Childhood trauma, social cognition and schizophrenia: Specific association between physical neglect and cognitive theory of mind in homicide offenders

Anja Vaskinn,Katharina N Engelstad,Anne-Kari Torgalsbøen,Bjørn Rishovd Rund

doi:10.1016/j.psychres.2021.114093

Anja Vaskinn, Katharina N Engelstad + Show 2 more

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https://doi.org/10.1016/j.psychres.2021.114093

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Abstract

Schizophrenia is associated with a small, but increased risk of violent behavior, including homicide. Violent individuals with schizophrenia have elevated rates of childhood trauma and substantial social cognitive impairments. The aim of this study was to examine if childhood trauma is related to social cognition in homicide offenders with schizophrenia. We recruited 26 individuals with schizophrenia sentenced to compulsory mental care for homicide/attempted homicide and 28 non-violent schizophrenia controls. They filled out the Childhood Trauma Questionnaire (CTQ), providing scores for physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect. Social cognition was assessed with two measures of emotion processing (Emotion in Biological Motion, Pictures of Facial Affect) and two theory of mind (ToM) tests (Hinting Task, Movie for the Assessment of Social Cognition: MASC). Spearman's rho correlation coefficients were computed, and significant results followed up with partial correlation analyses controlling for IQ. Three associations were statistically significant, all in the homicide group; between CTQ physical neglect and cognitive ToM assessed with Hinting Task and with MASC, and between CTQ emotional neglect and Hinting Task. Only the first remained significant after controlling for IQ, indicating a specific association between physical neglect and cognitive ToM in homicide offenders with schizophrenia.

Highlights

It is more common for someone with schizophrenia to be a victim of violence than a perpetrator, a subgroup of individuals with schizophrenia are at increased risk of violent interpersonal behavior
Three were both statistically significant and of medium magnitude, all three in the homicide offenders with schizophrenia (HOS) sample. This was the case for the associations between Childhood Trauma Questionnaire (CTQ) emotional neglect and Hinting Task (Spearman’s rho = −0.437, p = 0.026) as well as between CTQ physical neglect and both Hinting Task (Spearman’s rho = −0.443, p = 0.027) and MASCcog (Spearman’s rho = −0.545, p = 0.005)
In support of our hypothesis, which was based on the existing literature, childhood neglect was significantly associated with social cognition, with cognitive theory of mind (ToM), but only in HOS

Summary

Introduction

It is more common for someone with schizophrenia to be a victim of violence than a perpetrator (de Vries et al, 2019), a subgroup of individuals with schizophrenia are at increased risk of violent interpersonal behavior. A recent review/meta-analysis on neuropsychological functions reported lower IQ, memory and executive function in violent schizophrenia compared to healthy controls (Sedgwick et al, 2017). Later studies focusing on the most severe type of interpersonal violence, homicide, confirmed more pronounced deficits for IQ, memory/learning (Stratton et al, 2018; Engelstad et al, 2018) and executive functions (Stratton et al, 2018) in homicidal compared to non-violent schizophrenia participants. We reported larger social cognitive deficits for individuals with schizophrenia who committed homicide compared to non-violent people with schizophrenia, with substantial impairments seen for theory of mind (Engelstad et al, 2019a). Others have found social cognition to predict violent outcome, both directly and by mediating the effect of nonsocial cognition, on inpatient violence in forensic schizophrenia (O’Reilly et al, 2015)

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