Aggressive behavior and metacognitive functions: a longitudinal study on patients with mental disorders

Abstract

Background: Metacognitive functions play a key role in understanding which psychological variables underlying the personality might lead a person with a severe mental disorder to commit violent acts against others. The aims of this study were to: (a) investigate the differences between patients with poor metacognitive functioning (PM group) and patients with good metacognitive functioning (GM group) in relation to a history of violence; (b) investigate the differences between the two groups in relation to aggressive behavior during a 1-year follow-up; and (c) analyze the predictors of aggressive behavior. Methods: In a prospective cohort study, patients with severe mental disorders with and without a lifetime history of serious violence were assessed with a large set of standardized instruments and were evaluated bimonthly with MOAS in order to monitor any aggressive behavior. The total sample included 180 patients: 56% outpatients and 44% inpatients, and the majority were male (75%) with a mean age of 44 (± 9.8) years, and half of them had a history of violence. The sample was split into two groups: poor metacognition (PM) group and good metacognition (GM) group, according to MAI evaluation scores. Results: The PM patients reported a history of violence more frequently than GM patients, during the 1-year followup, but no differences between groups in aggressive and violent behavior were found. The strongest predictors of aggressive behavior were: borderline and passive-aggressive personality traits and a history of violence, anger, and hostility. The metacognitive functions alone did not predict aggressive behavior, but metacognitive functions interacted with hostility and angry reactions in predicting aggressive behavior. Conclusions: This study led to some important conclusions: (a) some aspects closely related to violence are predictive of aggressive behavior only in patients with poor metacognition, thus good metacognition is a protective factor; (b) poor metacognition is associated with a history of violence, which in turn increases the risk of committing aggressive behavior.

Young age and the risk of violent behaviour in people with severe mental disorders: prospective, multicentre study

“…Anger, evaluated using the STAXI-2, 35 also decreased significantly with increasing age, confirming that younger age is associated with a higher level of anger. As some authors have shown, 47 – 51 at least in people with psychotic disorders, anger might be the fundamental mediator between psychotic symptoms and the trigger of violent behaviour. Higher levels of anger, as detected with the STAXI-2, in young people and in people with personality disorders might be an extremely important therapeutic target: a reduction in anger might result in a reduction in the risk of aggressive and violent behaviour.…”

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience

“…Another Italian prospective study, comparing never aggressive with verbally, physically, and sexually aggressive male psychiatric patients, found that the latter had displayed an increased number of aggressive behaviors in the previous 2 years [71].…”

Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States

“…For this reason, they may tend to express their thoughts and emotions through violent behavior toward others. 24 Based on these factors, we hypothesized that a history of physical violence reflects the high risk of physical violence in patients with BD-M.…”