonly seen in forensic population. However, self-harm and aggression have often been studied separately, and the factors associated with dual-harm remain unclear. This study aimed to explore potential risk factors associated with co-occurring self-harm among individuals with violent behaviors. Methods: This multi-center case-control study was conducted from May 2013 to January 2016 and involved seven qualified forensic institutes located in seven provinces in China. Participants were individuals with violent behaviors who were suspected to have mental disorders. Lifetime history of self-harm was obtained by a self-report questionnaire, and violent behaviors were assessed with the use of participants’ forensic archive. Sociodemographic and clinical information were collected using a self-designed standardized data collection form, and childhood adverse experience was assessed using a clinician-rated scale designed by our research team. The psychopathy checklist- Revised was used to assess psychopathic traits and the Brief Psychiatric Rating Scale was used to assess psychiatric symptoms of the participants.Results: A total of 429 participants were enrolled in the current study. Of them, 74 (17.2%) with self-harm history assigned into the dual-harm group (D-H) and 355 (82.8%) without self-harm history assigned into the violence-only group (V-O). According to the binary logistic regression analysis, current diagnosis of mood disorder (OR=3.03, 95%CI: 1.15 - 7.97), child abuse (OR=2.92, 95%CI: 1.33 - 6.40), parental death (OR=2.79, 95%CI: 1.14 - 6.81), and the score of the affective subscale in BPRS (OR=1.77, 95%CI: 1.31 - 2.39) were significantly associated with dual-harm.Conclusions: Our study suggested the necessity of integrated evaluation of self-harm among violent offenders. Childhood adverse experiences and psychiatric symptoms in this population require special attention.

People with schizophrenia (SZ) are at increased risk of violence compared to the general population. However, the neural mechanisms of violent behavior in patients with SZ are still unclear due to the heterogeneity of the diseased population. In this study, we aimed to examine the neural correlates of violent behavior in SZ and to determine whether the structural deficits were related to psychopathic traits. A total of 113 participants, including 31 SZ patients with violent behavior (vSZ), 39 SZ patients without violent behavior (nvSZ), and 43 healthy controls (HC), completed the T1-weighted magnetic resonance imaging (MRI) scan and were analyzed using voxel-based morphometry approach. The psychopathic traits were assessed using the Psychopathy Checklist: Screening Version (PCL:SV). The results showed decreased gray matter volume (GMV) in the vSZ group in the right temporal lobe and bilateral inferior frontal gyri compared to HCs; while reduced GMV in the inferior parietal lobe, parahippocampal and orbital frontal gyri was found in the nvSZ group compared with HCs. Correlation analyses showed that psychopathic traits were negatively associated with the GMV in the right superior temporal and left fusiform gyri in the vSZ group, indicating that psychopathic traits, as reflected by the score of antisocial factor, might be related to structural deficits in the temporal lobe, which led to a propensity to violent behavior in patients with SZ. Our findings suggest that violent behavior in patients with SZ might have a personality background associated with the frontotemporal network aberrance. In future studies, we need to take a closer look at psychopathic traits for better understanding of the mechanism of interpersonal violence in patients with SZ and to explore whether the imaging findings from this study can serve as a biomarker to predict future violent behaviors and community living.