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

Abstract

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.

Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor?

“…This suggests the presence of a larger number of traumatic events in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…Although no statistically significant differences were found, the total CTQ score in the PSCH-V group was higher (103.5), in comparison to the Non V-PSCH group (83.89), which suggests the presence of a larger number of traumatic events (cumulative polyvictimization) in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…According to studies that examined the impact of childhood abuse in the general population, there is an increased risk of violent and criminal behavior later in adulthood in children who have been victims of violence in childhood. The conclusions of some studies indicate that this finding is in accordance with the model of transgenerational transmission of violence ( 1 , 2 , 19 ). Research has shown that victims of childhood abuse also have an increased risk of developing mental disorders that include personality disorder, schizophrenia, psychosis, and substance abuse.…”

Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor?

“…This suggests the presence of a larger number of traumatic events in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…Although no statistically significant differences were found, the total CTQ score in the PSCH-V group was higher (103.5), in comparison to the Non V-PSCH group (83.89), which suggests the presence of a larger number of traumatic events (cumulative polyvictimization) in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…According to studies that examined the impact of childhood abuse in the general population, there is an increased risk of violent and criminal behavior later in adulthood in children who have been victims of violence in childhood. The conclusions of some studies indicate that this finding is in accordance with the model of transgenerational transmission of violence ( 1 , 2 , 19 ). Research has shown that victims of childhood abuse also have an increased risk of developing mental disorders that include personality disorder, schizophrenia, psychosis, and substance abuse.…”

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

“…Emotional neglect was solely correlated with proactive aggression. Nevertheless, our findings align considerably with earlier research showing that CM is associated with problems in aggression regulation later in life ( 15 ). This aggression dysregulation in patients who experienced more childhood adversity may indicate DTD, reflecting dysregulation in internal and psychological systems (nervous system, stress system, emotion regulation) due to early trauma and neglect ( 3 , 11 ).…”

Interpersonal Trauma, Gender, and Psychiatric Symptom Severity: Insights from Forensic Psychiatric Inpatient Data in Ontario, Canada

“…In our sample, approximately 27% reported exposure to at least one form of interpersonal PTE. Although this rate is higher than that reported among general psychiatric inpatients assessed using the RAI-MH (22.4%; Behdinan et al, 2024), it is lower than estimates from prior studies of forensic inpatients who had a personality disorder (36.5%; Bohle & de Vogel, 2017), were women with intellectual disabilities (58%; de Vogel & Didden, 2022), and men reporting childhood interpersonal PTE (61.5%; Fosse et al, 2021). Given that our sample included more men than women, men may have underreported exposure to interpersonal PTE, which could have affected prevalence estimates (de Vogel et al, 2025).…”

Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor?

“…This suggests the presence of a larger number of traumatic events in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…Although no statistically significant differences were found, the total CTQ score in the PSCH-V group was higher (103.5), in comparison to the Non V-PSCH group (83.89), which suggests the presence of a larger number of traumatic events (cumulative polyvictimization) in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…According to studies that examined the impact of childhood abuse in the general population, there is an increased risk of violent and criminal behavior later in adulthood in children who have been victims of violence in childhood. The conclusions of some studies indicate that this finding is in accordance with the model of transgenerational transmission of violence ( 1 , 2 , 19 ). Research has shown that victims of childhood abuse also have an increased risk of developing mental disorders that include personality disorder, schizophrenia, psychosis, and substance abuse.…”

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

“…Emotional neglect was solely correlated with proactive aggression. Nevertheless, our findings align considerably with earlier research showing that CM is associated with problems in aggression regulation later in life ( 15 ). This aggression dysregulation in patients who experienced more childhood adversity may indicate DTD, reflecting dysregulation in internal and psychological systems (nervous system, stress system, emotion regulation) due to early trauma and neglect ( 3 , 11 ).…”

Interpersonal Trauma, Gender, and Psychiatric Symptom Severity: Insights from Forensic Psychiatric Inpatient Data in Ontario, Canada

“…In our sample, approximately 27% reported exposure to at least one form of interpersonal PTE. Although this rate is higher than that reported among general psychiatric inpatients assessed using the RAI-MH (22.4%; Behdinan et al, 2024), it is lower than estimates from prior studies of forensic inpatients who had a personality disorder (36.5%; Bohle & de Vogel, 2017), were women with intellectual disabilities (58%; de Vogel & Didden, 2022), and men reporting childhood interpersonal PTE (61.5%; Fosse et al, 2021). Given that our sample included more men than women, men may have underreported exposure to interpersonal PTE, which could have affected prevalence estimates (de Vogel et al, 2025).…”

Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor?

“…This suggests the presence of a larger number of traumatic events in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…Although no statistically significant differences were found, the total CTQ score in the PSCH-V group was higher (103.5), in comparison to the Non V-PSCH group (83.89), which suggests the presence of a larger number of traumatic events (cumulative polyvictimization) in childhood. This result is in accordance to the previous studies that have shown that the presence of a large number of traumatic events in childhood in one person affects the frequency of violent behaviors in the community ( 1 , 2 ).…”

“…According to studies that examined the impact of childhood abuse in the general population, there is an increased risk of violent and criminal behavior later in adulthood in children who have been victims of violence in childhood. The conclusions of some studies indicate that this finding is in accordance with the model of transgenerational transmission of violence ( 1 , 2 , 19 ). Research has shown that victims of childhood abuse also have an increased risk of developing mental disorders that include personality disorder, schizophrenia, psychosis, and substance abuse.…”

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

“…Emotional neglect was solely correlated with proactive aggression. Nevertheless, our findings align considerably with earlier research showing that CM is associated with problems in aggression regulation later in life ( 15 ). This aggression dysregulation in patients who experienced more childhood adversity may indicate DTD, reflecting dysregulation in internal and psychological systems (nervous system, stress system, emotion regulation) due to early trauma and neglect ( 3 , 11 ).…”

Interpersonal Trauma, Gender, and Psychiatric Symptom Severity: Insights from Forensic Psychiatric Inpatient Data in Ontario, Canada

“…In our sample, approximately 27% reported exposure to at least one form of interpersonal PTE. Although this rate is higher than that reported among general psychiatric inpatients assessed using the RAI-MH (22.4%; Behdinan et al, 2024), it is lower than estimates from prior studies of forensic inpatients who had a personality disorder (36.5%; Bohle & de Vogel, 2017), were women with intellectual disabilities (58%; de Vogel & Didden, 2022), and men reporting childhood interpersonal PTE (61.5%; Fosse et al, 2021). Given that our sample included more men than women, men may have underreported exposure to interpersonal PTE, which could have affected prevalence estimates (de Vogel et al, 2025).…”