Childhood trauma, antisocial personality typologies and recent violent acts among inpatient males with severe mental illness: Exploring an explanatory pathway Matt Bruce ⁎, Dionne Laporte Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom abstract article info Article history: Received 1 November 2013 Received in revised form 23 November 2014 Accepted 19 December 2014 Available online 28 January 2015 Keywords: Childhood trauma ASPD Violence Crime Severe mental illness Background: Prevalence of childhood trauma is elevated among individuals with severe mental illness (SMI) compared to the general population and associated with poor prognosis, substance misuse, lower treatment compliance and violence. Antisocial personality disorder (ASPD) typologies (childhood vs adult onset) also rep- resent possible mediating mechanisms to explain risk of violence among men with SMI. The current study aimed to explore an explanatory pathway linking childhood traumatic exposure, antisocial personality typologies and risk of violent behaviour among adult male inpatients with SMI. Methods: A total of 162 male inpatients with SMI were examined using a cross-sectional survey design. Informa- tion was extracted from medical files, interviews and official criminal records. Results: Fifty-two participants (32.1%) reported experiencing a childhood trauma before 15. This group was 2.8 times more likely to engage in violent acts within the past 6 months than those without such a history. Further- more, those with childhood onset ASPD (early starters) were more likely to report childhood trauma and engage in violence compared to adult onset ASPD (late starters) and those without antisocial histories. Multivariate anal- yses revealed that early starter ASPD was the only variable that independently predicted violence and mediated the relationship between childhood trauma and recent violent acts. Conclusions: A significant subset of men reporting trauma and antisocial conduct from childhood (early starter ASPD) is at considerably elevated risk of engaging in violent behaviours. Assessment of antisocial typologies in men with SMI may assist effective and defensible case prioritisation, resource allocation and treatment planning. © 2014 Elsevier B.V. All rights reserved. 1. Introduction Individuals with severe mental illness (SMI) report elevated rates of traumatic experiences compared to the general population (Spidel et al., 2010) with estimates of lifetime interpersonal trauma ex- posure ranging between 16% and 98% (Morgan and Fisher, 2007; Husted et al., 2010; Bebbington et al., 2011; Subica et al., 2012). Trau- ma has been associated with more complex presentations and poorer prognoses among persons with SMI (Alvarez et al., 2011). Trauma can be defined as events that threaten one's physical and psychological integrity (Briere and Scott, 2006) and can refer to a number of adverse events, which include (but are not limited to) physical and sexual abuse. More specifically, a history of childhood physical and/or sexual trauma among individuals with SMI has been associated with earlier illness onset, severity of symptoms (Üçok and Bikmaz, 2007; Maniglio, 2009), poorer social functioning (Cusack et al., 2004), lower treatment compliance (Lecomte et al., 2008), substance abuse (Maniglio, 2009), higher rates of admissions (Alvarez et al., 2011), and elevated risk of suicide (Conus et al., 2010). These associated complications and adversities highlight the importance of consideration of childhood trauma in the treatment and management of adults with SMI. A history of trauma among individuals with SMI has further been associated with increased rates of violent behaviour. The develop- mental pathway from victim to victimiser has been thoroughly documented within prior research (Widom, 1989; Nikulina et al., 2011). Swanson et al. (2002) found that individuals with SMI who reported experiencing sexual or physical trauma in childhood were three times more likely to engage in recent violent behaviour than controls. Brekke and colleagues (2001) also found similar findings within an outpatient sample. However, a large-scale epidemiological twin study by Forsman and Långström (2012) found a weak causal link between childhood maltreatment and adult violent offending, attributing familial and environmental factors as more predictive. Accordingly, it is important to explore possible intermediary factors that might explain the pathway from childhood trauma to violent Schizophrenia Research 162 (2015) 285–290 ⁎ Corresponding author at: Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, PO 20, 21, 22, 23, Decrespigny Park, London SE5 8AF, United Kingdom. E-mail address: matt.bruce@kcl.ac.uk (M. Bruce). http://dx.doi.org/10.1016/j.schres.2014.12.028 0920-9964/© 2014 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres