Beliefs about voices and aggressive behavior in inpatients in an acute psychiatric setting.

OBJECTIVE: To examine the relationship between the personal beliefs that patients with auditory hallucinations have concerning their voices and the incidence of aggression toward self, others, and objects on the inpatient ward. METHOD: Forty actively hallucinating adults were recruited from the psychiatric inpatient service at Bellevue Hospital Center in New York. The beliefs that subjects had about their voices were measured using the revised Beliefs About Voices Questionnaire, and symptom severity was measured using the Positive and Negative Syndrome Scale. Frequency and severity of aggressive acts were measured retroactively over a 2-week period using the retroactive Overt Aggression Scale-Modified. The study was conducted from August 2007 to December 2007. RESULTS: Analyses revealed that hallucinators' beliefs that their voices are omnipotent, malevolent, and unable to be resisted accounted for 34% of the variance in predicting aggression on the psychiatric inpatient service. Subsequent stepwise regression analysis determined that hallucinators' belief in the omnipotence of their voices accounted for 21% of variance in predicting aggressive episodes on the inpatient service. Additionally, hallucinators with the strongest conviction in the omnipotence of their voices engaged in almost 10 times more aggressive acts on the inpatient service compared to voice hearers without these convictions. CONCLUSIONS: Individuals who believe their hallucinated voices to be all-powerful, malevolent, and irresistible are significantly more likely to engage in aggressive acts on the inpatient service. Examining the beliefs that an individual has about his/her voices may be a useful addition to current aggression risk batteries utilized on acute psychiatric inpatients.

Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits.

Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.