Trait Disinhibition and NoGo Event-Related Potentials in Violent Mentally Disordered Offenders and Healthy Controls

Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients

BACKGROUND

Exposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals' health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients.

METHODS

The current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose-response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression.

RESULTS

In file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI.

CONCLUSIONS

We report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

Attention-affect interactions and triarchic psychopathy: New electrophysiological insights from the late positive potential

One of the most prominent characteristics of psychopathy is a reduced processing of emotionally relevant information. However, it is still unclear how attentional mechanisms may modulate this deficit. The current study aimed to examine the impact of attentional focus on emotion processing in relation to the triarchic constructs of boldness, meanness, and disinhibition. Participants performed two tasks in which pleasant, neutral, and unpleasant framed pictures were presented. In the first task, participants were required to indicate the color of the frame (alternative-focus task), whereas in the second task they were instructed to indicate the emotional category of the image (affect-focus task). The Late Positive Potential (LPP) was used as an index of sustained engagement of attention to affective material. Confirming a successful task manipulation, we observed reduced LPP amplitudes, particularly for affective relevant material, in the alternative-focus task compared to the affect-focus task. Most interestingly, our results evidenced that trait meanness scores were associated with blunted elaborative processing of affective material (both appetitive and aversive) when this information was task-relevant (affect-focus task), but not when it was task-irrelevant (alternative-focus task). These findings indicate that high mean individuals are characterized by blunted elaborative processing of affective stimuli when their motivational relevance is determined in a top-down manner (i.e., when it is task-relevant). Our results highlight the need for further studying of the bottom-up and top-down dynamics of emotional attention in psychopathy.

Adverse childhood experiences do not moderate the association between aggressive antisocial behavior and general disinhibition in a forensic psychiatric inpatient sample

Adverse childhood experiences (ACE) and high levels of disinhibition have been associated with a variety of negative outcomes such as aggressive antisocial behavior (AAB). However, forensic psychiatric populations remain an understudied group in this field of research. This study aimed to fill that gap by investigating associations between ACE, AAB, and disinhibition in a forensic psychiatric sample. Furthermore, we aimed to explore such findings by investigating whether ACE might have a moderating effect on the association between disinhibition and AAB. A sample of forensic psychiatric patients (n = 89) was recruited from a high-security forensic psychiatric facility in Sweden. All study variables were moderately to strongly related to each other, although we found no moderating effect of ACE. Post hoc analysis indicated that our ACE items had differential effects on AAB scores, with placement outside the family home, absent parents, and parental drug abuse producing the largest effect on AAB levels. Our findings are in line with previous research demonstrating a significant and robust relationship between ACE, AAB, and disinhibition. Forensic psychiatric populations are exposed to high levels of both self-reported and documented ACE. This calls for trauma-informed care and highlights the importance of considering ACE in risk assessment, preventive work, and policy making.

Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients

Emotion regulation has been specifically linked to both non-suicidal self-injury (NSSI) and attempted suicide. It is also known that self-harm is disproportionally higher (30–68.4%) in forensic samples than in the general population, yet knowledge about the association between emotion regulation and self-harm in forensic settings is scarce. The purpose of this study was to describe emotion regulation in a sample of forensic psychiatric patients, to explore dimensions and levels of emotion regulation between forensic psychiatric patients with and without self-harm, and to explore associations between forensic psychiatric patients’ self-reported emotion regulation and self-reported functions of NSSI. A cohort of forensic psychiatric inpatients (N=98) was consecutively recruited during 2016–2020 from a high-security forensic psychiatric clinic in Sweden. Data were collected through the self-report measures Difficulties in Emotion Regulation Scale (DERS) and Inventory of Statements About Self-injury (ISAS). In relation to the first aim, median total and subscales scores for DERS were reported. Results showed a statistically significant difference in emotion regulation between participants with and without self-harm (p=0.004), with a medium effect size (Cohen’s d=0.65) for the DERS total scale. The DERS subscales returned large differences for Impulse (p=0.001, d=0.86), Goals (p=0.014, d=0.58), and Strategies (p=0.012, d=0.54) between participants with and without self-harm. Finally, DERS scores were correlated with both the interpersonal (r_s=0.531, p<0.001, n=43) and intrapersonal factors (r_s=0.503, p<0.001, n=43) of NSSI as reported on the ISAS. Participants with self-harm (NSSI and/or suicide attempts) demonstrated significantly more difficulties with emotion regulation than those without self-harm. Emotion dysregulation was associated with both interpersonal and intrapersonal functions of NSSI in the participants. We suggest further studies on forensic psychiatric patients’ maladaptive behaviors that focus on substance abuse, self-harm, and aggressive behaviors in relation to the regulation and expression of emotion.

Give me your password! What are you hiding? Associated factors of intimate partner violence through technological abuse

The present study explored the associated factors of intimate partner violence through technological abuse (ITPV) in a sample of 1113 participants aged 18 to 65 (71.3% females). Our research's primary questions were the following: 1). Is there a significant link between relationship attachment styles and ITPV perpetration or victimization?; 2). Is there a significant link between participants' demographic and relationship characteristics (i.e., relationship length and partners' fidelity), online behavior (i.e., benign and toxic disinhibition), moral disengagement, psychological distress), and ITPV perpetration or victimization?; and 3). Did the COVID-19 pandemic increase ITPV perpetration or victimization?. We analyzed our data by creating three different groups, depending on participants' answers concerning ITPV, i.e., the overall sample, abusers' and victims' groups. Our main results suggested significant, positive correlations between ITPV perpetration and victimization, moral disengagement, psychological distress, and online disinhibition. Age negatively correlated with IPVT victimization and perpetration. We also found significant associations between participants' dominant relationship attachment style and their own and partners' cheating behavior, as well as ITPV-victimization and perpetration. Finally, 13.7% to 23% of participants in all three groups considered that the Covid-19 increased the frequency of ITPV behaviors (for both abusers and victims). Results are discussed considering their theoretical and practical implications for domestic violence and the potential related prevention and intervention strategies.

Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research

Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.