Introduction: Schizophrenia is associated with an increased risk of offending, likely mediated by multiple clinical and psychosocial factors. Childhood trauma, attributional biases, and persecutory delusions have been implicated in both psychosis and aggression; however, their relationships with verified offense categories remain unclear. This study investigated the associations between childhood trauma, attributional biases, persecutory delusion subtypes, and offense categories in individuals with schizophrenia.
Methods: Ninety-six individuals with schizophrenia under court-ordered forensic psychiatric monitoring and with at least one verified criminal offense were included. Participants were in remission and adherent to treatment. The Childhood Trauma Questionnaire - Short Form, Internal, Personal and Situational Attributions Questionnaire-Turkish Form, and Persecution and Deservedness Scale were administered. Delusional subtypes were classified as poor-me (PM), bad-me (BM), unclassified persecutory, or non-persecutory. Offenses were categorized as interpersonal aggression/violence crimes, property/economic crimes, or system-directed/institutional crimes.
Results: Offense categories were not associated with persecutory delusion subtypes. However, personalizing bias was significantly higher among individuals convicted of interpersonal aggression and violence than among those convicted of system-directed and institutional crimes (p=0.042). Childhood trauma differed across delusional subtypes, with higher emotional abuse scores in PM and BM groups and higher physical neglect and total trauma scores in the BM group. In multinomial logistic regression analyses, higher personalizing bias independently predicted lower odds of belonging to the property/economic crime group relative to the interpersonal aggression group (OR=0.029, p=0.035).
Conclusion: Delusion subtype was not associated with offense category in schizophrenia. In contrast, personalizing bias was associated with offending patterns, while childhood trauma was linked to specific persecutory delusion subtypes. These findings suggest that attributional processes may be more informative than delusional content alone for understanding offending behavior in schizophrenia.
Keywords: Attributional bias, childhood trauma, offending, persecutory delusion,