The role of ideational distress in the relation between persecutory ideations and reactive aggression JOSANNE D. M. VAN DONGEN, NICOLE M. L. BUCK AND HJALMAR J. C. VAN MARLE, Department of Forensic Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands ABSTRACT Background People with schizophrenia are more likely to be violent than the people without it. Feeling driven to act on persecutory delusions may be one explanation for this, but it remains unclear why some should act on such delusions but some not. Acquisition of data from people who are very ill is problematic. Our study explores testing of hypotheses on similar ideational and behavioural associations among healthy recruits from the general population. Aims This study aims to test the effect of distress induced by persecutory ideas on any relationships between those ideas and aggressive behaviour, and the effect of gender. Methods Twenty-four men and 53 women from the general population participated in this study. The measures of aggressive behaviour were experimentally induced aggressive responding, self-reported aggressive behaviour in general, and self-reported reactive and proactive aggressive behaviours. Results Among men, persecutory ideation predicted reactive aggressive responding and aggressive style of behaviour only in those who experienced higher levels of persecutory ideational distress. Among women, with generally lower levels of aggression, the role of ideational distress was more complicated; Women in the low distress group responded with higher aggression on the task. Women in the higher distress group responded with higher aggressive style. For neither men nor women were there links between persecu- tory ideation and proactive aggression, regardless of distress. Conclusions Ideational distress moderates the relation between persecutory ideation and aggression in different measures of aggression in men and women. Implications for practice and/or research • Recognition of a relation between persecutory ideations and aggression is also important in the general population. Copyright © 2012 John Wiley & Sons, Ltd. 22: 350–359 (2012) DOI: 10.1002/cbm Criminal Behaviour and Mental Health 22: 350–359 (2012) Published online 31 August 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/cbm.1836