Attachment, mentalizing and personality pathology severity in premeditated and impulsive aggression in schizophrenia

Decades of research have displayed a robust relationship between schizophrenia and aggression, with the majority of studies focusing on the role of comorbid Axis I disorders, including drug and alcohol abuse, psychosis, and other sociodemographic and clinical variables. However, only a few studies have examined the role of mentalizing abilities (i.e., the ability to understand mental states) and personality pathology severity, and none have examined the role of attachment representations believed to play a role in aggression. Furthermore, there is a paucity of research that differentiates between premeditated and impulsive aggression in schizophrenia. To this end, we conducted a cross-sectional study of 108 patients with schizophrenia to explore if a specific combination of mentalizing abilities, attachment representations and personality pathology severity pertain to premeditated aggression, while controlling for clinical and sociodemographic variables. Findings reveal that a constellation of diminished mentalizing, an attachment pattern characterized by positive self-representations and negative representations of the other, and severe personality pathology, was associated with premeditated aggression. These results suggest that risk assessment of aggression and future intervention programs targeted at reducing severe aggression in schizophrenia could benefit from including psychological functions such as mentalizing, as well as assessing personality pathology severity and attachment representations.