TCO Symptoms as Markers of Violence in a Sample of Severely Violent Psychiatric Inpatients

A sample of 39 patients with a history of violence was assessed using the Revised Symptom Check List (SCL- 90-R). In addition to the patients' self-reports, an observer-rated SCL-90-R was obtained. The present study aimed to conduct an exploratory item analysis of SCL-90-R symptoms based on the findings from several studies that indicate that violence becomes more likely when mentally ill individuals feel threatened, and when their internal controls are compromised (TCO symptoms). Other aims were to examine the presence of TCO as compared to other delusions, and to look for possible sex differences, differences between violent subgroups, and differences between diagnostic groups concerning TCO symptoms. Furthermore, medical charts and police records were scrutinized to examine the immediate impact of TCO symptoms at the time of the actual violent act. We also wanted to explore possible discrepancies between observer ratings and selfreports of TCO symptoms. Other delusions were stronger hallmarks of the patients' symptomatology than were TCO symptoms. However, over half of the patients had TCO symptoms as immediate precursors to the actual violent incident. About one third of the SCL-90-R items, including five out of six TCO items, were scored significantly higher by the observers than by the patients. Implications of the findings for violence risk assessment are discussed.