'Theory of mind' in violent and nonviolent patients with paranoid schizophrenia

The role of mentalizing abilities (or theory of mind) and empathic abilities in violent behavior were studied in 24 hospitalized males with paranoid schizophrenia (ICD-10). Patients were divided into violent and nonviolent groups based on their history of committing violent acts against others. To examine these abilities, patients heard a series of 12 short scenarios depicting social situations followed by questions that require making mental state or empathic inferencing. Our results show that violent patients have more difficulties than nonviolent patients in tasks involving empathic inferencing, and better abilities in inferring cognitive-mental states in others. In addition, violence seems to be associated with a history of alcohol and drug abuse, young age, and the hostility component of the Brief Psychiatric Rating Scale. Logistic regression analyses suggest that violence is associated with the combination of hostility towards others, good mentalizing abilities and poor empathy. These results are discussed in light of recent theories on violent behavior in psychiatric populations.